Reviews

The Wisdom of Whores by Elizabeth Pisani

subversive_augury's review against another edition

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1.0

Beware any work such as this which claims fidelity to data above all things but then only concerns itself with a particular field of research (epidemiology) as it considers a complex issue with wide-ranging socio-political and historical dimensions.

The title of the book is the publishing world’s version of clickbait. Only the most overwrought explanation could make the case that the titling is grounded in the thesis of the book unless of course you ignore “Wisdom” altogether and only focus on the latter noun. This is all the more true when the author is so resoundingly opposed to the vast majority of peer-led interventions—and even more particularly opposed to them in the case of sex workers. But, sure, “Wisdom” it is.

If you ever wanted a primary source document for 21st epidemiologists supporting fascist policies, this is your text. Think this is hyperbole? Take the author’s unbothered, unqualified assessment then: “Public health is inherently a somewhat fascist discipline” (p. 154). It continues: check page 170-171 for a gem of an unironic case in support of involuntary testing. It includes a self-consciously glib admission that such a politically charged approach could lead to stigmatization (but no need for an historical analysis to assess the likelihood or empirical grounding of such a possibility) followed by a conclusion that only an early-20th ends-justify-the-means utilitarian with an interest in eugenics would find uncontroversial:
“But the fear of violating people’s perceived rights overrode many otherwise routine principles of public health.” (Emphasis added)

This is accompanied by equally glib support for an end to the inconvenience of confidential testing: “[…] Western activists exported their horror of any HIV testing that was not voluntary and entirely confidential”. Pisani skips put on anything resembling an even-handed analysis of what formed the basis of that pejoratively-termed “horror”. But “data first”, we’re told.

The arguments in this book about treatment-as-prevention are already dated. The literature regarding treatment displacing prevention is poorly reviewed (which itself is too generous of a statement), leaving the reader to have to examine footnotes and sources for depth and nuance. The footnoted source on this one is singular and hinges on a 2004 paper by a working group, two years prior to Atripla’s approval by the US FDA and eight years before PrEP. As a resource for a general audience, I am deeply concerned that readers who are not trained in research analysis will leave with a dated and distorted view of this issue. It also is at odds with the chapter, “Ants in the Sugar-Bowl,” whose primary thesis is that HIV/AIDS funding is awash in cash. The tension between being awash in funding and there still being a zero-sum game between prevention versus treatment is unaddressed—hardly the hallmark of a sober and thorough analysis of the facts.

Other weaknesses of this text include the lacking historical analysis which leads to rather wildly inaccurate descriptions of the history of AIDS activism in which the role of lesbians and queer women is magically erased. This gives me the sense that the author only finds epidemiological and numerical data and not historical or narrative data worthy of consideration. A similar disregard for sociological outcomes is again on display for vulnerable populations who would be subject to the more drastic policy advocacy like holding low-income and poor HIV-positive people’s medication hostage in exchange for participation in prevention programs (p. 172).

The author, though a scientist, lacks the kind of careful, nuanced consideration of complex issues that I take to be the hallmark of her discipline, perhaps because it would have interfered with her “tells it like it is” persona that she so carefully curates in this text. A careful, nuanced treatment of complexity this text is not. I absolutely cannot recommend this book except to historians interested in 21st-century manifestations of epidemiology as populace control.

jfit400's review against another edition

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informative slow-paced

3.5

ameliabedeliaful's review against another edition

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challenging funny informative medium-paced

4.0

maribeaux's review against another edition

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2.0

I lost my respect for the work when I reached chapter six and it made me overall question the information presented on the topic of sex and drugs.
I won't say much, just that it would have been wiser if Pissani had left her uneducated, anecdotal-evidence-based opinions on human trafficking to the experts on the issue, who not only admit that most of the females in the sex trade in Asia are trafficked, but also that commercial sex not only hasn't fallen, but it is rooted so deep in many cultures of Asia, that people can't seem to step away from it because they can't, they don't want to, they're used to it, or all those. Human trafficking is a pandemic. Girls and women are held captive against their will like slaves (actually, even worse), they are manipulated, mentally broken, threatened to not speak to anyone or leave their spots.
Yes, stories of such women would make good documentaries if these women would actually have been free physically and psychologically to speak, available to be exposed to random interviewers. But oh, these are all rumors (!) "A friend of mine said this", "a friend of mine said that". I wonder how much money was thrown to make the UN and WHO look clean, innocent, reliable, honest on that matter. Just because one doesn't or can't see cases of human trafficking doesn't mean it doesn't exist, that it is rare or that it is not a serious matter.
But let's not forget that Pissani's goal wasn't ever to take a deep dive into the sex trafficking so it doesn't much surprise me that the chapter is quite contradictory to studies of the noughties.

