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on 14 July 2009
I met Elizabeth Pisani in one of her earlier lives when she was a business journalist. She was pretty impressive at that, but she would end an email with "got to get back to sexual networking now". She was already a medical demographer moonlighting as journalist. Now she has written a remarkable book about her life and work. It's partly a hard-nosed statistical account of why so much of what we are told about AIDS is wrong, backed up by 40 pages of footnotes and references and a website. In particular how little AIDS actually spreads among heterosexuals outside southern and eastern Africa; but telling people that everyone was at risk was the way to mobilise public attention. It's also the story of the author's nights doing "qualitative research" in dodgy bars and street corners in the sleaziest parts of Asia, which is often very funny as well as shocking. And the politics of the AIDS Industry. The book was written while the Bush administration was pushing its "faith-based" programmes while insisting that drugs available at $1.50 a dose be bought from US suppliers at $71. Meanwhile funding was rolling in on massive scale, but very often, Pisani tells us, for spending on the wrong things. East Timor had a big AIDS budget and plenty of other public health problems, but no AIDS. Despite the grim theme it's actually a very funny book with a lot of sympathy for the people she meets. There are positive messages. There are some very dedicated people in health ministries across Asia; and there are programmes that do seem to work. The UK DfID and the Chinese government also come out of the story better than many other players. One is left with great admiration for the author. She has done a very tough job and has written a marvellous book about it, with many lessons for the world.
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on 12 October 2009
I've just finished reading The Wisdom of Whores by Elizabeth Pisani and it is a wonderful book. Ok, a wonderful book especially if you find yourself compulsively turning the pages of popular science books more than novel, but still - a book written by a real expert who also happens to have been a journalist before becoming an epidemiologist, and can write vividly, entertainingly and with passion about fairly obscure statistical points. Most of all, I loved the sense of fun, and genuine liking for people, that came across from the book: despite the fact that it deals with a disease that has killed millions and will kill more, it's a book that celebrates the lives of the people it destroys, gay guys, whores and junkies to use Pisani's definition: not with a funeral but with endless descriptions of wit, spirit, dinner parties and shared meals, cigarettes and drinks.

It makes quite a number of vibrant points, that boil down to "to stop HIV spread you need to do nice things for whores, junkies, and gay guys, and lots of people don't want to." And there are wonderful anecdotes, like the erotic Chinese classic novel she appropriated for a lesson in relationship networks and reality check for a Chinese apparatchnik, or how she rescued a night's worth of samples from a couple of Indonesian policemen...

I'll just say, go out and buy this book, it will entertain you and outrage you and leave you with a faint sense of hope in the human race.
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on 18 June 2014
Pisani's book doesn't get off to the strongest start - I had the impression that she was trying to get across an image of herself and her colleagues at UNAIDS as a bunch of bright young things rushing around and being idealistic - but it gains momentum impressively.

She talks about her experience in Indonesia putting surveillance of HIV into practice (and all the problems associated with this, including the very different sexual identities and risk groups which she came across in Asia), her work with African companies and NGO/government funding and organisation hypocrisies. She leaves discussing the infectious mechanisms of HIV a bit late in the book, but this doesn't undermine the message that The Wisdom of Whores is trying to get across (that we can and should tackle the spread of HIV in a different way, that we have the tools and need to use them).

A note on the title - ignore it, because it makes this sound like a pile of pop-science crap, which it is not. I feel that this was chosen as an eye-catching cover rather than one which appeals to the target market of interested, not-necessarily-scientist individuals with some focus on health. Before I bought this I read a review which claimed there was no actual wisdom from whores in the book, which I found hilarious having read it - there are very good anecdotes and plenty of personal stories from those in the sex industry, and wisdom too.

