The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS

by Elizabeth Pisani (Goodreads author)

book data

126 ratings, 4.01 average rating, 47 reviews (more data...)

rating	frequency	%
5		29%
4		46%
3		21%
2		2%
1		0%

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published

June 2nd 2008 by W. W. Norton

binding

Hardcover, 288 pages

isbn

0393066622 (isbn13: 9780393066623)

description

A flame-throwing epidemiologist talks about sex, drugs, and the mistakes (dismal), ideologies (vicious), and hopes (realistic) of international AIDS p...more

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01/25/09

Mark Desrosiers rated it:

bookshelves: sex

Read in January, 2009

She gets the boring stuff out of the way first -- a tour of U.N. bureaucracies and statistics-gathering methods -- before setting off on what amounts to a galloping rant about common knowledge, our perception, of AIDS and why it spreads. Lots of received wisdom gets demolished here -- I felt pretty much like an idiot at some points. For example, she evaporates the widespread trust in "peer advocacy" by citing a personal anecdote in which a skeletal, angry, dying "AIDS counselor"...more

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09/01/08

Kerry rated it:

Read in August, 2008

recommends it for: Folks interested in Public Health, Development and HIV/AIDS

This book is an epidemiologist's take on conducting field work for AIDS research. She is candid about her experience and the lessons that the various people she encounters from all types of various backgrounds have to teach her and her colleagues about society, common sense and practical matters.

I didn't quite manage to get through the whole book before I had to return it to the library.

The accounts range from humorous to maddening and frustrating. It offers hope th...more

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03/06/09

Stephy rated it:

bookshelves: aids, have_to_be_able_to_think, health, non-fiction, social_commentary

Read in October, 2008

Having been on the front lines of the AIDS epidemic in the United States when it was still called GRID, (Gay Related Immune Deficiency) I have watched in stunned horror as our Government refused to earmark money for AIDS education and research, and limited money to countries that were, sensibly enough, distributing condoms to sex workers and people with multiple partners.
I have been far too close to the actuality of people dying to stand back and get this broad overview. I'm delighted tha...more

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01/10/09

Feminist Review rated it:

The arrival in 1994 of HIV and AIDS to the London School of Hygiene's curriculum led Elizabeth Pisani, a former journalist and scholar of classical Chinese, to contemplate "a career in sex and drugs." The Wisdom of Whores recounts her work for (and increasingly against) the funding and technical juggernauts of UNAIDS, Family Health International (FHI), the World Bank, the WHO, and the President's Emergency Plan For AIDS Relief (PEPFAR) in defining and surveilling upon HIV and AIDS. Pis...more The arrival in 1994 of HIV and AIDS to the London School of Hygiene's curriculum led Elizabeth Pisani, a former journalist and scholar of classical Chinese, to contemplate "a career in sex and drugs." The Wisdom of Whores recounts her work for (and increasingly against) the funding and technical juggernauts of UNAIDS, Family Health International (FHI), the World Bank, the WHO, and the President's Emergency Plan For AIDS Relief (PEPFAR) in defining and surveilling upon HIV and AIDS. Pisani collects data in fetid settlements, brothels, sex clubs and hairdressing salons from the body parts and fluids of marginalized people and then massages the data ("beating them up" in journo speak) to placate politicians and sponsors.

Even chapter titles such as "The Honesty Box," "Sacred Cows," and "Ants in the Sugar-Bowl" critique the "big business" of AIDS managed by "the AIDS mafia." Skewering the absurdities of the "abstinence-only" movement and the opponents of "harm reduction" in matters sexual and drug-injecting, Pisani pits the "truth" of painstakingly gathered empirical data (doing "good" science in HIV and AIDS work) against the "right answers" that keep politicians elected and funding streams flowing. Here is her solution: "We could save more lives with good science, if we spent less time worrying about publishing the perfect paper and more time lobbying, more time schmoozing the press, more time speaking in the language that voters and politicians understand. If we behaved more like Big Tobacco, in fact."

