Elevate Difference's Reviews > The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS

The Wisdom of Whores by Elizabeth Pisani
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Jan 10, 09

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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.
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