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

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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 peop 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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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 peop 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.

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

  1. 4 out of 5

    Elizabeth

    I wrote this book so of course I think it's fantastic. But if you want more objective opinions, you will find all reviews so far (good and bad) at http://www/the-wisdom.com/reviews I wrote this book so of course I think it's fantastic. But if you want more objective opinions, you will find all reviews so far (good and bad) at http://www/the-wisdom.com/reviews

  2. 4 out of 5

    James

    What a difference a title makes!!! Sexual Ecology: AIDS and the Destiny of Gay Men by Gabriel Rotello Is a far more interesting and informative book, but with a dull title it only has 8 ratings and 2 reviews. Compare to the 288 ratings for this book! I don't know what the title is suppose to mean, there's no "wisdom" from the whores that are interviewed. I guess it would make sense if the author considers herself a whore, but I doubt that's the case. Over 300 tedious pages, about 49% of the time t What a difference a title makes!!! Sexual Ecology: AIDS and the Destiny of Gay Men by Gabriel Rotello Is a far more interesting and informative book, but with a dull title it only has 8 ratings and 2 reviews. Compare to the 288 ratings for this book! I don't know what the title is suppose to mean, there's no "wisdom" from the whores that are interviewed. I guess it would make sense if the author considers herself a whore, but I doubt that's the case. Over 300 tedious pages, about 49% of the time the author is preaching. Another 49% she has this weary attitude that everyone else is stupid, and if Seven Billion people would just do things HER way, all would be right in the world. I was surprised to learn, according to the author, that the average whore in the Philippines only has 2 customers a week. And that the wives in Africa fool around as much as their husbands. When you think about it it kinda has to be that way doesn't it? How can a bunch of men cheat if there aren't an equal number of women doing the same thing? hmmmmm, that's not even 2%, maybe I should adjust the 49% numbers. No glossary, and a poor index. She explains what a "rent boy" is early in the book, better remember, because it isn't explained again and the index won't help you. I put it on the Health shelf, I think maybe I need a "Books I wish I never started" shelf.

  3. 5 out of 5

    Elevate Difference

    The arrival in 1994 of HIV and AIDS to the London School of Hygiene's curriculum led Elizabeth Pisani, a former journalist and scholar of classical Chinese, to contemplate "a career in sex and drugs." The Wisdom of Whores recounts her work for (and increasingly against) the funding and technical juggernauts of UNAIDS, Family Health International (FHI), the World Bank, the WHO, and the President's Emergency Plan For AIDS Relief (PEPFAR) in defining and surveilling upon HIV and AIDS. Pisani collec The arrival in 1994 of HIV and AIDS to the London School of Hygiene's curriculum led Elizabeth Pisani, a former journalist and scholar of classical Chinese, to contemplate "a career in sex and drugs." The Wisdom of Whores recounts her work for (and increasingly against) the funding and technical juggernauts of UNAIDS, Family Health International (FHI), the World Bank, the WHO, and the President's Emergency Plan For AIDS Relief (PEPFAR) in defining and surveilling upon HIV and AIDS. Pisani collects data in fetid settlements, brothels, sex clubs and hairdressing salons from the body parts and fluids of marginalized people and then massages the data ("beating them up" in journo speak) to placate politicians and sponsors. Even chapter titles such as "The Honesty Box," "Sacred Cows," and "Ants in the Sugar-Bowl" critique the "big business" of AIDS managed by "the AIDS mafia." Skewering the absurdities of the "abstinence-only" movement and the opponents of "harm reduction" in matters sexual and drug-injecting, Pisani pits the "truth" of painstakingly gathered empirical data (doing "good" science in HIV and AIDS work) against the "right answers" that keep politicians elected and funding streams flowing. Here is her solution: "We could save more lives with good science, if we spent less time worrying about publishing the perfect paper and more time lobbying, more time schmoozing the press, more time speaking in the language that voters and politicians understand. If we behaved more like Big Tobacco, in fact." The Wisdom of Whores reads (and was edited) breezily, but there is much to praise. Clinical and pharmaceutical specialists and development agency reps have had aired the dirty laundry of their infighting, money-grubbing and ill-conceived treatment programs. Lay readers will be titillated by her frank talk, have their eyes opened by her revelation of greed and corruption in national AIDS programs, and be liberated by her constant use of metaphor and colloquialisms. "Sex can be a sticky business. The stickier the better...A wet vagina is usually a pretty safe environment" conveys the frisson of having seemingly encountered dangerous words and ideas. Nevertheless, the clarity of her take on needle exchange, data coding, epi-speak, and religious squeamishness about sex belies their nuances and complexities. She contends that "the circumcision and untreated STIs are easy to understand [in figuring varying HIV antibody prevalence:] and they are relatively easy to measure." Not so. Men are becoming circumcised instead of using condoms. The recently circumcised heighten their own infectiousness when they have sex still wounded. Women don’t benefit at the population level from circumcision. Men sometimes undergo supercision, superincision and even circumincision. None of this is easily measured. Pisani discusses the politics behind use of acronyms such as MSM (Men who have Sex with Men), FSW (Female Sex Workers), and IDU (Injecting Drug Users) that stuffs into conceptual boxes for epidemiologists the identities and behaviors that won’t stay put. Her summary nicely spells out the difference between epidemiologists and ethnographers. Admitting that she and her colleagues "bulldozed happily through the minefield of language," she then castigates the very calls for nuance and caution in such matters that elsewhere she uses to dink mainstream epidemiology. Her confession that, "When we started to look, it didn’t take long to explode the 'junkies don’t get laid' myth," insults the legions of social scientists and activists who invented no such myth in the first place. This is the blessing and curse of The Wisdom of Whores. Pisani complains (rightfully) about the language of mainstream epidemiology and its sacred cows, but her language is as imprecise as are her conclusions debatable. Her picking on the World Bank for believing “poverty and gender inequality spread AIDS” lets off the hook the sum total of the negative effects of the structural adjustment programs and unregulated capitalism supported by it and the IMF and WTO and ignores how hard social scientists worked to enable the World Bank even to put "poverty and gender equality" on the same table of HIV blame as cognitive shortfall and individual responsibility. Her claim that the fact that HIV antibody-positive men are eschewing condom use "wouldn't really matter if they were having sex with people who were also infected," is flatly untrue on several levels. She confuses "hot and dry" sex for "dry and tight," and ignores its "Western" manifestations. Indonesia’s waria (men who dress, identify and have sex as heterosexual women) do significant rhetorical duty here, but she fails to cite the important works of Jake Morin, Leslie Butt, and Gerdha Numbery, and ignores the lengthy genealogy in male-male sexual activity in the region. Her language often exoticizes ("Madurese women are famed for their sexual prowess") and is sometimes inflammatory: "If you have sex in ways that do not follow basic human sexual design (which includes a lubricated vagina), you will increase the chance of small tears and abrasions." While rightly calling for ethnographic data and sensibilities that would explode myths, they were largely the making of Pisani and her colleagues. Rushing to appear marginalized as a consulting epidemiologist, she neglects how marginalized are most ethnographers by epidemiologists and the funding agencies and conservative philosophies underwriting them. The "big business" of AIDS begins properly with just such epidemiological conceits. Review by Lawrence James Hammar, Ph.D.