The Wisdom of Whores reads (and was edited) breezily, but there is much to praise. Clinical and pharmaceutical specialists and development agency reps have had aired the dirty laundry of their infighting, money-grubbing and ill-conceived treatment programs. Lay readers will be titillated by her frank talk, have their eyes opened by her revelation of greed and corruption in national AIDS programs, and be liberated by her constant use of metaphor and colloquialisms. "Sex can be a sticky business. The stickier the better...A wet vagina is usually a pretty safe environment" conveys the frisson of having seemingly encountered dangerous words and ideas.

Nevertheless, the clarity of her take on needle exchange, data coding, epi-speak, and religious squeamishness about sex belies their nuances and complexities. She contends that "the circumcision and untreated STIs are easy to understand [in figuring varying HIV antibody prevalence:] and they are relatively easy to measure." Not so. Men are becoming circumcised instead of using condoms. The recently circumcised heighten their own infectiousness when they have sex still wounded. Women don’t benefit at the population level from circumcision. Men sometimes undergo supercision, superincision and even circumincision. None of this is easily measured.

Pisani discusses the politics behind use of acronyms such as MSM (Men who have Sex with Men), FSW (Female Sex Workers), and IDU (Injecting Drug Users) that stuffs into conceptual boxes for epidemiologists the identities and behaviors that won’t stay put. Her summary nicely spells out the difference between epidemiologists and ethnographers. Admitting that she and her colleagues "bulldozed happily through the minefield of language," she then castigates the very calls for nuance and caution in such matters that elsewhere she uses to dink mainstream epidemiology. Her confession that, "When we started to look, it didn’t take long to explode the 'junkies don’t get laid' myth," insults the legions of social scientists and activists who invented no such myth in the first place.

This is the blessing and curse of The Wisdom of Whores. Pisani complains (rightfully) about the language of mainstream epidemiology and its sacred cows, but her language is as imprecise as are her conclusions debatable. Her picking on the World Bank for believing “poverty and gender inequality spread AIDS” lets off the hook the sum total of the negative effects of the structural adjustment programs and unregulated capitalism supported by it and the IMF and WTO and ignores how hard social scientists worked to enable the World Bank even to put "poverty and gender equality" on the same table of HIV blame as cognitive shortfall and individual responsibility. Her claim that the fact that HIV antibody-positive men are eschewing condom use "wouldn't really matter if they were having sex with people who were also infected," is flatly untrue on several levels. She confuses "hot and dry" sex for "dry and tight," and ignores its "Western" manifestations. Indonesia’s waria (men who dress, identify and have sex as heterosexual women) do significant rhetorical duty here, but she fails to cite the important works of Jake Morin, Leslie Butt, and Gerdha Numbery, and ignores the lengthy genealogy in male-male sexual activity in the region. Her language often exoticizes ("Madurese women are famed for their sexual prowess") and is sometimes inflammatory: "If you have sex in ways that do not follow basic human sexual design (which includes a lubricated vagina), you will increase the chance of small tears and abrasions."

While rightly calling for ethnographic data and sensibilities that would explode myths, they were largely the making of Pisani and her colleagues. Rushing to appear marginalized as a consulting epidemiologist, she neglects how marginalized are most ethnographers by epidemiologists and the funding agencies and conservative philosophies underwriting them. The "big business" of AIDS begins properly with just such epidemiological conceits.

Review by Lawrence James Hammar, Ph.D.(less)

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05/21/08

Tera rated it:

A wonderful informative and actually entertaining book on a subject that you would imagine to be dry and depressing. Elizabeth has a great voice and allows personality and humanity to take hold of the subject matter rather than an bury the reader with mind numbing facts.
Perhaps if the subject matter was dealt with in our communities, schools and even homes with the same informative yet humanizing approach progress would be more than a goal.