I found this book hard to put down, which is something I haven't found since I read Goldacre's Bad Science book. The writing style is almost on a par with his, and Pisani is occasionally very funny on top of being insightful. The tone is sometimes forced but overall it's not detrimental to the ease of the read. If you want to know anything about HIV, epidemiology, politics, the sex industry or even Asia in general, this is a fascinating book.
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on 3 September 2014
This is a really interesting book about the whole subject of public health, based on a decade's work on HIV in south-east Asia (particularly Indonesia). You learn how difficult it is to pin down the problem, how everything effects everything else, the frustration of finding that the things donors are willing to fund are not the things that would actually help, and the ways in which being perceived as a mad Westerner can let you solve problems.
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…is what Elizabeth Pisani says she does for a living. She says that it is a lot easier than trying to explain that she is an epidemiologist working in HIV/AIDS prevention and treatment. She is feisty, irreverent, provocative, knowledgeable, and deeply caring; a human who can be brought to tears simply by looking at numbers – and knowing what they truly represent. Her outlook is admirably captured by the title to her book. She does not specifically cite Thomas Pynchon’s “Proverbs for Paranoids”, the one that posits: “If you have them asking the wrong questions, you don’t have to worry about the right answers,” but she sure did act upon those truths. In the preface, she relates what the professor at the London School of Hygiene and Tropical Medicine asked at the end of the first lecture: “Why was there a fourteen-year gap between the first case-controlled study showing a strong association between smoking and lung cancer, and the first US Surgeon General’s report on the dangers of smoking?” She reports that there was only stony silence in the classroom, so she dared to break the ice with: “You’re asking the wrong question…Surely the key question is: how much money did British American Tobacco and Philip Morris give to US Senate campaigns in that fourteen-year interval? As with Big Tobacco, time and time again Pisani will reinforce the eternal truth that “follow the money” will provide the answer to a given action in the field of HIV / AIDS.

Before getting into “sex and drugs,” Pisani was a reporter for Reuters. Her media background, her ability to speak Chinese, and her medical scientific training has provided a strong background for being able to explain both the HIV / AIDS epidemic as well as the political and medical establishments’ responses. Admittedly I had never heard of the phrase “beating it up,” which is journalist-speak for “making a mountain out of a molehill,” as Pisani explains. How does one successfully “cook up” an epidemic – in the sense of getting serious money allocated to treat people who are engaged in “deliberate, disgusting and revolting conduct,” to use the description of Senator Jesse Helms? Market the “innocents”! The stay-at-home wives and their to-be-born children infected by their philandering husbands. A small element of truth that was “beat up” into very large appropriations spearheaded by Helms and the religious right (bless ‘em).

Down and dirty. The author can do spreadsheets, and sit in the back row at the international conferences playing *** Bingo while also asking provocative questions with the best of them. But she also does “HIV surveillance,” a nice neutral term that means she is out in the upscale gay clubs of Jakarta as well as along the railway tracks talking (and gaining the confidence!) of waria. Waria? Pisani says that it is a “smush-up” of a term, deriving its letters from the Indonesian words for “woman” and “man.” She develops an understanding for their lives, and what they truly do, and conveys it all to the reader in straightforward, “plain speaking” prose? “Bottoms.” A term of the trade along the railroad tracks, and Pisani discovers the percentage of times they become “Tops,” thus learning how HIV is so readily transmitted through the “community,” a term she proves is often not operative. In terms of “plain speaking,” the author’s chapter “The Naked Truth” is truly excellent on describing how HIV is actually transmitted.

Another truly excellent chapter is entitled “The Honesty Box.” It explains the many difficulties involved in epidemiological work in trying to obtain accurate numbers that truly depict an epidemic. There is simple miscoding of the survey forms. There are dispositive survey differences brought about via decentralization (everyone “doing their own thing.”) There is “survey bias,” i.e., receiving different answers depending on who is asking the questions. And on and on, including, of course, asking the wrong questions, or ones inappropriately formulated, in months, instead of yesterday.

Equally informative are chapters on the dominance of ideology over science (and how the scientists quietly try to circumvent this), particularly with American funding for HIV / AIDS, as well as the many intergovernmental and inter-NGO squabbles over the distribution of the now ample “sugar” of funding that is now in the pot. And then there is her own assessment why she herself, might not always undertake the appropriate protective measures (he is a “nice boy” through the second bottle of wine). Equally powerful is her discussion of her (apparently one-time) husband’s drug addiction problem and how she did not want to talk about it… but wanted strangers to talk about theirs. Yes, the ironies.

