Sex sells and Elizabeth Pisani knows
this. If you ask her she's in the 'sex and drugs' business. That
would be true, except for the fact that she's actually an
epidemiologist, who has written a fascinating - and controversial -
book on the history and politics of HIV/AIDS.
In The Wisdom Of Whores:
Bureaucrats, Brothels, And The Business Of AIDS she argues that
the Bush Administration - and, of course, the US Congress that went
along with the plan - bears a large responsibility for a continued
rise in global HIV infections.
Pisani writes that the Bush
Administration's take-it-all-or-leave-it approach to HIV/AIDS world
prevention funding - about $65 billion - leaves most of it wasted.
Governments accepting the aid cannot use it for the most effective
prevention programs – programs that specifically target the sex
industry (such as educating prostitutes and clean needle programs).
The money can only be used for promoting abstinence, an ineffective
strategy for dealing with the disease. Not only are US dollars
attached with this string, rules also stipulate that a government
accepting aid from the US for AIDS abstinence programs cannot use its
own taxpayers' money for programs that engage the sex industry .
This rule is called the Loyalty Oath. Some countries, such as
Brazil, have refused the aid altogether.
Where governments have accepted the
aid, Pisani says, the programs do little in combating the spread of
the disease. In Africa, where the disease is widespread, Bush's
policy has meant higher infections. That's because abstinence
programs reach the people least likely to contract HIV.
In fact, Pisani writes, the most
effective strategy for combating the disease is to target the people,
and their behaviors, most at risk: Gay men, prostitutes and drug
addicts. And, in fact, that's just the problem. If the risk of
heterosexual infection is small, then can governments expect the
support of the general population in funding prevention – and even
research - programs?
Pisani says the answer to that question
is no. With the exception of Africa – where, she explains,
heterosexuals have multiple simultaneous sexual partners – there is
little risk of infection in the heterosexual population. Then, what
about all the data and grim scenarios of a world pandemic?
Politics, explains Pisani. AIDS
organizations, suchs as UNAIDS, understood the need to “massage”
the information in order to make it palatable for politicians and
voters. For there to be an interest in the story, these leaders felt
there needed to be an ongoing threat to all of humanity.
Back to sex selling, then. If Pisani's
book is about anything it's about sex, sex, and sex. And the reality
on the ground - who acquires HIV and why. She argues that
white-picket fencing the problem is not helping. Pisani wants
governments to look at the disease differently: From a cultural
behavior standpoint. Honest programs that reach at-risk groups –
gay men, prostitutes, and drug addicts – would help stem the rise
of new infections.
“It would mean spending lots more of
the available money on prostitutes, addicts and gay guys, and lots
less on school kids, pregnant women and church groups,” Pisani
writes. “It would mean making fun things (sex, drugs) safer,
instead of trying to make safe things (abstinence, monogamy) fun.”