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12/29/08

Christina rated it:

Elizabeth Pisani gives an interesting perspective to the business of AIDS. She is a journalist turned epidemiologist. She explains how politics, ideology, and theology prevent AIDS funds from being used to prevent infections in people most at risk; prostitutes, men who have sex with men, and injectors . Her argument is not focused on AIDS in Africa but she does highlight that there everyone is at risk. She argues against viewing AIDS only as a development problem. She describes strings atta...more

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12/13/08

Caty Simon rated it:

Read in December, 2008

recommended to Caty by: Tracy Quan

First off, go to the author's cool website---wwww.wisdomofwhores.com. She has great links to sex work movement stuff, & amazing stories you can't get elsewhere, like the new trend of older heterosexual white women sex tourists in Kenya, or banned Durex commercials, or urban legends about African women literally "boovytrapping" men by dousing their chests with chloroform (uuuhhhh, if this were actually happening, wouldn't the women pass out as well?)
I didn't always agree and some...more First off, go to the author's cool website---wwww.wisdomofwhores.com. She has great links to sex work movement stuff, & amazing stories you can't get elsewhere, like the new trend of older heterosexual white women sex tourists in Kenya, or banned Durex commercials, or urban legends about African women literally "boovytrapping" men by dousing their chests with chloroform (uuuhhhh, if this were actually happening, wouldn't the women pass out as well?)
I didn't always agree and sometimes I was even offended, but the wealth of information, new models and commonsense were invaluable. Pisani has nothing but reverence for the populations she studies, no matter how deviant or foreign they are to her. Plus, the anecdotes are gripping. And what she reveals--that we have the tools to control the epidemic, but puritanism, politics, & ideology stop us from doing so b.c it would involve "doing nice things for wicked people" --well, it's a shocking & vital revelation. Politicians would rather make programs based on the faulty idea that HIV is spread by poverty & gender discrimination etc. b/c those are more popular things to talk about than the true spreaders of the disease--sex & injection drug use, & the true at-risk populations that spread it into the general populations--gay men, IV drug users, & sex workers. & how the African model doesn't work in most places--in South & East Africa, b/c of different cultural patterns of having sex, the virus has spread into the general heterosexual population--a 14 year old girl in Africa is twenty times more likely to be infected than a junkie in Australia. But the African model doesn't *work* for Asia & Europe, where the vectors of disease are the high risk pops mentioned above.

I was shocked to discover the Bush administration's "loyalty oath"--******all countries recieving AIDS funds from the US have to pledge that they will work for the abolition of prostitution rather than provide prevention services for sex workers. They can't even use non-US funding for these prevention services for sex workers, or else they risk losing US AIDS moneys!**** It's fucking abominable. There was all sorts of sobering & enlightening information like that about how the big AIDS funding bureauocracy has let us down in so many ways--Pisani uses the apt analogy of ants in the sugar bowl to describe the parasitical, ineffective bevy of NGOs gathering around the AIDS money boom. & then there was all sorts of info only an epidemiologist (sp.) could share about how things go wrong in studies, in all sorts of ways. The book gets its title from Pisani's belief that we must learn how to serve affected populations from the affected populations themselves, & that every culture & situation is different & requires different modalities.

Plus, it was cool just finding out about how different cultures have different risk factors for HIV b/c of different cultural norms--the more sex partners you have at a go, the more likely you are to spread HIV, so serial monogamy (a la the US) isn't a very risky sexual model, but casual de facto polygamy (a la Africa) is. (& there's a totally different predominant Asian sexual model, too.) Or how uncircumcised men are much more likely to spread HIV, & thus encouraging circumcision within a culture can very much cut down on new infections. Or how

There were some key points I disagreed with her on--she didn't include the fact that in First World countries, the vast majority of prostitution is middle/upper class prostitution, & these sex workers are *not* vectors of HIV, & in fact have much safer sex than the general populace. She also doesn't appear to know much about the bad health effects of methadone, writing about it as unqualifiably Good Thing, since it reduces injection even among IDUs who still continue doing injectables on the side during the course of their methadone treatment, & since it eliminates the dopesickness that often leads to desperate, unhealthy decisions like opting to share needles. (Kudos to Pisani for emphasizing how important syringe access is, & how empty the arguments of the Drug Warriors against it are.) This is true, but it's not the only truth about methadone at all, & I didn't appreciate the fact that she mentioned "blackmail"--connecting the availability of HIV treatment to the use of methadone. Forcing people on a heavy duty drug like methadone, which is so many, many times more addictive & more deleterious to one's health in the long term than short-acting opiates, is morally wrong. I was also ethically opposed to her toppling the sacred cow of anonymous testing, although I agree with her that we have to work against the stigma until anonymous testing is no longer necc. But in general, this was a brilliant, vibrant, essential book that tells us all exactly what we need to know about how to tackle the HIV epidemic, & how our governments are failing us around the issue. It's the first time I've learned so many new things about HIV in a long, long while.
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12/27/08