  4. 4 out of 5

    Lindsay Wilson

    June 2016 re-read: I graduated from my MSc. in Epidemiology last week, so I thought I would re-read the book that started it all: The Wisdom of Whores. I first read this book back in 2010 and it literally changed my life. I was in the middle of a degree in International Development, and my main interest was in Global Health, with a particular emphasis on HIV. I was really unclear about what I wanted to do with my life and was increasingly dissatisfied with the largely ineffective development wor June 2016 re-read: I graduated from my MSc. in Epidemiology last week, so I thought I would re-read the book that started it all: The Wisdom of Whores. I first read this book back in 2010 and it literally changed my life. I was in the middle of a degree in International Development, and my main interest was in Global Health, with a particular emphasis on HIV. I was really unclear about what I wanted to do with my life and was increasingly dissatisfied with the largely ineffective development work we've been doing for the last century or so and the seemingly ambiguous marking schemes this degree involved. As I became increasingly jaded, I picked up this book. In it, Elizabeth Pisani mentions that she is an epidemiologist (the first time I'd ever heard that word) and on learning what the hell that was, I said, "That's what I've been looking for. That's what I want to do." Cut to six years later, where I ultimately finished that undergraduate degree in 2012, started a graduate epidemiology program in 2013, and defended my Master's thesis (focusing on HIV testing) at the end of last year. I've also spent the last two years working in harm reduction research focusing on HIV and Hepatitis C. So, with all the ceremony surrounding convocation last week, I thought I'd revisit this book to really bookend the whole thing. Now that I've given this exceedingly long back-story, here are my highly anticipated thoughts on the re-read. This book is still amazing. I'm glad to see I had good taste in books six years ago, and I still see why it spoke to me so deeply. The only difference this time around was that now I've spent two years of my own life actually working on this issue rather than just researching it for school, and I've come across so many of the issues that Elizabeth Pisani talks about in my own life that it's frankly alarming. That so little has changed in the near decade since the book came out is a travesty. My work with people who use drugs has given me a pretty good idea of the lack of existing political will that would make the health of people who use drugs a priority. There have been encouraging steps forward in some areas, but there is still so much more to do. (For specifics of what those seemingly straightforward solutions are, I encourage literally everyone to read this book.) Elizabeth Pisani is unflinching in her delivery of the realities of working in the field of HIV and her no-bullshit explanations of why we are failing so badly in getting HIV under control is eye-opening. She says so much of what needs to be said. If we could just get some more people saying it, maybe we could do better for the people who would genuinely benefit from the industry getting its shit together. Original Review: "The Wisdom of Whores" immediately captured my attention with its thought-provoking title. The book within the cover just served to draw me in further. Elizabeth Pisani brilliantly captures one of the main obstacles in dealing with the HIV/AIDS crisis - sometimes smart people make bad choices. This is just one of the simple, yet brillint insights provided in this book; I couldn't put it down. I have been studying HIV/AIDS for several years, and never has a book on the subject spoken to me in such a profound and meaningful way. In fact, due in large part to the world I was exposed to through Pisani's writing, I am now applying to my Masters in Epidemiology. Never underestimate the power of an excellent book.

  5. 4 out of 5

    Brendan Conner

    Elizabeth Pisani’s book, The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, while choc-a-bloc full of policy and statistics, lacks the whore’s-eye view the title first leads the reader to believe. While The Wisdom of Whores is certainly a well-written and eminently useful insider’s take on international HIV/AIDS policy, I fail to see the relevance of the title. Pisani’s Whores actively calls into question the very “Sacred Cows” of sex worker rights and HIV/AIDS activism: the r Elizabeth Pisani’s book, The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, while choc-a-bloc full of policy and statistics, lacks the whore’s-eye view the title first leads the reader to believe. While The Wisdom of Whores is certainly a well-written and eminently useful insider’s take on international HIV/AIDS policy, I fail to see the relevance of the title. Pisani’s Whores actively calls into question the very “Sacred Cows” of sex worker rights and HIV/AIDS activism: the rejection of compulsory testing as inhumane, the prioritization of antiretroviral treatment, and, activist’s full-on endorsement of peer education among high-risk groups: commercial sex workers, injecting drug users (IDUs), and men who have sex with men (MSM). This titular technicality out of the way, I’m not sure I entirely disagree with Pisani’s take on the matter. The strength of this book, in my view, is its ability to shake up the treatment and prevention debate among sex workers themselves. Perhaps it’s time the "golden cows" of sex worker rights, as Pisani puts it, were recast.

