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A review by jwsg
The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS by Elizabeth Pisani
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.
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.