irwan rated it:

bookshelves: social-sciences

Saya baca terjemahannya yang terbit bersamaan dengan edisi Inggrisnya. Sebuah buku yang menarik karena informatif dan provokatif, terutama bagi mereka yang berkecimpung dalam isu HIV/AIDS. Karena ditulis dengan gaya bahasa populer -- penulisnya ahli epidemiologi dan mantan jurnalis -- maka orang awam lebih mudah mengerti ketika membaca tentang angka-angka hasil survei tentang AIDS. Penulis melontarkan sejumlah argumen yang asik untuk diperdebatkan misalnya tentang penggunaan kondom, meningkatnya...more

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06/05/08

Elizabeth rated it:

bookshelves: aids, epidemiology, hiv, intelligent-non-fiction, science

I wrote this book so of course I think it's fantastic. But if you want more objective opinions, you will find all reviews so far (good and bad) at http://www/the-wisdom.com/reviews

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03/29/09

Sharon rated it:

Read in April, 2009

This was a very interesting and well-written book, a fun look at the world of AIDS research, if you'd believe it. I learned a lot about the international public policy system, and a lot about prostitution and the underworld in different Asian countries.

The only drawback to the book is something you can't blame the author for--you can't help but get bogged down in long organization names, acronyms, amounts of money. Describing international politics inevitably results in long para...more

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12/28/08

Lindsay rated it:

Read in January, 2009

recommends it for: People interested in public health & sex research

Overall I think it's a pretty good book and something worthwhile for anyone interested in HIV to read. My main criticisms have to do with her analysis of many of the conclusions she draws from her work. I think I can best summarize my thoughts in a few points...

Chapters 1-3 were really good. The middle and end were hit and miss. I think the main reason behind this is because Pisani is trained as an epidemiologist (and apparently in medical demography which draws a lot on epi) and N...more Overall I think it's a pretty good book and something worthwhile for anyone interested in HIV to read. My main criticisms have to do with her analysis of many of the conclusions she draws from her work. I think I can best summarize my thoughts in a few points...

Chapters 1-3 were really good. The middle and end were hit and miss. I think the main reason behind this is because Pisani is trained as an epidemiologist (and apparently in medical demography which draws a lot on epi) and NOT a behavioral health scientist. The first three chapters deal mainly with epi related content (stats, data collection methods, etc.) and I think she does an excellent job of explaining the intersection of public health as a science and working with "tough" situations and problems in the field. I think these chapters are especially helpful for students (or others) who really want to know what public health does and how things can go wrong when you move from theory to practice. However in public health we have 5 sub-specialties for a reason. Generally people focus on areas they are interested in and what they are good at. I think that many of the conclusions she draws from her stats/epi viewpoint are a little absurd coming from my behavioral viewpoint. I think the chapters after Chapter 3 are drawn from her viewpoint and that's why they are hit or miss. She certainly has a wide breadth of experience so she does have some good insights (particularly around religion and politics and their impact on sex-related research).

I also think that she is a tired, jaded researcher. I do like her flippant style, but I think it comes from the fact that she's dealt with years of frustrating bureaucracy. For sure, HIV is a tough field and behavior change is even more difficult. I think there is a high rate of burnout in the field because of this. You really have to keep plugging along without getting bitter and frustrated and look for small victories where you can. This is general to public health, but even more so for sex-related public health because sex is such a taboo topic. It makes it even more complicated. Sure we haven't done as much as we'd all like to hope (especially with the amount of money that we've been getting recently), but again, behavior change is HARD and it takes a long time. If behavior change was easy we wouldn't be an intensely overweight country, and we wouldn't be burning oil like it was going out of style. And we have the resources to do those things easily. With HIV we are talking about behaviors that are usually intensely enjoyable (sex, and to a lesser degree drug-using) so telling people to just stop what they're doing is really hard. We don't do the best job of it here, so how can we expect to do a good job in a place where you might get one good meal a day? If you are hungry and have no money, tough shit. Sex might cost you nothing or very little and it might help you forget about being hungry. So I think she is very simplistic in her conclusions section. Like if we just implemented her points all would be well. It wouldn't. It might be better if we could do some things that are currently being impeded, but it wouldn't be a miracle cure.