  6. 5 out of 5

    Dean Rizzetti

    Elizabeth Pisani knows how to make banal things sexy. I’m not convinced that a job writing manuals at UNAIDs or consultancies helping government setup monitoring systems is really the stuff that gets the heart pumping. But Pisani trounces my skepticism, using her experience as an anchor for compellingly, well-argued observations about development, research and HIV. The first third of the book is focused on Pisani’s transition from a journalist in Hong Kong to a scientist writing cook-books on mon Elizabeth Pisani knows how to make banal things sexy. I’m not convinced that a job writing manuals at UNAIDs or consultancies helping government setup monitoring systems is really the stuff that gets the heart pumping. But Pisani trounces my skepticism, using her experience as an anchor for compellingly, well-argued observations about development, research and HIV. The first third of the book is focused on Pisani’s transition from a journalist in Hong Kong to a scientist writing cook-books on monitoring HIV at UNAIDS. This technocratic post ultimately turned into a job tracking Indonesia’s HIV rate, wandering the back streets of Jakarta asking prostitutes about their practice. This is the foundation for her broader assessment on research and the way we use the data we collect. Two points in this discussion really stood out for me. The first was a round-about but ultimately spirited defence of qualitative methods. As Pisani admits, it easy to dismiss qualitative research for the hard certainty of numbers. It can be very wishy washy, and the quality of data is hard to assess. But under this certainty lies a lot of mushy, rusty assumptions. How, for example, should you quantify a man who sells sex to men, dates a street walker and visits cross-dressers from time to time, all the while resolutely claiming to be straight. He doesn’t fit any of the UNAIDS boxes of a female prostitute, gay man or drug user, which leaves him without a box in the AIDS monitoring cookbook. But he’s clearly at risk - with so many chances for the AIDS virus to enter his bloodstream. These blindly obvious challenges only come to the fore when we ask questions to really understand what we’re studying. But when we rely on numbers we often avoid first understanding who or what we’re actually to measure. The second blindingly good insight was the data spin cycle. Early in the life of UNAIDS, there was a problem - AIDS wasn’t growing fast enough in the right places for anyone important enough to notice. Absolute rates were skyrocketing in places no-one cared about, but were stubbornly small elsewhere. However, with a quick in the interpretation of the data from absolute numbers to rate of change, suddenly important places were experiencing an epidemic. This was something you could build a movement with (which UNAIDS did with admirable efficacy!). But ultimately, the statistically story rested on spin - both concerning and impressive. As the book opens up, the argument expands from Pisani’s direct experience into a broader take on HIV. Pisani spends a fair chunk of the book on Africa, which has overwhelmingly borne the brunt of the HIV epidemic. At the time of writing, "a schoolgirl in South Africa was thirteen times more likely to have HIV than a sex worker in China, while a civil servant in Swaziland is forty times more likely to have HIV than a junkie in Australia”. And what drives such incredible transmission in hetrosexual people? Sex with multiple partners at a time when your viral load is high. For most people, this is the first six months of infection and the last few months before death. Assuming that you don’t share infected blood or have anal sex, this is the time that transmission is likely to occur. And for transmission to occur in this period you need to have multiple partners, across generations and within marriages. African politicians tried to avoid this fact, abetted by international bureaucrats who focused on poverty, gender or basically anything but sex. Leaders who were willing to focus on sex like Uganda’s strange-hat-wearer in chief Musevene saw HIV rates decline, while others watched people die. As someone who works on climate change - a field that can be similarly distracted by beat-ups and focusing on the wrong issues - I found Pisani’s focus on the facts of transmission really compelling. In the climate change world, we spend a lot of time worrying about a lot of issues that do nothing to reduce emissions. Similarly, in the HIV world, Pisani argues, we spend a lot of time funding interventions that won’t help reduce actual transmission rates. It might be nice to focus on the general public but the truth is that if you want to stop transmission you have to go to the virus, which thrives amongst the politically palatable populations of sex workers and drug injectors. Spending 99% of your budget on the general population (as Ghana does) is unlikely to make any difference to HIV when 76% of your new transmissions happen in commercial sex. Taking action requires us to look deeply at cause no matter how uncomfortable and focus religiously on the bottom line, no matter how compelling the co-benefits of an ineffective policy might be. The final third of the book is dedicated to sacred cows. Yes, Pisani argues, ARV treatment can increase HIV rates as people get lazy. No, infected populations are not always the best placed for designing interventions. And yes, Government can actually play a useful role in treating HIV, while NGOs often can only scratch the surface. Pisani provides a great anecdote to illustrate the point. Thailand is home to one of the world’s most effective HIV treatment programs through targeting the people with the greatest economic incentive. The Government held brothel owners accountable for ensuring their clients used condoms. Women were tested fortnightly for STDs, and men who showed up at health clinics with gonorrhea were traced back to the brothel. If gonnorhea was present, then odds were that condoms weren’t, and the brothel owner was shut down. Condom usage went up 90%. This was primarily because Government had the reach and enforcement power - this wasn’t a bottom-up, client driven approach. It was a "mediocre service provided to a lot of people”, which is often far more impactful than the most attractive but limited services of NGOs. The final telling piece of wisdom was that Thailand payed for 75% of this program out of their budget, with donors making up the rest. For those of us who spend their time trying to get developing countries and communities to care about as issue, this should be a number one indicator - will the government or community actually pay for the service? If not, are we really sure it’s what they want? A lot of people have fretted that this book wasn’t actually about providing the wisdom of whores. But that’s fine; this is the wisdom of someone who has been in trenches and kept her head down long enough to come up with some blindingly good wisdom of her own. A great book for someone who doesn’t know a lot about HIV and perhaps an even better book for someone working in development.