11corvus11's review against another edition

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3.0

I have mixed feelings about this book. In the beginning I was trudging through it because I found it to be rather unlikeable. I should confess that I thought from the title that this book was written by someone who was a sex worker or would have lots of sex workers sharing their experience. This is a topic I have some prejudices about so I was hoping to learn more and that mixed with public health was interesting. The title is wrong. I think it should just be called "Bureaucrats, Brothels, and the Business of AIDS" alone.

That said, the author initially came off as another researcher with disdain for her participants- proudly emotionally detached and pseudo-logical but with plenty of subtle cheap shots at waria especially. I almost put it down for this reason.

When I pushed through and got to the second third of the book I really found it interesting. Pisani became more nuanced as did her critiques of government and other funding systems as well as participants in studies. I found the sections that focused on sex work (victimization vs circumstance vs just work) and harm reduction in drug injectors extremely interesting and enlightening.

I think the book could have been better organized. It seemed to shuffle around a lot. I think it could have been much shorter. I wouldn't read it again but I don't regret reading it, especially the parts I really enjoyed.

vbright's review against another edition

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5.0

This book was more than I expected. The author gives great information about people infected with HIV, and also about the funding and public policy associated with AIDS/HIV. It offered a new perspective for me. There was a little bit of preaching, as some other reviewers have noted. However, if had to deal firsthand with seeing how HIV affects people and populations, then see how funding and programs are ridiculously implemented to supposedly help these situations, I would probably be a little mad and preachy, too.

jwsg's review against another edition

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3.0

The security guard checking my bag at the British Library raised an eyebrow and remarked "interesting book" when he saw Elizabeth Pisani's behind the scenes look at the AIDS industry, a heady mix of bureaucrats, scientists, politicians, prostitutes, drug addicts, gays and many others that don't fit into the neat checkboxes of official surveys and reports.

Behind the scenes exposes are always fun to read, giving you another side to a story that you might previously had only guessed at, if at all. Pisani's adventures as an AIDS researcher begins with her job in UNAIDS, where she tries to whip up interest (and funding) for AIDS by putting her writing skills (she used to work as a journalist) to good use, casting AIDS as some apocalyptic scourge that would race through the world's population. She admits that these dire pronouncements were exercises in creative writing, backed up only by scanty data gathered with blunt measurement tools:

"[HIV] continues to spread around the world, insinuating itself into communities previously little troubled by the epidemic and strengthening its grip on areas where AIDS is already the leading cause of death in adults...The majority of those now living with HIV will die within a decade. These deaths will not be the last; there is worse to come..."

Pisani talks about organisations like the "Beltway Bandits" that park themselves in DC to lobby for a piece of a foreign aid funding pie, and how, like dealers, take a hefty slice of the pie before the anyone else. How the Bush Administration diverted funding away from programmes that it deemed inconsistent with its political agenda and conservative values - like needle exchange programmes or programmes for sex workers - even if these were proven to have a positive impact on stemming infections. Instead, it steered funding towards feel good, but ultimately useless programmes like the promotion of abstinence (even to sex workers who earn a living through sex).

The bits of the book that were the most fascinating for me (being a bit of a policy dork) was Pisani's account on data collection.That without understanding the dynamics of a culture/place, one's sampling strategy could be statistically sound but seriously flawed (such as when a waria in Indonesia informed Pisani that their sampling of waria would underestimate the true number of clients per seller since the sample was biased towards the 'dogs' who were less popular with clients and hence free to answer questions from nosy researchers). And Pisani's reminder that the way you ask a question affects your results: ask a drug user how many times they injected the previous day and they are likely to remember; ask them how many times they injected the week before or in the last month and things get fuzzy. Yet we persist in asking people to remember things they can't remember or to calculate things they can't calculate, all in the name of collected detailed, albeit meaningless data.

Pisani, an ex-journalist turned AIDS researcher, writes in a punchy and self-deprecating style. Freely admitting that as a well (over?) paid expatriate researcher, she is one of the recipients of a not insignificant share the foreign aid funding pie, Pisani notes of her experience working in Indonesia that she was "being sold to the Indonesians as an HIV surveillance expert, and on paper [she] looked ok. But [she]'d never done any surveillance...never collected a blood sample, never been in a laboratory, nor drawn up a statistical sample frame, nor coded a questionnaire. [She]'d written manuals about how to do these things, but...had never actually done them."

Pisani's revelations about the AIDS industry are illuminating and at points, disturbing. Some parts of the books, particularly the last couple of chapters, lose their punchiness as Pisani becomes a tad repetitive or begins to belabour her points. But overall, The Wisdom of Whores, as the security guard at the British Museum commented, is an interesting book and well worth delving into.

caromore13's review against another edition

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5.0

Lots of facts about HIV...took a lot longer than expected to finish due to life and work, but definitely recommended!

iparakati's review against another edition

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4.0

This book gave me a new appreciation for epidemiology and encouraged me to think about culture as well as statistics. The author recounts her experiences during the AIDS boom with a good dose of straightforwardness and humor.

cemell's review against another edition

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challenging informative sad medium-paced

4.25