Anyway, I think anyone who reads the book with an open mind will gain something from the book. I think it gives people a little glimpse into why HIV is important and why it has gotten a lot of attention. And I think in the context of African politics it's critically important to understand. Regardless of whether or not you think that money is being wasted or taking away from other areas, HIV is such a big part of life that you can't talk about African politics without thinking about the impact that HIV and especially the money is making. (less)

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10/05/08

David rated it:

Like most books, it could have been shorter and more tightly edited IMO, but very interesting perspective on the science and politics of HIV/AIDS prevention from someone who's been on the front lines.

She does a nice job of detailing how the development/international aid politics interfere with doing what might make the most sense from a public health/epidemiology perspective. Actually the last chapter summarizes her analysis quite well, whereas the preceding chapters elaborating the...more

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07/21/08

Kristen marked it as to-read

bookshelves: to-read

recommended to Kristen by: Joe

I just got an email from a friend with the following review of this book written by Stephen Lewis. It sounds like a must-read.

"This is an utterly fascinating book. I must admit that it's been growing on me since I read it, the arguments and language reverberating in my mind. Elizabeth Pisani writes with enormous verve and acerbity, her prose alive with anecdote and metaphor. There is, to be sure, a certain adolescent touch, delighting in naughty words and vivid sexual description...more

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05/07/08

Andrea rated it:

bookshelves: nominated, read-for-notables

Read in June, 2008

In this surprisingly lively, funny and fast paced book Pisani combines reporting and memoir to introduce readers to the epidemiology of HIV/AIDS. The book is a paean to the civil servants, scientists, activists and PLWAH (People Living With AIDS/HIV) she has worked with over the course of her career as an epidemiologist. However Pisani’s ultimate purpose is to explain why it is that although AIDS now attracts billions of dollars in aid, and is the focus of countless NGOs, governments and found...more

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03/09/09

Sarah rated it:

Fasinating look into sexual politics. Pisani is razor sharp and a refreshing first-hand witness to real life sexual practices and attitudes that aren't reported by even the most "enlightened" documentators, such as the World Health Organization.

It seems we still don't have the will or the vocabulary to name what people really do.

Pisani's blog is worth checking out as well: www.wisdomofwhores.com

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03/31/09

Caroline rated it:

Read in March, 2009

You should read this book. That's what we read these reviews for, right? This book is worth your time and you will learn something. Beyond that, it is well written, highly entertaining and very worthwhile. Not many epidemiologists are capable of producing something entertaining, so this is a particularly good find.

9/52/2009

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04/26/09

Alyssa Banotai rated it:

After reading this, I wished to be an epidemiologist. Seriously. Pisani is witty, knowledgeable and reminds me of Laurie Garrett as far as readable public health journalists go. Anyway, it's an eye-opener about the dire state of global AIDS and the drawbacks of morality-based funding by government agencies and politicians.

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07/01/08

Alicia rated it:

The author started life as a journalist and later, became an an epidemiologist researching AIDS. She has worked for a variety of NGO's and has seen the programs around the world that have worked and those that have not. Again she has more to say but the important point I took from this book is that until the US (and other countries) stop putting restrictions on this money, especially in not allowing a program to give out condoms and needles, the battle to stop the HIV virus will be a losing one....more

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06/24/09

Andrea rated it:

Read in June, 2009

This was a surprisingly easy and interesting read for a book that's written by an epidemiologist about an incredibly complicated and intense issue. It was a huge eye opener, and I highly recommend it to anyone wanting to learn more about the AIDS "industry".

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02/05/09

Suj1980 rated it:

Read in January, 2009

Lots of good stuff for epi people to think over. Perhaps too many TMI moments in this one, but aside from those moments are some pretty compelling arguments for the poor manner in which HIV programs are designed and funded.

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