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

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 www.straitstimes.com 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.

AsiaOne: When Papa became Mama (Sept 8 2008)

When Papa became Mama

When Frankie first told his friends that he was changing his name to Fanny, most were stunned that he was going to change his sex.
Wong Kim Hoh

Mon, Sep 08, 2008
The Straits Times

TWO months ago, a former first sergeant who served 10 years in the Singapore navy sent a mass SMS to all his friends.

It said: 'Dear friends, I have changed my name from Frankie to Fanny.'

Some laughed it off as a prank. Others called up Frankie Ler, 34, and were stunned when he told them he had decided to become a woman.

The divorcee and father of a 10-year-old girl told them he had started 'transitioning': He had grown his hair, was taking female hormone pills, and had begun wearing women's clothes.

'I didn't want them to get a shock if they bumped into me on the street,' said the administrative assistant, sitting in a Rowell Road Cafe with her daughter.

Her face is powdered, and she is wearing light eyeshadow and lipstick. Her broad shoulders fill out a conservative black blouse which she complements with a knee-length patterned skirt and sensible pumps.

Half an hour earlier, Fanny was the main 'attraction' at My Wife, My Kids, one of several events in this year's IndigNation - the local gay community's annual pride season.

Facing an inquisitive audience of more than 60 people, she explained why she had to change sex so late in life, after marriage and fatherhood.

Fanny - who has a younger sister - claims her transsexualism surfaced only last year. Her late father was a factory worker, her mother, now 56, is a retired washerwoman.

'I never thought I had any problems, I just thought I had an abnormal hobby,' she says in a mixture of English and Mandarin. That hobby was a penchant for dressing in women's clothes. She discovered she liked it while trying on her mother's clothes at 10, and continued to furtively cross-dress until she got married at 23.

The Yio Chu Kang Secondary School alumnus - who signed up with the navy after a brief stint as a security guard - met and fell in love with her wife on an Internet chatline.

They got married three months later. Their daughter was born the following year. 'Just before I got married, I threw out all the shoes and dresses I had bought over the years. We were a very normal couple during our marriage. I was not gay and I did not have any interest in men,' says Fanny.

The marriage broke up seven years later in 2004. The couple have joint custody of their daughter.

'We just drifted apart. It had nothing to do with cross-dressing,' she says.

One day in June last year, she typed 'men who love to dress up as women' in Google. The search engine threw up many links, one of which led to sgbutterfly.org - a resource site for local transsexuals.

She trawled through the site's many articles and discussion threads, and even posted questions, on transsexual issues - from identity struggles to hormone treatments and make-up tips. 'I was so happy. I finally found the answers to so many of the questions in my head,' she says.

Two months later, after she was convinced that she was a woman trapped in a man's body, she spoke to the person closest to her: her daughter.

'I wanted to be a woman but I had to be sure it wouldn't hurt my daughter. So I decided to ask, not tell, her if I should transit. If she had said no, I wouldn't have done this.'

The Primary 4 pupil (whom we are not naming to protect her identity) says she was 'a little bit surprised that he should ask this question'. Fanny carefully explained what she was going through and why she felt the way she did.

The precocious little girl gave her approval. 'His physical looks will change but he is still my father. He has always been very caring, and is always teaching me to be brave,' she says, adding that she has told two of her closest friends but sworn them to secrecy.

Fanny felt a big load taken off her shoulders. 'My mind was very clear. I was divorced and I've been given a second chance to live my life right.'

She went for psychiatric evaluation which confirmed she had gender identity disorder (GID). She started her hormonal therapy late last year. Her sister, parents and friends were told next. They were shocked but took it well save for just one friend who has cut off all contact.

The last to know was her former wife.

'She was very upset but I explained that I found it hardest to tell her because we had such a close relationship,' says Fanny who plans to have her operation in Singapore next year.

'To her credit, she joined sgbutterfly to try and understand why I had to do this,' says Fanny, who adds that the former spouse occasionally takes her shopping for women's clothes.

Fanny happily lets on that she recently found a job in a construction firm. Her boss and her colleagues are aware of her status.

She does not harbour grand plans such as marriage for the future. 'I just want to focus on my daughter.'

The latter ponders when asked what it's like to have two mothers. 'It's okay to have two mummies. I can still enjoy both their love.'

This article was first published in The Straits Times on Sept 6, 2008.