The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS

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A flame-throwing epidemiologist talks about sex, drugs, and the mistakes (dismal), ideologies (vicious), and hopes (realistic) of international AIDS prevention.
When people ask Elizabeth Pisani what she does for a living, she says, "sex and drugs." As an epidemiologist researching AIDS, she's been involved with international efforts to halt the disease for fourteen years. With swashbuckling wit and fierce honesty, she dishes on herself and her colleagues as they try to prod reluctant governments to fund HIV prevention for the people who need it most—drug injectors, gay men, sex workers, and johns.Pisani chats with flamboyant Indonesian transsexuals about their boob jobs and watches Chinese streetwalkers turn away clients because their SUVs aren't nice enough. With verve and clarity, she shows the general reader how her profession really works; how easy it is to draw wrong conclusions from "objective" data; and, shockingly, how much money is spent so very badly. "Exhibit A": the 45 billion taxpayer dollars the Bush administration is committing to international AIDS programs.
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Editorial Reviews

Library Journal

Despite billions of dollars in funding, international HIV-prevention efforts sometimes achieve only modest results, a reality the author sums up as the triumph of politics and ideology over sound science. Combining a background in journalism with experience as an epidemiologist (who has worked with, among other organizations, UNAIDS, the World Bank, and the health ministries of several Asian governments), Pisani here presents a blunt, cynical, and even funny insider's view of global HIV-prevention efforts. When she isn't telling colorful stories, she's skewering everyone who allows ideology to overrule science, e.g., conservatives who oppose needle exchanges and the distribution of condoms despite evidence that they reduce the spread of HIV significantly; well-meaning international development professionals who argue that HIV is spread by poverty and gender inequality rather than by sex and IV drug use; and, especially, politicians who allow the epidemic to grow rather than make unpopular-but evidence-based-decisions. Though she writes in a lively journalistic style, Pisani crafts cogent arguments and supports them with detailed footnotes and an extensive bibliography. Highly recommended for all collections. [See Prepub Alert, LJ2/1/08; visit the author online at]
—Janet A. Crum

Kirkus Reviews
Savvy epidemiologist Pisani takes an eye-opening look at who gets AIDS how, when and where. The "how" hasn't changed: HIV infects via the exchange of body fluids in sex, in transfusions and contaminated needles and from mother to infant in birth or breast milk. But the author's revelations are startling. In the course of developing surveys and collecting blood samples to get an accurate reading of HIV prevalence in Southeast Asia, Pisani got to know the prostitutes, pimps, brothel owners, gays, rent boys, drug injectors and a class of transvestites (with or without genital surgery) called waria, as well as their clients. She discovered that some men and boys who consider themselves straight sell sex to other men, that whores sometimes use condoms with their johns but never with their pimps or boyfriends, that drug injectors also buy sex and have girlfriends who may also be prostitutes, that waria have loving "husbands." All those questionnaires with check-off boxes to distinguish one high-risk group from one another just don't make any sense, she concludes. Pisani paints likable portraits of many of the contacts she made as she explored the dives and street scenes in major cities. The whores are not actually very wise, she admits, but neither are the donors and administrators of government programs who demand abstinence, oppose family planning, think they can create a drug-free world and often operate in ignorance of what other groups are doing. A further dilemma goes to the heart of AIDS stigma. People give money to forestall the epidemic infection of all those innocent wives and children, but Pisani makes it clear that they are not the most vulnerable, at least on the turf she hascovered (Africa is different). She argues that the money ought to go to needle-exchange programs, condom promotion and other preventives. Delivers a strong, well-told and believable message-would that it makes a difference. Agent: Felicity Bryan/Felicity Bryan Agency
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Product Details

  • ISBN-13: 9780393066623
  • Publisher: Norton, W. W. & Company, Inc.
  • Publication date: 6/17/2008
  • Pages: 400
  • Product dimensions: 6.30 (w) x 9.30 (h) x 1.30 (d)

Meet the Author

Elizabeth Pisani has lived in
Indonesia at various times over the past twenty-five years, originally as a journalist and later as an HIV
epidemiologist. The author of The
Wisdom of Whores and Indonesia Etc., she is based in
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Table of Contents

