The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS by Elizabeth Pisani
Pisani is an epidemiologist who has been covering the AIDS crisis around the world since the 1990’s. Her main focus has been in Asia, particularly Indonesia. Her journalism background means that what she writes is always both entertaining and informative. Her writing doesn’t get weighed down by jargon and she’s able to explain the many complicated facets of the fight against AIDS, including the politics behind it.
Her main concern throughout this work is that because AIDS is caused by two “wicked” things, sex and drugs, that the politics of fighting AIDS has become murky. Tax payers don’t want to give money to wicked behavior, and they want their money to have an effect and politicians realize this. AIDS activists, including Pisani, have had to massage their statistics so that it seemed as if the AIDS crisis would affect innocents, good wives and children, in the hope that they would get the funding that they needed. In reality, it’s only in Sub-Saharan Africa that the AIDS crisis has become this all-consuming monster that regularly affects everyone in society. Pisani argues that there are two ways of thinking about AIDS and HIV: thinking about the spread of disease in Africa and thinking about the spread of HIV in the rest of the world. In Africa, anyone is at risk of getting HIV, and Pisani comes up with a few reasons why sexual behavior and cultural mores may have caused that. In the rest of the world, the people who are most at risk are those who engage in high risk behavior. They are sex workers or intravenous drug users or they have anal sex or some combination of the three; often they are extremely marginalized in society.
For example, intravenous drug users are the most at risk of getting HIV, because of the nature of the fluids exchanged. However, the programs that would most help prevent the spread of HIV in this group, are clean needle programs, and those are hard to get people to pay for. Even in Canada, the Conservative government keeps on threatening to shut down the Vancouver needle exchange. It is easier to get money to pay for treatments (which can only last as long as the money lasts) because it makes donors (including donor countries) feel like they are truly being effective. However, if they really wanted to change the world and stop the spread of HIV, they should focus more on prevention: condoms and clean needles and making sure that those who need these items have access and incentives to use them.
For Pisani, the main issue is that the public view of morality and fighting this disease seem to be at cross-purposes. In her opinion, sex and drugs are fun things, and people love doing them. Though other people may have a moral problem with this, the best option is to make these fun things safe. Unfortunately, at the moment of her writing (2008) the focus was on trying to make safe things like abstinence seem fun. Human nature really does not seem to work on these lines. The problem is, is that when people focus too much on morality they ignore the people who are most at risk. Pisani notes that sex workers need to make money, and there are many highly functioning drug addicts out there. Our concern as human beings is to make sure that we don’t discount other people’s lives just because they don’t behave like we want them too. Pisani seems to recognize how hard it is for people to think about these populations in a positive way. It’s key that she notes that she couldn’t handle her (now ex-) husband’s descent into drug addiction, even though she had no problem helping the drug addicts and sex workers on the streets of Indonesia. It was just too close for comfort.
Pisani isn’t the most politically correct person, and she’s really trying to fight back against the politics of development that seem to have overtaken all conversations about HIV and AIDS. As well, she doesn’t offer any opinions on how to make people change their minds about those who are at risk. I feel that her argument would be even stronger if she made an argument for the marginalized that stood against the moralizing of donors and tax payers. She needs to argue more strongly that these people matter, simply because they are people. Sometimes we need to be reminded of that fact.