The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS | 
 enlarge | Author: Elizabeth Pisani
Publisher: W. W. Norton
Category: Book
List Price: $25.95
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Avg. Customer Rating:  6 reviews
Sales Rank: 10291
Media: Hardcover
Number Of Items: 1
Pages: 288
Shipping Weight (lbs): 1.6
Dimensions (in): 9.3 x 6.5 x 1.4
ISBN: 0393066622
Dewey Decimal Number: 614.599392
EAN: 9780393066623
ASIN: 0393066622
Publication Date: June 2, 2008
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Condition: Brand New. 100% money back guarantee. All books shipped from Strand Bookstore, New York City, USA.
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Product Description
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. 12 illustrations.
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books don't get better than this June 25, 2008
3 out of 3 found this review helpful
I read a lot, on a wide variety of topics. If it has words on it, I'll try to read it, even if I _don't_ know the language, I'll try to decipher it. But some books are much more rewarding than others, and this is one of the most rewarding books I've ever read.
The other reviews cover the topic well: she's a great writer, a person who really cares about people and not just people who are like her, a scientist who can understand numbers and make them make sense to others. She has a wide-reaching understanding of how AIDS is transmitted, and how that transmission is partly biologically determined and partly culturally determined. And she can convey that complex and detailed understanding in a simple way. Repeatedly, so if you miss it the first time, you get a lot of additional chances. And with hilariously shocking illustrative stories, so there's no remote chance of boredom ever setting in.
I know there's no way she's going to slog through bureaucracy for a second cause -- that would be unfair to ask of anyone. But I hope global warming/climate change/peak oil/etc. gets someone half as brilliant as Pisani. Hopefully several someones.
Great science meets great journalism June 23, 2008
1 out of 1 found this review helpful
For sheer accuracy of synopsis, maybe "The Wisdom of Whores"'s subtitle ought to be "Practical Epidemiology, What We Know About Solving the AIDS Crisis, and How the Politics of International Aid Complicate Matters." Though Pisani probably wants to sell a copy or two.
This is one of the few books I've read that actually lives up to its jacket blurbs. One author describes it as not only a work of science, but also a page-turner. And indeed it is. Pisani holds a Ph.D. in epidemiology, and you can tell from reading The Wisdom of Whores that she has the chops to do serious data analysis. It's data analysis in the service of a practical end, namely figuring out the most efficient ways to stop AIDS. Pisani has been on the ground interviewing prostitutes and junkies for a couple decades now, so she's learned a bit about how the disease actually spreads.
Part of the answer is just common sense: HIV spreads when an infected person's blood comes in contact with an uninfected person's blood. When heroin users share needles, the risk of HIV's spreading rises. Unprotected sex is riskier than protected sex. Unlubricated sex is riskier than lubricated sex, because the risk of causing tears is higher. Uncircumcised men are at higher risk than circumcised men. Prostitutes and their johns are at higher risk than non-prostitutes, because they have more partners.
This much should be common sense; the fact that this common sense often doesn't translate into policy is where the "bureaucrats" in the subtitle come in. The Bush administration and many other nations have changed the conversation: we don't talk about the actual mechanics of sex and drug use, in part because prostitutes and drug users are considered wicked, and it helps no politicians to aid the wicked. From a public-health perspective, most of our effort ought to be focused on the populations that are most at risk: addicts, gay people, and prostitutes. But that doesn't sell. What sells is to talk about "neutral" topics: pretend that consumers of prostitution come home to their innocent wives and unwittingly give them the disease, which then spreads to their kids. When you frame the issue as "AIDS hits everyone," surely you can get votes. Likewise with international aid: if you tell your voters that "poverty and gender disparities" cause AIDS, you can sidestep the icky topics of sex and heroin injection.