Author's Note     xi
Acknowledgements     xiii
Preface: The Accidental Epidemiologist     1
Cooking Up an Epidemic     13
Landscapes of Desire     43
The Honesty Box     84
The Naked Truth     124
Sacred Cows     161
Articles of Faith     188
HIV Shoots Up     227
Ants in the Sugar-Bowl     269
Full Circle     301
Notes     327
Bibliography     347
Index     365
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Customer Reviews

Average Rating 4.5
( 6 )
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Sort by: Showing all of 6 Customer Reviews
  • Posted September 5, 2012

    more from this reviewer

    A must read

    Elizabeth Pisani has written an informative book that gives you a solid look at how governments shape how money is used when trying to help people.
    The book introduces you to people who care about how those with AIDS are treated. You will meet people who although they have this deadly disease live full and interesting lives.
    This is a book you will not find boring, it has wit and humor and compassion.
    I recommend this be placed on your reading list.

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  • Posted July 11, 2010

    more from this reviewer

    An Engaging and Informative Overview of Effective HIV Policy

    After nearly a decade of conducting AIDS/HIV research in Southeast Asia, Elizabeth Pisani recants the lessons she has learned while helping governments and NGO's reduce the spread of this disease. From stressing the importance of adequate disease surveillance to clearly outlining the ways that AIDS/HIV spreads throughout societies, Pisani clearly states the measures that must be taken in order to curtail the AIDS/HIV epidemic. In short, needle exchange programs as well as abundant access to condoms and lubricant for at-risk populations--mostly prostitutes, their customers, and drug injectors--offer the most potential for limiting the infection rate.


    Overall, Pisani provides an insightful book. She responds to numerous counterarguments, provides a vast array of empirical evidence, as well as many personal anecdotes as case studies. Her passion and demand for policy clearly shows. She has avoided adopting any degree of ideology, developing policy recommendations that stem directly from evidence. Her work should be commended and utilized.

    Pisani is a staunch advocate for HIV/AIDS prevention and her policies stem from that perspective. In other words, her analysis does not include other perspectives within social sciences. For example, Pisani argues that forcing NGOs to purchase supplies and materials from U.S. companies creates a highly inefficient system for providing AIDS/HIV prevention and treatment. However, she does not provide an economic analysis of this policy. In short, the added revenue to U.S. companies and subsequent boost to the American economy may outweigh the ineffectiveness within the HIV/AIDS prevention and treatment industry. Or it may not. Either way, Pisani neglects to provide analysis and her policies should be analyzed from several lenses before being adopted to avoid any unintended consequences.

    Lastly, Pisani acknowledges the political dilemma for implementing her policy suggestion: people don't like doing nice things for junkies like needle exchanges. She fails to provide any solutions to overcome this dilemma. Though creating awareness and understanding of the HIV epidemic is certainly one useful strategy (and one assumes this book is part of that strategy), Pisani never explains a framework for moving forward. Then again, Pisani is an epidemiologist and shouldn't be faulted for not developing a strategy of policy advocation.

    Bottom Line:

    This book is required reading for anyone involved with AIDS/HIV. Not only has Pisani presented a decades worth of work in an incredibly engaging book, her work has immediate implications for NGOs and governments worldwide. Highly accessible and deeply informative characterizes the entire book.

    For more reviews and a summary of Pisani's main points, find us at Hand of Reason.

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  • Anonymous

    Posted April 9, 2010

    Right on

    Pisani is an excellent writer and makes a crazy topic understandable while allowing us to even laugh at the ridiculous-ness of the HIV/AIDS world. Being un-afraid to call a spade a spade, her frank-ness is refreshing. Too many of us (myself included) count on this industry for our bread and butter and do not have the skills or the networks and authority to share such wisdom. Glad Pisani is there to do it. I hope the global health donors and other decisionmakers all read this and tune into the fact that we are not doing what needs to be done!

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    Posted February 23, 2011

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    Posted August 14, 2011

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    Posted March 20, 2011

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