  7. 5 out of 5

    Lesbianfunworld Online

    I am getting older. Yes yes, I know we all are, but this is my story, so shush yourself. I am getting older, and so are my family and friends and colleagues. Not all, mind you, but enough. Too many. I’m watching them age, and I think to myself, they are getting smaller. They are shrinking their worlds, their experiences, their understanding of the world. The world that changes. They are not keeping up, they are not challenging their own conventions and beliefs. Maybe they aren’t getting smaller/ I am getting older. Yes yes, I know we all are, but this is my story, so shush yourself. I am getting older, and so are my family and friends and colleagues. Not all, mind you, but enough. Too many. I’m watching them age, and I think to myself, they are getting smaller. They are shrinking their worlds, their experiences, their understanding of the world. The world that changes. They are not keeping up, they are not challenging their own conventions and beliefs. Maybe they aren’t getting smaller/. Maybe they are staying the same, but it’s the world that’s getting bigger. As an old school lesbian feminist, I was around before AIDS and HIV. Not much more, mind you – I am not that old – but there was a time, just off the edge of my consciousness, when there was no AIDS, no HIV, no GRIDS. I’m not kidding myself, it’s a disease older than me, but it just wasn’t, well, here. Here is the gay community, here in the outer world. It wasn’t here. And now it is. Back I the early 1980s, or maybe the mid 1980s, I don’t exactly recall, I started doing my thing for HIV and AIDS. At the time we didn’t distinguish. It was AIDS, or full blown AIDS. Life expectancy was low and political activism was high. It seemed like the entire community was dying, or at risk of dying. We had to take charge because no one cared about us, no one cared about the [insert hurtful homophobic word of choice] and the [insert another hurtful homophobic word of choice]. We were left to die, it seemed, so we said F-you and didn’t die. We fought back, we created a new reality and, kicking and screaming, we brought the whole rest of the world with us. Now when I say “we”, I don’t mean me. I did my time in the early years, but then the movement changed. People with AIDS needed to care for people with AIDS. The rest of us were sources of money and not much more. I have one friend who dedicated more time to fighting AIDS and helping people with AIDS than just about anyone I know – and I am talking at least a decade here – despite the fact that as a straight woman without the disease she was judged The Lesser. She persevered when many of us gave up, and I wonder how many people are alive today because of her. She knows who she is and if anyone never said thank you: THANK YOU! My time on the AIDS front faded quickly at the time, and has hovered just above indifferent since the 1990s. I donate or donated to the AIDS Committee of Toronto and People with AIDS Foundation, CANFAR and AMFAR, and World AIDS Day. I have a Product RED iPod and my Product RED Starbucks card and I donate occasionally. I’ve accepted my role as money giver just as much as I have accepted the fundamental truths – I think Elizabeth Pasani calls them “Sacred Cows” – and I have never really questioned them. But (and here’s the tie-in you’ve been hoping for), one of the ways to make sure that as you grow older you don’t grow smaller and staler, is to challenge your long-held beliefs with an open mind. I am not saying you have to change your mind, I am saying you have to challenge your mind. Elizabeth Pasani does that, and more. There were a few times I wanted to put down The Wisdom of Whores, a few arguments she caused between Kelly and I (which is *really really* rare, trust me), and a few times I thought… she is freaking brilliant! Yes, she hit me right in the iPod: “HIV prevention programmes that don’t focus on reducing the likelihood that infected people will pass the virus on to uninfected people make governments, votes 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.” Wha? Who does she think she is? Oh, she’s a scientist, an epidemiologist who has travelled the world dealing with AIDS. Okay. Yes, she knows way more about this than I do. And her perspective on the AIDS epidemic is very challenging indeed. I won’t go too much into what her theories are and what formed her outlook, but no matter what you think about AIDS, she will challenge it. She even challenges herself and admits when she comes up short and can’t believe what she ought to. So who is this book for? It’s for 5 different kinds of people: 1. People who know little about AIDS 2. People who know everything about AIDS 3. People who don’t know what to think about AIDS 4. People who don’t give a damn about AIDS because more people get cancer, dammit! 5. People who don’t want their world to get smaller as they get older, but want their world to become bigger than they ever dreamed If you fit into that group, read the book. If you don’t fit into that book, well then, have yourself a nice little life.

  8. 4 out of 5

    Michael Connolly

    The author is a journalist-turned-epidemiologist. She has a master's degree in Classical Chinese from Oxford University. She also speaks Spanish, French and Bahasa Indonesian. She has a doctorate in Infectious Disease Epidemiology from the London School of Hygiene & Tropical Medicine. Pisani is very outspoken. She criticizes the political Left for saying that AIDS is a threat to everyone, because it takes the focus away from high-risk groups such as prostitutes and drug addicts. She also critici The author is a journalist-turned-epidemiologist. She has a master's degree in Classical Chinese from Oxford University. She also speaks Spanish, French and Bahasa Indonesian. She has a doctorate in Infectious Disease Epidemiology from the London School of Hygiene & Tropical Medicine. Pisani is very outspoken. She criticizes the political Left for saying that AIDS is a threat to everyone, because it takes the focus away from high-risk groups such as prostitutes and drug addicts. She also criticizes the Left for asserting that poverty is a primary cause of the AIDS epidemic, because it concentrates aid on the poorest people, rather than those at most risk for AIDS. She criticizes the Left for asserting that routine HIV testing stigmatizes homosexuals. She criticized the political Right, for its objections to providing addicts with clean syringes and prostitutes with condoms. She is critical of feminists, for pretending that African women are pure victims of husbands who sleep around, but not admitting that many young African women are also promiscuous. Pisani points out that the main path for the infection of young African women is their association with older men who have more money than young men. Besides condoms, she also emphasizes the use of sexual lubricants, because they prevent skin tears that can let the AIDS virus in. She also mentions that other STD's, such as herpes and syphilis, increase the risk for HIV infection, because the skin sores offer a route into the blood stream. Male circumcision substantially reduces transmission of the AIDS virus. Pisani says that countries, such as Uganda, whose governments speak openly about AIDS, drugs and sex do a better job restraining the epidemic than those that are less candid, such as South Africa. Pisani is not just a bureaucrat who sits behind a desk. She has spent a great deal of time in Indonesia talking with people in high-risk groups. She is a believer in the idea that the perfect is the enemy of the good. Sure, it would be nice if there were no drug addicts, no prostitutes, and no cheating husbands, but given that no one knows how to change human nature, we should concentrate instead on the prevention of the transmission of the HIV virus among high-risk groups. Pisani talks about the waria of Indonesia, who are a third sex, people who are physically men, but think of themselves as women. Most of them do not want a sex-change operation, even if they could afford it, because with the loss of the penis would come the loss of the ability to experience orgasms. Waria who are sex workers do not have pimps. I was surprised that Jakarta was such a wild place, since Indonesia is a Muslim country. Pisani mentions that following the lead of the West, homosexuality has become more open in Asia in recent years. Another surprise was the high variability of the frequency of AIDS between different places. For example, there is almost no AIDS in East Timor, especially since the Indonesians have left.

  9. 4 out of 5

    Wealhtheow

    Pisani has been working in AIDS research pretty much since its inception, at all the big organizations: UNAIDS, WHO, CDC, World Bank, Ministries of Health in China, Indonesia, East Timor, and the Philippines. She tells the story of the evolution of AIDS programs, which started out as shamefully poorly funded and are now overwhelmed with badly managed donor money. Personal and political ideologies have blocked the most effective programs, channeled money toward populations that don't need it, use Pisani has been working in AIDS research pretty much since its inception, at all the big organizations: UNAIDS, WHO, CDC, World Bank, Ministries of Health in China, Indonesia, East Timor, and the Philippines. She tells the story of the evolution of AIDS programs, which started out as shamefully poorly funded and are now overwhelmed with badly managed donor money. Personal and political ideologies have blocked the most effective programs, channeled money toward populations that don't need it, used resources in the most inefficient ways possible (for example, when she wrote this book most US aid was tied up so that a program in Asia would have to buy condoms made in the US and ship them across the world, as opposed to just buying the much cheaper condoms made locally. Same problem but on a grander scale with drugs, which pharma companies made a mint off of, even after Brazil and India rebelled against their patents and started making their own generics)...Pisani has a light, cheeky tone for most of this book, but hints of righteous anger filter through, mostly in the form of bitingly sarcastic footnotes. God, I love sarcastic footnotes. Definitely worth a read if one is interested in donor aid, AIDS, or the research of infectious diseases.