Once the money flows, there's a great risk of corruption and waste. Fortunately, Pisani tells us, there are a lot of people on the receiving end of that money who are really trying to do right by the world's taxpayers. And there are organizations like the Bill and Melinda Gates Foundation that seem to disburse funds more efficiently and measure programs' effectiveness better than a lot of governments do. And the governments are learning from their mistakes, in no small part because the epidemiologists on the ground are pushing back on them. Pisani never takes the step that a lot of libertarian fanatics do, namely jumping from the observation that foreign aid can be wasteful to the conclusion that all foreign aid should end. That's because Pisani isn't a libertarian fanatic. She's a hardworking, nose-in-the-details scientist who, like a good disciple of Herb Simon, tries to assume as little as she can before she starts gathering data.
Indeed, the big takeaway from The Wisdom of Whores is that reality is complicated, and that the only way to actually help solve the AIDS epidemic is to dig into the details and be honest about how the disease actually spreads. Don't let ideology, for instance, blind you to the virtues of free condom distribution. Don't let ideology stop needle-exchange programs. At the same time, don't let ideology convince you that needle-exchange programs always work: look at the data first. This book is what happens when a truly scientific worldview merges with the passion of an activist.
Genuinely enjoy getting the facts straight June 19, 2008
1 out of 1 found this review helpful
I am seldom found without at least one book close at hand, and end up trying to give books away in order to keep my shelves from collapsing. But I'm not ready to give this one away, I intend to read it again in a while. What I might do, however, is to order a few extra copies and have them delivered to people I know. Why just this one? Because it is one of those books that you come across once in a while, that works on more than one level. It is a book that keeps me turning the pages, with the energy that comes from a genuinely engaging story. Then there is the author's solid knowledge of the topic, and her ability to present it in an accessible way. This is a writer who knows her tools: she knows how to structure a presentation and how to juggle angles to keep it interesting, all in a style that gets the message across clearly and simply, with a strong personality and sense of humor. But the main reason why I want to gently blackmail my friends into reading it by buying it for them, is the information it contains and the message that it spells out. It is an important book. It untangles the facts about HIV and HIV prevention from the myths, which is good. It also shows clearly how ideological/religious/political/economical agendas often play a bigger role than science, which is depressing ... but essential to know. Getting the facts straight, about the infection and about the HIV/AIDS industry, is vital. And in my mind, Elizabeth Pisani is exactly who you should turn to for those facts
A Must-Read June 10, 2008
10 out of 11 found this review helpful
Elizabeth Pisani's The Wisdom of Whores - Bureaucrats, Brothels and the Business of AIDS is a great book (along with a great website). Elizabeth Pisani is an epidemiologist with years of experience working on HIV/AIDS (or sex and drugs, as she puts, which sounds a lot, well, sexier) at a variety of agencies, including UNAIDS. The book is the story of her frustrations at the way the international community, national governments, NGOS and AIDS activists have dealt with the epidemics, as well as her hopes in some of the progress made.
I got interested in the book when I read an interview Pisani gave to the Guardian. The interview kinda billed the book as a controversial work where Pisani would be the mean lady who said people got AIDS because of their stupid behavior and not enough was being done because of political correctness. So, I was ready to get really pissed off with the book. That has not been the case at all.
Elizabeth Pisani is a scientist and that perspective is pervasive in the book. That's a good thing. I much prefer sober, "just the facts" perspective to touchy-feely stuff. Actually, one of the main frustrations that Pisani deals with in the book is the fact that AIDS had to be made about innocent wives and children for the international community to gear into action, as opposed to the real populations at risk in most parts of the world (except Africa, and she shows that even in Africa, the innocent wives and children trope does not work, as the data show): drug injectors and people who buy and sell sex.
To me, precisely because the book is data-driven, it was not controversial. My reaction was more, "well, if that's what the data show, so be it." But also, I think, the book was billed as controversial because Pisani calls things what they are: penises, receptive or insertive anal sex, etc. and she does spend a lot of time describing her study in red light districts of Jakarta and other (mostly Asian) place. She discusses the brothels, the warias (transgendered male prostitutes) and rent boys, the drug injectors. She does spend a lot of time describing that world that a lot of people would rather never hear of: the stigmatized, the marginalized, those we can safely ignore and those that don't get politicians votes come election time. Doing nice things for whores and junkies carries no political rewards. Doing things for innocent wives and children does. So, that's what has been done with HIV/AIDS and this has been a tragic mistake.
