The wisdom of whores

More on the way political correctness has corrupted the world's fight against AIDS. Here's a review of Elizabeth Pisani's new book "The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS," which is about how the worldwide AIDS bureaucracy throws money at populations who really aren't at risk. From the review:

How then to explain the "massive in-your-face failure of the HIV industry", as Elizabeth Pisani describes it, with 30 million people infected worldwide, two million deaths and a similar number of new infections (7,000 a day) last year alone? "It might have been even worse without our efforts," she writes, "though it is hard to see how it could be."

Ms Pisani should know better than most, having spent the best part of ten years within "the industry". As such her analysis inevitably extends beyond the practicalities of HIV prevention to touch on matters of more universal significance, confirming, regrettably, the common prejudice that the corruption and incompetence of international aid agencies are a major impediment to solving the problems that are ostensibly their raison d'être.

Her account begins in the mid-1990s when, recently recruited to UNAIDS, she finds her task is to "talk up" the threat posed by HIV into a potential pandemic, the better to galvanise the rich donor countries to increase their funding for its programmes. This has the desired effect, but her own reality check comes when, seconded to Jakarta, she encounters (and vividly relates) the bizarre subculture of the transsexual waria epitomised by Fuad, "a self-proclaimed heterosexual guy who has unpaid sex with a woman who sells sex to other men, while himself also selling sex to men and buying it from transgendered sex workers". Fuad may have pushed most "high-risk" buttons for HIV infection, yet "he didn't fit into a single one of our boxes". And therein lies the key to it all - recognising who in any particular society is having sex with whom, and how, and doing something about it.

That should not be too difficult. Indeed, the two countries that have pursued this approach, Thailand and Uganda, have been spectacularly successful in containing the spread of the virus. In the early 1990s, the Thai government, recognising the threat posed to its flourishing sex industry, imposed a mandatory 100 per cent condom-use edict on brothel owners, with the threat that any transgression would result in immediate closure. By contrast, in Uganda HIV was spread by (a lot) of unpaid sex where "plenty of women are having sex with people other than their husbands". Here, the universal distribution of condoms alone could never be effective without a major shift of sexual mores in favour of exclusively monogamous relationships.

But where Thailand and Uganda have led, international aid agencies have refused to follow. Fearful of being labelled judgemental or racist, Pisani claims, they would rather blame the epidemic on "poverty and underdevelopment" and devise ineffectual education programmes directed at the general population.

According to Theodore Dalrymple's favorable review of the book:

She thinks that two great forces have distorted international attempts to control the AIDS epidemic in Africa and Asia: political correctness and religious fundamentalism. Political correctness has inhibited unequivocal official recognition that AIDS is spread by certain sexual practices and the injection of drugs, which means that efforts at prevention are often directed at people who are not at risk in the first place, while neglecting those who are. Religious fundamentalism has prevented or obstructed practical solutions, such as the distribution of condoms, in favour of utopian goals such as sexual abstinence.

Turns out Pisani has a website and a blog for the book. It's well worth checking out. She is not, I hasten to say, any sort of conservative (she wishes Bishop Gene Robinson congrats for civilly marrying his male partner, for example). But she's hard on the politically correct minions of the AIDS establishment. Here, for example...