  10. 5 out of 5

    Stephy

    Having been on the front lines of the AIDS epidemic in the United States when it was still called GRID, (Gay Related Immune Deficiency) I have watched in stunned horror as our Government refused to earmark money for AIDS education and research, and limited money to countries that were, sensibly enough, distributing condoms to sex workers and people with multiple partners. I have been far too close to the actuality of people dying to stand back and get this broad overview. I'm delighted that Eliz Having been on the front lines of the AIDS epidemic in the United States when it was still called GRID, (Gay Related Immune Deficiency) I have watched in stunned horror as our Government refused to earmark money for AIDS education and research, and limited money to countries that were, sensibly enough, distributing condoms to sex workers and people with multiple partners. I have been far too close to the actuality of people dying to stand back and get this broad overview. I'm delighted that Elizabeth Paisani has written such a book. Taking care of people who are living with, and in the beginning, drying from AIDS opportunistic infections, was an exhausting experience, physically and emotionally. many of us who survived are still in a kind of shock. This book had more about how organizations work than I ever cared to know, that is true. Primarily though, it is an honest appraisal of how AIDS and the the people and governments of the world have interacted since it all began. I highly recommend this book.

  11. 4 out of 5

    Alicen

    This book is a searing commentary on the state of the HIV/AIDS prevention/treatment world- or at least the author's take on it. I really appreciated, however, her criticisms and critiques and think that it's important to be constantly analyzing and re-analyzing one's work and field. Some will find this book controversial and it is in many ways, but she also has some useful comments. Great for anyone working this field or interested in understanding some of the complexities in the HIV/AIDS world.

  12. 5 out of 5

    Cindy

    This review has been hidden because it contains spoilers. To view it, click here. This is a damn good book and should be read by anyone even tangentially associated with the aid (and, better yet, AIDS) industry. Having recently left yet another big international development mtng, I sympathize with both Pisani's passion and frustration with the perplexing way in which development resources are used.

  13. 4 out of 5

    Serian

    I thought this was a really fascinating book - about AIDS, about international organisations, about epidemiology, about statistics, about health, about people. It's incredibly readable and straightforward but still manages to explain really complicated issues. I liked the way Pisani structured it around her own life and career, though that might not appeal to some other readers. I did find myself getting a bit bored of her disdain for political correctness - the point really didn't need to be la I thought this was a really fascinating book - about AIDS, about international organisations, about epidemiology, about statistics, about health, about people. It's incredibly readable and straightforward but still manages to explain really complicated issues. I liked the way Pisani structured it around her own life and career, though that might not appeal to some other readers. I did find myself getting a bit bored of her disdain for political correctness - the point really didn't need to be laboured so far - and there are areas where I think she oversimplifies. But overwhelmingly I think these were responses to the existing literature/debate and they're minor niggles. I borrrowed this from the library, but I'm definitely getting my own copy!

  14. 4 out of 5

    Ocrema

    The book is totally cool.

  15. 5 out of 5

    Jite

    Fascinating take on the global AIDS epidemic! I am not huge into non-fiction but as someone working in public health who saw this listed as the first book of the APHA (American Public Health Association)’s new book club, I decided to check this out. It’s the kind of book I read in grad school but wouldn’t have necessary have selected if not for the book club. Or so I thought. The “Wisdom of Whores” is a fascinating take on the global AIDS epidemic that was written about a decade ago, but which is Fascinating take on the global AIDS epidemic! I am not huge into non-fiction but as someone working in public health who saw this listed as the first book of the APHA (American Public Health Association)’s new book club, I decided to check this out. It’s the kind of book I read in grad school but wouldn’t have necessary have selected if not for the book club. Or so I thought. The “Wisdom of Whores” is a fascinating take on the global AIDS epidemic that was written about a decade ago, but which is sadly still very relevant in talking about the way we address not just AIDS policy and programming, but health policy and programming in general. The author focuses on talking about all the missed opportunity, wasted funds, things we’ve done wrong over decades of programming. Her thesis looks a lot at the dichotomy between science and evidence and ideology and self-interest, between epidemiology and politics and between plain-speaking and political correctness. In short, Elizabeth Pisani is not shy to list EVERYTHING wrong with AIDS programming and believe me, the list according to her, is long. She is not interested in prevarication or sensitivity and will step on any toes required to get her point across and she is intentional in this- from the start of the book, she tells you of her fatigue with all the pussyfooting that goes on in the AIDS discourse, in her opinion, getting in the way of the plainspeaking that might bring about useful discussions and actual change. She, like everyone who works in the field, is very convinced of her own ideologies and as a scientist (specifically an epidemiologist), she puts out her data to convince you that she is right, and in fairness, she is very convincing. As a reader of this book, and as someone from a developing country, it needs to be said that this book is not for “us.” By us, I mean readers from the countries that would be defined as “most affected.” Pisani‘s writing about developing countries is what I imagine colonialist’s who first arrived African shores sounded like in their clinical anthropological descriptions of “the natives and their ways.” Whilst Pisani is equally scathing about Western leaders, there is certainly a degree of condescension when she’s writing about certain regions (Africa being one). Even her beloved Indonesia doesn’t escape her patronizing tone at times. Once I recognized that this was not a book that was afraid of sounding racist or bigoted or condescending (she warns you early on) and once I realized that I was not the target audience for this book, which seems more aimed at whistleblowing funders to their constituents (tax-payers), I was pretty much unoffended. The book title is pretty accurate. This is not one of those pop science book that promises you one thing but delivers dry textbook biscuits that no one is interested in reading. If anything, the title is underselling just how “red light district” this book is. She might have called it “Sex, Drugs and HIV” and that would have been an accurate summary because basically, all the science is viewed through the lens of the human pursuit of pleasure above all things even common sense. I learned a lot more about sub-cultures and sexual and injected drug use networking in developing countries than I’d ever known before- from proper sex workers to warias (transsexual sometimes prostitutes) to rent boys, to men sleeping with men who don’t identify as gay, to “faithful” couples who occasionally sell sex, to injected drug users who know better than to share needles or inject drugs but do it anyway... the list is endless- the high risk subcultures numerous and if anyone is treated with compassion by the author in this book, it is these very high risk populations who according to her get the least focus and the least programming even though they have the highest need. And because of the compassion with which Pisani treats these populations, you’ll find your compassion towards them increase. My takeaway from this book is that Elizabeth Pisani comes across as a lover of pleasure, an asked of questions, a shaker of tables, a master of data, a know it all, a condescending so-and-so, a compassionate supporter of the underrepresented and many other things along those lines. However, she’s not wrong in her call for interventions to be more evidence-supported and less based on feelings, ideologies and self-interest. I highly recommend reading this book if you’re even vaguely interested in sex, drug use and HIV programming.