But these descriptions are unvaluable and fascinating because we never read about them. If you read about HIV/AIDS, you will read a lot about Africa (which does make sense since the high rates of infection in the general population are to be found in Eastern and Southern Africa). The problem is that the African patterns of infection have been assume to apply everywhere, especially Asia, where that is just not the case. So, the solutions and programs suggested are inadapted.
The programs needed in Eastern and Southern Africa are not those that are needed in Asia. In these parts of Africa, AIDS does affect the larger population but that's just not the case in Asia where most of the solutions described by Pisani involve programs to distribute condoms, lubricants and clean needles. It is also one of Pisani's other frustrations: we know how HIV is transmitted (biologically, that is), we know the types of behavior most likely to facilitate this transmission, so, we know what kind of prevention is needed. And yet, there is too much focus placed on treatment, rather than preventing people from getting infected in the first place.
Another thing that definitely comes through as Pisani tells the story of her peregrinations through Jakarta, trying to collect good data to design good public health policy, is that, whether she likes it or not, she comes across as someone who really does care about all the junkies, whores and warias she meets along the way. Her scorn is reserved for other people: UN bureaucrats who do not want to call things what they are because of who might get offended, religious conservatives who lie and work their hardest to prevent good prevention or good policy. But don't think the liberal crowd, the NGOs or activists are off the hook either.
Pisani has no patience for distraction, a major one being that AIDS is a gender / development / poverty issue. Pisani shows that this liberal idea, favored by a lot of NGOs and UN agencies and other donors is a distraction. First, it's a distraction because first, you may have the causality wrong (AIDS causes development / gender issues rather than the other way around), second, as shown in the book, even in Africa, that's not always the case, and third, because, again, that gets in the way of common sense prevention which should be the main focus, along with treatment for the already infected population. But again, focusing on women and children makes the AIDS issue more palatable to donors than those filthy whores, junkies and fags, so, Pisani and her colleagues at the AIDS Mafia, as she calls them, played that game too. After all, once you have the money, you can still get stuff done.
And, of course, I particularly enjoyed the chapter blasting the Bush administration and its faith-based initiatives and PEPFAR (President's Emergency Plan for AIDS Relief). Although she does credit the Bush administration for putting money on the table, Pisani makes mince meat of the Bush and his religious nuts crowd for their hypocrisy and nonsensical attitude. She deals swiftly with Virginity Pledges and the creepy Virginity Balls and the whole family values crowd.
Finally, Pisani has also no patience for the workings of the international community and civil society, the demands that donors put on local activists, the circuits of money distribution which end up sometimes producing ridiculous policies: like having an AIDS program in East Timor when there is no AIDS problems in East Timor (although there are other problems that would need funding but don't get it).
Again, let me state: when was the last time you read an epidemiology book that was a great read, straight to the point, data-based, sometimes fun, but always informative.
Superb! An excellent book for the layman and scholar June 2, 2008
7 out of 7 found this review helpful
Dr. Pisani is a rarity in that she is a scientist who can write! She is a former journalist turned epidemiologist (aka "epi")working in AIDs research amd prevention. Her book will interest not just those readers concerned with AIDs, but anyone who wants to understand the effect politicians and bureaucrats and competing NGOs(Non-government orgaizaions) have on public health. Often only scientists and academics can grasp the process and explanation of scientific research. Dr. Pisani explains it so clearly that the general reader will understand as well. However, she hasn't "dumbed down' the scientific research process and data analysis. Through out this excellent book she shows a deep respect for the intelligence of her reader. No matter what opinion someone has regarding AIDs and its victims, this book will help improve understanding of the disease, its transmissions, the risks of being infected, and how its spread could be stopped. The title may be shocking, but sometimes it take a shock to get many of us to pay attention. Buy this book! Once you start reading you will not put it down until you reach the final page!
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