AIDS funding is tainted by religious ideology and the U.S. could learn a lot from the successful programs in China and Brazil. Those are theories at the heart of Elizabeth Pisani’s book The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS.
Digital Journal — “We need to start telling the truth.” Elizabeth Pisani tells me this bluntly when I ask her to sum up her recent book The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS. The eye-catching title is only the lure to hook the attention to what Pisani calls the truth: relying on AIDS treatment instead of prevention is close-minded. Forget abstinence programs that don’t work, she stresses. Safe-needle injection sites, arming prostitutes with condoms and learning about HIV on the battleground level is how governments and AIDS workers should approach this issue.
An epidemiologist since 1996, Pisani has worked all over the world to study how and why people get infected with HIV. She has seen how politicians stick to palatable cause and effects, such as the relationship between gay men and HIV infection. She saw how HIV publications and conferences focused on issues of gender, poverty, and leadership rather than on condoms and clean needles.
Pisani points out the two separate AIDS in epidemics in the world – one in Africa and one in the rest of the world. It’s too easy for the U.S. to simply exports abstinence programs to other countries, throw money at Africa and say it’s done a great job. The U.S. is ignoring the HIV problem peppering its own country and abroad, she notes.
In her book, she tears a strip out of misguided HIV ideas: “HIV prevention programmes that don’t focus on reducing the likelihood that infected people will pass the virus on to uninfected people make governments, voters and even people who buy Bono’s red iPods feel like they are tackling the HIV epidemic when in fact they are completely missing the plot.”
Speaking from her London home, Pisani spoke to DigitalJournal.com about how sex workers can teach policy makers about HIV and why President Bush’s claim to fame as an AIDS activist is all bluster.
DigitalJournal.com: Explain why you think fusing HIV treatment with prevention is the ideal route for preventing infection?
Elizabeth Pisani: Treatment is rightly very popular among funders and activists. It’s the most successful thing we have in our response to HIV so far. It’s how we change lives, what is called the Lazarus Effect – a sufferer goes from wondering who’ll take care of the cat during hospitalization to dancing at the clubs and enjoying a full recovery. The problem is we don’t have a compassionate view of prevention, because people are less likely to give clean needles to drug injectors then they are to give drugs to those already infected.
Also, resistance issues are going to be bigger problem inevitably. HIV is an extremely wily virus that builds up resistance very quickly. The health care system hasn’t really faced the issue of the virus building up a resistance to the popular drugs.
DigitalJournal.com: You wrote in your book how China restored some of your optimism in dealing with HIV. You wrote: “The most populous nation in the world is making sensible scientific estimates of who is infected and who is most at risk.” What can other countries learn from China?
Pisani: They can learn the value of pragmatism. Officials took a hard look at its epidemic, which varies greatly geographically and said “OK, the south and west have problems with injection drug use, and the eastern seaboard has a problem with the sex trade. In large cities, we’ve noticed a growing gay scene and rising infection. Let’s deal with those issues now.” It reached that position partially because China is not a democracy — the government can tackle those things without worrying about losing votes or losing a seat in Congress.
But if could single out one country in the developing world giving us the single best response to HIV, it’s Brazil. They worked hard to promote the rights of people with HIV and groups facing high risk. They greatly improved the health and safety conditions in the sex trade. They were also the first country to make treatment available and free to those who needed it.
DigitalJournal.com: You’ve also been critical of President Bush’s initiative known as the President’s Emergency Plan for AIDS Relief (PEPFAR). Recently, the program’s funding jumped $15 billion up to $48 billion over the next five years. Do you think this will be Bush’s main legacy left over from his presidency?
Pisani: Yes, PEPFAR is up there as a positive initiative. But the money could’ve been used better, because the funding comes with restrictions that make it much more difficult to use it sensibly. PEPFAR caters to fundamentalist religious interests. [As Pisani wrote: “By law, 20 per cent of the PEPFAR money must be spent on HIV prevention, and one-third of that is specifically allocated to programmes that do nothing but push abstinence until marriage”]
DigitalJournal.com: Do you think the media has done a good job in reporting on AIDS-related announcements and news?
Pisani: Journalists need to talk to affected people, not just experts. They need to go Vancouver’s Downtown Eastside, for instance. Why should an AIDS story be based solely on what experts say? Journalists are far too willing to swallow what a press release says. After all, they don’t want to read a 357-page UN report. But I don’t want to heap all the blame on journalists. Sometimes, scientists don’t communicate their message clearly.
For information on Pisani and her book, visit www.the-wisdom.com