With an estimated 40 million dead from HIV /AIDs, and the fact that almost all of them would be alive today if they had used either a simple piece of latex and/or a clean needle, I felt it would have been useful if Pisani could have devoted a chapter to why people don’t, which would have expanded on her own reasons. In terms of inaccuracies, I was stunned with her description (and calculations!!) of Muslim religious beliefs concerning sex and Ramadan. First, it is only during the DAYLIGHT hours that Muslims must refrain from food, drink, sex. And during my 1979 visit to Indonesia, during Ramadan, I asked the rickshaw driver about the fast: “That is only something rich people do.” And then there is the “survey bias” that she did not seem to account for (p. 91-96).

Still, an excellent book that should be a required part of any course in Public Health… or for the “general” public who wants to know more about the epidemic of our times. 5-stars.
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on 10 June 2010
An interesting and provocative look at the HIV epidemic and the public health response. With stigma on the one side and political correctness on the other it's perhaps not surprising that many interventions have lacked effectiveness. Even if, like me, you find Pisani's writing style grating you'd do well to persevere with this book: you will learn something. Her arguments for the impact of long-term concurrent relationships (not promiscuity) on the spread of HIV within Africa were especially interesting.
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on 6 February 2015
There is a lot information in this book in terms of statistics but Elizabeth does put her point across quite clearly.
Again a good book to have the shelf, it gives a different perspective to the world of HIV and the political scene.
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"The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS," is a remarkable new book by London-based Elizabeth Pisani. The author, who is an epidemiologist, specializes in HIV surveillance and protection, and has provided research, analysis and policy advice for UNAIDS, the World Health Organization (WHO), the World Bank, governments on four continents, and other organizations. Pisani began her work life as an Asia-based journalist; and she brings considerable knowledge of Asia, an impassioned commitment to the eradication of AIDS, and a journalist's clear, informal writing to the book at hand. It makes for quite a package.

The author formerly wrote for Reuters, and "The Economist;" she is evidently a hands-on sort of gal, who's been out and about, principally in Asia, spending 14 years trying to figure out how AIDS spreads, and how to stop it. She's met a great many bureaucrats in her efforts; also a great many whores, and quite a few brothel-keepers, too; her reports back from the front line are fascinatingly factual: despite the ultimate seriousness of her subject, they are entertainingly written, to boot. I wouldn't have thought it possible.

She reaches a few surprisingly controversial, at this late date, conclusions: condoms used in sexual intercourse, and clean needles for injecting drug addicts, save lives. She argues against waste, foolishness, and fraud in the effort to beat the disease. She further argues that the way the Western world first became familiar with the disease, largely among the homosexual community, set disease circles and clichés of treatment that do not necessarily apply to society as a whole. Finally, she argues, convincingly to me, at least, that the horrendous swathe AIDS has taken through Africa, laying waste to whole towns and orphaning innumerable children, will not be the way AIDS will spread in other countries. This African pattern has been used to scare the world into greater AIDS awareness, and into donating greater sums of money to fight the epidemic, all to the good, she says; nevertheless, she argues, overwhelming political correctness has prevented the AIDS community from acknowledging that the patterns of sexual activity seen in Africa are simply different from those she sees elsewhere.

Well,who'd a thunk it? An entertaining, seriously educational, accessible, easy-to read book about AIDS, written by a qualified scientist, no less.
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on 28 March 2014
Really great book - who could have thought epidemiology could be so entertaining?! Bought this because, having recently moved to South Africa, I wanted to know more about HIV and AIDS and why it's so prevalent in some countries and not others: this book certainly gave me that education, plus some, frankly distressing, insights into the politicisation of AIDS causes and research. Big respect to Elizabeth Pisani for her fascinating work and her liberal and humanitarian standpoint - and also her writing style.
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on 28 June 2014
This book is a monument to the public health workers who gather the evidence and set out to implement it. Elizabeth Pisani writes deftly and her compassion for the individual turns statistics into individuals.
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