  16. 4 out of 5

    Rik Lubbers

    This book gives a great overview of how the aids epidemic was handled as described through the eyes of an epidemiologist. I agree with some people that the author sometimes seems to preach her views. She very much sees the world of policy making in a rational way. Find the best evidence and implement that, very simply said. However, I believe it happens more out of an incremental model. But that's another discussion. Great book!

  17. 4 out of 5

    Eugenia O'Neal

    In The Wisdom of Whores; Bureaucrats, Brothels and the Business of AIDS, Elizabeth Pisani, takes an incisive look at the sex trade, HIV/AIDS prevention strategies and the operations of national and international non-governmental organizations. Ms. Pisani, an epidemiologist who has worked with UNAIDS, the World Bank and other organizations and governments takes a no-holds barred approach to the issue. What works? What doesn’t? How can governments and multi-nationals spend their HIV/AIDS budgets m In The Wisdom of Whores; Bureaucrats, Brothels and the Business of AIDS, Elizabeth Pisani, takes an incisive look at the sex trade, HIV/AIDS prevention strategies and the operations of national and international non-governmental organizations. Ms. Pisani, an epidemiologist who has worked with UNAIDS, the World Bank and other organizations and governments takes a no-holds barred approach to the issue. What works? What doesn’t? How can governments and multi-nationals spend their HIV/AIDS budgets more effectively? As Ms. Pisani points out scare tactics don’t always work. Neither does ignorance. African governments were slow to respond to the crisis, slow to get the information about the disease to their populations and slow to put reduction strategies such as the distribution of condoms into effect with the result that the virus transmission rate went through the roof. With the exception of Senegal and Uganda, African societies made like or no effort to talk frankly about sex, about the risks of multiple partnering, about the need to use condoms, about the benefits of circumcision. Sexual relations in Africa happens in nets – for example, a man may have two or three wives in his compound but also has a visiting relationship with other women. By contrast, in Europe, relationships happen in ‘strings’ where a man will only have one partner at a time. These are some of the factors which hae led to sub-Saharan Africa having the highest rate of HIV/AIDS in the world, followed by the Caribbean where similar factors, multiple partnering and an unwillingness to talk about sex, also obtain. Ms. Pisani’s focus is mostly on Asia, however, and she explores the facts and the myths behind the spread of the disease in such countries as Thailand and East Timor. Abstinence only programmes, she points out, haven’t worked in the States and don’t work anywhere else. What works are programmes for drug injectors, men who have sex with men, and sex workers. Condom distribution programmes also work. Yet millions of people continue to contract HIV every year because, as Ms. Pisani charges, governments and NGOs don’t like spending money or time on the “wicked.” Thus, millions and millions of dollars go into prevention measures that actually do very little to prevent people from getting HIV. Instead, a weird confluence of religious leaders – the Pope, various imams, preachers, etc. – and non-governmental organizations with one eye on the enormous sums being funneled into AIDS and the other eye on each other, deliberately undermine efforts to reach the marginalized. This is a book that should be read by government leaders, particularly those of the Caribbean where HIV/AIDS prevention seems to have fallen off the radar but where the disease continues to spread.

  18. 4 out of 5

    Jacob

    If you like reading about activist manipulation of facts, government cover-ups, epidemiological facts about HIV, or up-close-and-personal descriptions of the seedy underbelly of several countries, you will probably enjoy this book. The author, a journalist turned epidemiologist who hooked up with studying AIDS just before funding kicked into high gear, is blunt but eye-opening. She describes how she and her coworkers "beat-up" the facts to scare "rich countries" into providing money to fight AID If you like reading about activist manipulation of facts, government cover-ups, epidemiological facts about HIV, or up-close-and-personal descriptions of the seedy underbelly of several countries, you will probably enjoy this book. The author, a journalist turned epidemiologist who hooked up with studying AIDS just before funding kicked into high gear, is blunt but eye-opening. She describes how she and her coworkers "beat-up" the facts to scare "rich countries" into providing money to fight AIDS by claiming that everyone was at risk when it was really just drug injectors, prostitutes, and those having homosexual sex (except in some countries in Africa, where HIV was already so prevalent and the culture so generally promiscuous that it really was everyone at risk). Then, when money finally started pouring in, Pisani relates how it went for "programmes" that didn't address the real problem: prevention for the general populace that wasn't really at risk but whose "risk" was motivating the money in the first place. It turned out that, once the money was provided, people still didn't want it to go to help junkies, prostitutes, and homosexuals. I think the point of this book was to put the entire situation in the open in the hopes that people might be more willing to do what should be done to really prevent HIV as a disease. I'm just glad to hear a more informed opinion of what the situation really is. And to not be in a group at risk. I almost decided not to write this review because I don't want people searching for comments on this book or HIV/AIDS and yelling at me for some opinion they assume I have, but I'll brave it for now and see what happens. If they're not much worse than manga fans I'll be fine ;)

