AsiaOne: Sex, drugs and the hard facts (Nov 9)

Sunday, November 9, 2008

Sex, drugs and the hard facts

In town last month to promote her work, Elizabeth Pisani, the London-based 44-year-old epidemiologist, is as unflinchingly honest in real life as she is in the book.
Tan Hui Yee

Tue, Nov 11, 2008
The Sunday Times

The speaker takes the microphone to address the handful of people at the corner of Page One bookstore. Please, he asks those milling around, take your seats for a session with the author.

No one stirs until a small, pixie-faced woman leans over the mike and announces: 'Sex and drugs in the corner! Sex and drugs in the corner!'

Peals of laughter break out. The seats fill up. The woman is Elizabeth Pisani. Her newly released book, The Wisdom Of Whores, gives an insider's view of the bloated Aids industry and it literally has a lot to do with sex and drugs.

In town last month to promote her work, the London-based 44-year-old epidemiologist is as unflinchingly honest in real life as she is in the book. The former Economist journalist, who spent more than 10 years tracking and fighting the spread of the disease in organisations such as the World Bank, UNAIDS and the World Health Organisation takes no prisoners as she attempts to pin down exactly what is wrong with the system.

Acquired immune deficiency syndrome (Aids), she says, is 'completely preventable' with a condom and a clean needle. The HIV virus, which causes it, is spread mainly through sex, and drug addicts using infected needles.

But bureaucrats, religious leaders and politicians are squeamish about providing or promoting the use of the two relatively cheap items. Some even insist on making abstinence central to HIV prevention programmes.

'But discouraging sex is never a winning game. Sex is a lot of fun and people will go a long way to get it,' she says.

'Abstinence has no effect on preventing the spread of HIV. It sometimes delays the spread of HIV by about a year and a half, but it doesn't seem to have any effect at all on the overall levels of HIV.'

She also pokes fun at unrealistic pro-abstinence groups, one of which suggests on its website that people 'visit a nursing home' instead of having sex.

'Hmmm, visit a nursing home or have an orgasm? Now let me see...If we base our prevention programme around things which are so obviously absurd, we're going to get nowhere,' she declares.

'Absurd' is also the word she uses for the Singapore Government's move earlier this year to criminalise anyone who has reason to believe that he may be infected with the HIV virus and yet has sex with another person without first informing that person of the risk.

She says: 'I can't imagine a situation when you're in Batam for the weekend with your golf buddy and you're in the brothel, and you think: Oh, you know what, actually I won't have sex with this girl because otherwise if I don't tell my partner I might get into trouble. Or I will use a condom because otherwise...People don't think like that. It's impossible to regulate your way out of this problem.'

'Nothing,' she declares, 'gets in the way of common sense like erections and addiction.'

In her book, she suggests instead that the enforcement of condom use be put in the hands of those in power. The Thai government, for example, registered great success when it threatened to put out of business brothel owners who were lax in enforcing the use of condoms.

The scientist in her will not let political correctness get in the way of plain facts.

While she is derisive of religious zealots who try to paint Aids as a gay disease, she is equally critical of gay men who are lax in their use of condoms.

She writes in her book: 'HIV is not divine retribution for unprotected anal sex with lots of other people. It is simply a consequence of unprotected anal sex with lots of other people, in the same way that lung cancer is a consequence of smoking, and obesity is a consequence of eating fast food, drinking supersized Cokes, and getting in your truck to drive the 800 yards to church instead of walking.'

In Singapore, where heterosexual sex is the main source of HIV infection but gay sex accounts for the fastest-rising source of reported cases, 'the gay community should be very worried', she tells The Sunday Times.

'To say 'Oh, this isn't a gay problem' doesn't help reduce the stigma because in the end what you get is more disease.'

However, she notes that Section 377A of Singapore's penal code, which criminalises sex between men, makes it more difficult for gay men to seek the information they need to protect themselves.

Globally, the budget for Aids in developing countries has grown from a mere US$300 million (S$449 million) a year in 1996 to US$10 billion last year, but vast amounts of money are wasted because governments, for ideological or political reasons, are not focusing enough attention on the groups which need them most - gay men, sex workers and drug injectors.

For example, the United States, which budgeted US$4.2 billion for HIV in developing countries this year, does not allow federal funds to be used on clean needles for drug injectors.

Wastage also stems from the fact that many countries prioritise Aids treatment over other equally or more pressing health threats.

'Why should someone with HIV get free treatment when someone with lung cancer doesn't? The reason that distortion exists is because there is a massive international lobby for free HIV treatment. So developing countries, where a big proportion of the health budget comes from donors - and Indonesia is a classic case - very often spend a big proportion of their health budget on HIV.'

Asked about the provocative title of her book, she paid tribute to the transgender sex workers on the streets of Jakarta who provided her with the greatest insights after she went there seven years ago to work on HIV prevention.

She mentions in particular Ms Ines Angela, a sex worker in Jakarta who pointed out that surveys on sex workers were skewed because researchers were interviewing the least active individuals.

Ms Pisani relates, with a chuckle: 'She said, 'Any sex worker who is on the street talking to a research team is a sex worker who is not with a client... I'm never on a street corner, I'm with a client.'

'And I was like...she's right. Oh dear.'

After that, surveys on the sex workers were conducted through their internal hierarchies, with each district's leader gathering interviewees at her home in the daytime, when they were not working.

The other reason for Ms Pisani's choice of title is somewhat more grim. The budget to fight HIV/Aids worldwide has ballooned almost disproportionately in relation to the number of people suffering from the infection. The number of people living with HIV rose by 38 per cent between 1996 and 2006, but spending on HIV in developing countries surged 2,900 per cent over the same period.

This money, in turn, has attracted groups - some not entirely relevant to the cause - into vying for a piece of the pie.

She reflects: 'After nearly 15 years in this ever-better funded industry, more and more money is sloshing around, and more non-governmental organisations, United Nations organisations and international organisations are jumping into the cause. You see people bending over backwards to get HIV money. In the Aids industry these days, we're all whores.'

» Go to for more on Ms Elizabeth Pisani.

The Wisdom Of Whores. Bureaucrats, Brothels And The Business Of Aids, published by Granta, by Elizabeth Pisani, is on sale at $40.66 (with GST) at major bookstores

This article was first published in The Sunday Times on Nov 9, 2008.