  19. 4 out of 5

    I lost my respect for the work when I reached chapter six and it made me overall question the information presented on the topic of sex and drugs. I won't say much, just that it would have been wiser if Pissani had left her uneducated, anecdotal-evidence-based opinions on human trafficking to the experts on the issue, who not only admit that most of the females in the sex trade in Asia are trafficked, but also that commercial sex not only hasn't fallen, but it is rooted so deep in many cultures I lost my respect for the work when I reached chapter six and it made me overall question the information presented on the topic of sex and drugs. I won't say much, just that it would have been wiser if Pissani had left her uneducated, anecdotal-evidence-based opinions on human trafficking to the experts on the issue, who not only admit that most of the females in the sex trade in Asia are trafficked, but also that commercial sex not only hasn't fallen, but it is rooted so deep in many cultures of Asia, that people can't seem to step away from it because they can't, they don't want to, they're used to it, or all those. Human trafficking is a pandemic. Girls and women are held captive against their will like slaves (actually, even worse), they are manipulated, mentally broken, threatened to not speak to anyone or leave their spots. Yes, stories of such women would make good documentaries if these women would actually have been free physically and psychologically to speak, available to be exposed to random interviewers. But oh, these are all rumors (!) "A friend of mine said this", "a friend of mine said that". I wonder how much money was thrown to make the UN and WHO look clean, innocent, reliable, honest on that matter. Just because one doesn't or can't see cases of human trafficking doesn't mean it doesn't exist, that it is rare or that it is not a serious matter. But let's not forget that Pissani's goal wasn't ever to take a deep dive into the sex trafficking so it doesn't much surprise me that the chapter is quite contradictory to studies of the noughties.

  20. 5 out of 5

    Mark Desrosiers

    She gets the boring stuff out of the way first -- a tour of U.N. bureaucracies and statistics-gathering methods -- before setting off on what amounts to a galloping rant about common knowledge, our perception, of AIDS and why it spreads. Lots of received wisdom gets demolished here -- I felt pretty much like an idiot at some points. For example, she evaporates the widespread trust in "peer advocacy" by citing a personal anecdote in which a skeletal, angry, dying "AIDS counselor" gets to tell a p She gets the boring stuff out of the way first -- a tour of U.N. bureaucracies and statistics-gathering methods -- before setting off on what amounts to a galloping rant about common knowledge, our perception, of AIDS and why it spreads. Lots of received wisdom gets demolished here -- I felt pretty much like an idiot at some points. For example, she evaporates the widespread trust in "peer advocacy" by citing a personal anecdote in which a skeletal, angry, dying "AIDS counselor" gets to tell a pregnant women she's HIV-positive by using the rage-shame-and-pointing technique. As for spending money on antiretroviral treatments, Pisani thinks that might not be such a great idea (without equal spending on prevention efforts, anyway) because those pricey drugs can make HIV and AIDS seem manageable and benign, thereby undercutting efforts to change sexual behavior. And this latter issue -- changing behavior -- points to another one of her rants, which is that public health is fascist: it restricts and controls personal liberty ostensibly for the greater good. She likes this, and thinks it's why public health works so well when religion and ideology don't fuck with it (very rare). I'm inclined to agree. Anyway, this is a wonderful book to read at the beginning of the Obama Era, as her many anecdotes of U.S. funding having abstinence-education strings attached had me smiling, knowing that those ass-backwards days are over. I hope.

  21. 4 out of 5

    Ani

    This was an interesting book, certainly countercultural, which impresses me. Some of her reporting seems quite radical, as she suggests that the staggering numbers related to AIDS that the rest of us are accustomed to hearing are exaggerated by a lot. As it is so radical, I would like to check her sources and research methods, just to be sure that she is not allowing her cynicism to color her reporting. Her take on human trafficking disappointed me, as she claims in all her research to not have This was an interesting book, certainly countercultural, which impresses me. Some of her reporting seems quite radical, as she suggests that the staggering numbers related to AIDS that the rest of us are accustomed to hearing are exaggerated by a lot. As it is so radical, I would like to check her sources and research methods, just to be sure that she is not allowing her cynicism to color her reporting. Her take on human trafficking disappointed me, as she claims in all her research to not have met as many trafficking victims as much of the current media frenzy would like us to think exist. My response to her would be, why would a brothel owner in Thailand report to a white, Western woman if his women were trafficked? And knowing what I do about how trafficking victims are treated and broken psychologically, they would not be likely to admit to a passionate, white woman that they had been trafficked. It is likely that by the time they were adults, if they had been trafficked, their spirits would already be broken down, and/or they would be terrified of what the pimp would do to them if he heard them telling a Westerner how they were treated. I still am glad I read the book, and I enjoy her writing, my only caveat is that her points are so off from what is "common knowledge" that I would like to see them verified.

  22. 4 out of 5

    Kerry

    This book is an epidemiologist's take on conducting field work for AIDS research. She is candid about her experience and the lessons that the various people she encounters from all types of various backgrounds have to teach her and her colleagues about society, common sense and practical matters. I didn't quite manage to get through the whole book before I had to return it to the library. The accounts range from humorous to maddening and frustrating. It offers hope that the public health communi This book is an epidemiologist's take on conducting field work for AIDS research. She is candid about her experience and the lessons that the various people she encounters from all types of various backgrounds have to teach her and her colleagues about society, common sense and practical matters. I didn't quite manage to get through the whole book before I had to return it to the library. The accounts range from humorous to maddening and frustrating. It offers hope that the public health community knows a great deal more about AIDS and HIV these days, but also some discouraging information on implementing and sustaining long-term behavior changes. I liked it, but it became a little academic for my tastes---but it is written by an epidemiologist. I was talking to a friend at the pool about the book and I got some WEIRD STARES when I was recounting a particular anecdote about a transgendered sex worker in Indonesia from the book to her. So watch out...some people might be suspicious of you reading a book with this title.

  23. 4 out of 5

    Eliza

    It took me forever to finish this book. I wanted to get a more eastern perspective on AIDS after reading "And The Band Played On", and Pisani is certainly the expert in the field. I can not say that this book is the page turner that ATBPO was, but what I can say is this book is about data... Tons of data; how they collected data, what data is wrong, how to get correct data, the meetings where they discussed data, how data can effect public policy and public opinion.... It was far too much data t It took me forever to finish this book. I wanted to get a more eastern perspective on AIDS after reading "And The Band Played On", and Pisani is certainly the expert in the field. I can not say that this book is the page turner that ATBPO was, but what I can say is this book is about data... Tons of data; how they collected data, what data is wrong, how to get correct data, the meetings where they discussed data, how data can effect public policy and public opinion.... It was far too much data to keep me interested. I expected more of a memoir, and the title really has nothing to do with the book either. It Should be called "The Wisdom of a Data Collector." With that said, I'm glad I read and finished this book. It gave me fresh insight into the unique challenges of AIDS in the East.

  24. 5 out of 5

    Tony and Rosa

    This book operates on three levels. It is a participant history of international efforts to tackle AIDS; it is a description of the Byzantine international bureaucracies and their donors; and it is a personal story of the author as she went from journalist to public health consultant while gaining and losing a husband. In truth the last is the weakest part of the book. It is where her sense of humour is at its most strained. That ability to laugh at experts and bureaucracies as they spend billio This book operates on three levels. It is a participant history of international efforts to tackle AIDS; it is a description of the Byzantine international bureaucracies and their donors; and it is a personal story of the author as she went from journalist to public health consultant while gaining and losing a husband. In truth the last is the weakest part of the book. It is where her sense of humour is at its most strained. That ability to laugh at experts and bureaucracies as they spend billions intended for people with HIV is what makes this book so readable. Of course, AIDS is not inherently humorous. It is a horrible disease that killed millions of people. The stigma associated with sexual transmission, particularly by gay men, meant it was initially a struggle to get the funding needed for research and prevention. This is particularly tragic because AIDS is an easy disease to control. If you have sex with many people in a short time period, wear a condom. If you inject yourself with drugs, use clean needles. That’s it. As simple and mechanical as wearing a coat during a rainstorm. Of course, some people had sex with one person and ended up with AIDS because they chose the wrong one person. However, controlling the disease, converting it from an epidemic into one of the many nasty background diseases simply requires condom use and clean needles. The power of the book comes from the struggle to apply this simple advice. There are two reasons for this. Strange as it may seem, the more forgivable were generally the men and women, and Pisani wants to make clear there were many women, who did not take precautions. Contrary to myth, drug users use clean needles when they are on offer and promiscuous people approached in the right way will mostly wear condoms. These people are many things, but they are not stupid. The wise whores of the title advised Pisani and other public health researchers on the best way to apply these simple interventions. The book is funniest when she describes earnest but naive researchers being educated in realities they, in the most literal of senses, could not imagine. It is easy to laugh at worthies. Sometimes they sound too similar to white missionaries entering jungles to civilise natives, or those Victorian gentlemen who tackled vice in the East End of London. But at least they try to do what is right. They met the people they did not understand and tried to understand them. When theory did not match reality, they threw out the theory. What mattered was helping people in need. If this had been the problem then AIDS would have been cracked long before drugs to slow it were developed. Unfortunately practical, cheap and simple approaches do not accord with the prior beliefs of funders and international bureaucracies who live off programs to tackle ‘complex’ problems. The result is that ideologically driven programmes that do not work were repeatedly applied and repeatedly failed. This second struggle, to have those with resources apply simple advice, is by far the more pernicious. The book’s subtitle mentions bureaucrats and it is they who were the biggest barrier. As someone who worked in a bureaucracy for twenty years, her description of their endemic failings is the best part of the book. She articulated a reality that is cloaked in obfuscation and self-serving words by people in comfortable jobs more important to them than dealing with the problems they are paid to address. To take one example. When Pisani started there was very little funding for research into AIDS. For a variety of reasons, of which work by her and her colleagues at the WHO was one, this abruptly changed. She is self aware enough to admit that some of her work in that early phase played with the truth, but she could at least justify it as the end justifying the means. There really was an epidemic, it was just the figures they gave considerably overstated the risks to those outside of society’s fringes. However the increase in resources was as big a problem as its lack. Suddenly from finding it difficult to get engagement, everyone wanted to harvest the new money tree of AIDS programmes and research. This was a new battle, where everyone thought they were the solution and had the political and financial clout to be a barrier if they were ignored. These fights are the core task of people in bureaucracies. Anything and everything is impossible when there is no money; anything and everything needs funding if money is made available. There is always a business angle, a gender angle or any other angle that happens to motivate someone. The loaf disintegrates into crumbs long before the needy see any crusts. An important insight true for all work in poverty is how this sweeping up of crumbs has many languages. For instance it is true that people from poorer countries were more affected by AIDS than those from wealthier countries. This saw the discussion of AIDS, a biochemical entity that could be dealt with by mechanical means, absorbed into a wider discussion of poverty whose language dismissed those who wanted to implement the mechanical solutions. They were yet another bureaucracy, this an academic one, that fought its funding corner tooth and nail. I hope it is obvious that people on the fringes of society are different from those who are not. What those of us in the mainstream need to understand is this different perspective gives some of them wisdom. What I learned from Pisani’s description of the fight against AIDS is that the corruption of outcomes I observed in national bureaucracies is ubiquitous to bureaucracy. The metaphorical whores are as wise as those who sell their bodies, and are ruthless in ensuring they retain any resources destined for the latter. The whores on the street are probably wise to that too.

  25. 5 out of 5

    Tera

    A wonderful informative and actually entertaining book on a subject that you would imagine to be dry and depressing. Elizabeth has a great voice and allows personality and humanity to take hold of the subject matter rather than an bury the reader with mind numbing facts. Perhaps if the subject matter was dealt with in our communities, schools and even homes with the same informative yet humanizing approach progress would be more than a goal.

  26. 5 out of 5

    Julie

    I'm kind of on the fence about this one. It's from the perspective of an insider to AIDS advocacy work, and she's fairly harsh about the way things have been approached and the politics that are involved. I think a lot of her cynicism is probably justified, but her attack on the link between AIDS and poverty made me feel a little uncomfortable, as did a lot of her discussion about AIDS in Africa. I'm still thinking about the book and may end up changing my mind about it several times.

  27. 5 out of 5

    Tim Jennings

    The Wisdom of Whores was a suggested book for a public health class in college. I certainly should have taken the suggestion, but I'm happy to have gone back and read this excellent book. It is a bold account from deep into the world of HIV/AIDS. It is colored by vibrant stories of public health workers, drug injectors, waria (transgender Indonesian sex workers), and local and global politics. Entirely worth the read if you have interest in any of the above.

  28. 5 out of 5

    Rebecca

    The author needs to learn how to get out of her own damn way when she's writing. She clearly has a lot of interesting things to say about the business of aids prevention, but the substantive points compete for space with the author's need to share with the reader what a bad ass life she lives as a globe trotting epidemiologist who hangs out with sex workers and junkies.

  29. 4 out of 5

    Rachel

    I'd love to watch her and Paul Farmer discuss AIDS epidemiology and effective preventions. That would be fun.

  30. 4 out of 5

    Patrick Quealy

    Good bridge/gap-filler between dissenter and conventional literature, though it doesn't mean to be.

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