The Bookseller to the Stars Vs. Elizabeth Pisani

One of the most daring and socially-essential books of this year is ‘The Wisdom of Whores’ by Elizabeth Pisani, of which I was lucky enough to attend her launch recently. In her book, she talks about sex in a wonderfully frank and exciting way, not unlike a Kim Cattrall, Sex and the City monologue which is so wholeheartedly refreshing in the same way from a female author, and especially a non-fiction one at that. Plus, you know what we are like here by now, any excuse to talk about sex.

The book is like a female Michael Moore’s account of public health and the politics of ignorance and saving face that unfortunately rides hand in hand with life-ending, infectious disease. There’s lots of jargon and figures and percentages and it does all put your head into a spin to a certain extent, but it is really just an example of how bureaucratic and unnecessary it has all got. But as we know with war, it’s not about many people you kill, it’s how much money you can make re-building your country after the tragedy.

Brilliantly witty and honest. I’d trust her with my country’s outbreak any day. I caught up with the author recently (fresh off the Hay Festival experience) for a little QA action, but first here’s ya synoppy:

Elizabeth Pisani has spent ten years working as a scientist in the bloated AIDS industry.

In "The Wisdom of Whores", she unfolds a universe of brothels and bureaucracies, of bickering junkies and squabbling charities, of men who sell sex and men who would rather prohibit it.
Illustrating solid science with ribald tales from the frontlines of sex and drugs, "The Wisdom of Whores" explains how we could shut down HIV everywhere except sub-Saharan Africa. We could do it with a few, simple steps. We could do it with less money than we already have. But we won't. This book shows how politics, ideology and money - lots of money, ten billion dollars a year - have bulldozed through scientific evidence and common sense. The consequences of our global hypocrisy are tragic. Over 70 million people have been infected with HIV. We know how to stop the virus. But instead of doing what is needed, governments continue to squander taxpayer's money on feel-good programmes that make no difference.

Like "Freakonomics", "The Wisdom of Whores" makes a complex discipline fascinating. Like "Liar's Poker", it provides a riveting insider's view of an industry. It's both a brave, campaigning book that will save lives and change policy on; and a fantastic read, written with passion, wit and integrity.

BTTS: Why is sex such a taboo subject and why do people find it so hard to talk about it?

EP: This is a whole book in its own right. The feminist riff would probably hold that the taboo was created in part because men wanted to control reproduction. Finding it hard to talk about it is a vicious circle. Because it's a taboo people don't talk about it. Because people don't talk about it, everyone worries that their own experience is somehow aberrant: (how come I'd rather read a book than have sex? how can I tell if she's come?), and that makes them even more reluctant to talk about it. Interestingly there is far, far more willingness to talk about it among gay men -- I wonder if that isn't because of role switching -- both partners can take the same roles in sex and that establishes some common ground for discussion.

BTTS: The details and extent of your experience within your field must really do wonders for your libido. Didn't any of this ...put you off?

EP: No. Like most people in the field (including most sex workers) I have the ability to separate work from the personal. Though it did reduce my chances, simply because I spent so long hanging out in places where I was unlikely to be bumping in to the sort of person I might have sex with.

BTTS: It seems to me that the main problem holding back prevention, and even treatment to a certain extent, is the stigma attached to being infected. Is half the battle getting a better understanding out there?

EP: That is a really, really complex issue. I am very unfashionable, but I believe that to a certain extent, stigma can work quite well as a prevention tool (look at smoking). The trick is being able to distinguish between stigmatising the risk behaviours (eg the smoking, the trawling around bars and fucking six guys in a night) and the people who have previously engaged in those risks (eg the person with cancer, the person with HIV).

We've quite rightly bent over backwards to avoid reinforcing stigma against those infected. But one of the consequences of that is that we now have a hard time stigmatising the behaviours. And if we want prevention to work, we need people to believe that those behaviours are something that should be avoided.

BTTS: I can see how that is though. People my age grew up with this extreme sense of fear that (in my case, trickled down into the playground) and I wonder whether the tactics of scare mongering that resulted in the initial awareness campaigns of the 80s were actually more counter productive than they first intended?

EP: As above. Actually, the blanket scaremongering worked pretty well for a while. But it wasn't focused on those who were most at risk. One of the problems with making everyone fearful is that it then becomes difficult to go back to more targeted messages. "If you're straight, you don't have to worry too much about AIDS, but if you're a gay guy, you need to use a condom every time" is a really hard sell.

BTTS: You bring up that most are more interested in treatment than prevention. Is this because our nanny state has made us both lazy and inherently complacent when it comes to our health?

EP: No I don't think so. I think it's part of the human condition to not worry about things until they go wrong, then want to fix them immediately, rather than to think ahead about preventing things going wrong in the first place. It's also largely political: you'll never lose votes for building hospitals and giving medicine to sick people. You'll rarely gain votes by investing public money in helping prostitutes, gay men and junkies have sex/shoot up more safely.

BTTS: It's nice to hear that foreplay is an essential in the fight against infection. Tell us more about that?

EP: Lubrication is an important part of keeping sex safe, because it reduces the likelihood of tears and abrasions which can open the door for the virus to get out of one body and into another. Good foreplay stimulates vaginal lubrication in women, especially pre-menopausal women. After that, or if you're having sex with someone that doesn't turn you on or with several people in quick succession (as some sex workers do), you want to be using lube even if you're getting the foreplay. And since the anus doesn't lubricate itself, you want to be using lube there, no matter how much foreplay there is.

BTTS: Robert Mugabe is kinda current in the news. How has his legacy affected his country and Africa to a wider extent?

EP: Oh don't get me started. Just to stay on topic, one thing he does is illustrate really perfectly, something that I call the Public Health Fallacy. A lot of worthy do-gooders like me want to "save the world" by doing cheap, sensible things that will prevent a lot of nasty, expensive diseases. We storm around with reams of good research proving how easy it is to do these things and badger governments to get going on it. And we can't understand why they won't. That's because worthy do-gooders believe the Public Health Fallacy: they believe that governments exist to do the greatest good for the greatest number of people. And it's just not true in many countries.

Robert Mugabe is an extreme example of a government that exists only to perpetuate itself in power. He will cling on to the end, and he doesn't care how many Zimbabwean children, parents, grandparents he takes down with him. I will say, though, that he's been quite good for HIV, because he's destroyed the economy so completely that men can't afford to entertain more than one woman.

BTTS: How is the African argument that condoms actively cause AIDS even taken seriously? What is their logic behind that?

EP: It's actually perpetuated by some very evil people in the Catholic Church; the most evil of them died last week and not many tears were shed in my world. There's no logic behind it, only ideology. Catholics don't want people to use contraception. By calling into question the effectiveness of condoms, the reduce the likelihood that they'll get used.

BTTS: There seems to be a growing feeling that the Church and society's pressures to only have one sexual partner and put a shameful limit on one's pleasure is an outdated state of mind. Are you a supporter of monogamy and abstinence in the West or has your work made you think otherwise?

EP: I believe that everyone should be able to choose to have sex (or not have it) when they want, with whom they want. I think that it is wise to take the views of your sex partners into account when making these choices. If you're a natural slut and know you're never going to stick to one partner, don't have sex with someone who believes very strongly in monogamy. Conversely if you are really after a settled relationship with just one person, try not to pick up someone married in a bar. I also think that you should be responsible for yourself -- avoid getting or passing on sexual infections (including pregnancy, unless you've both decided otherwise). If you enjoy sex, go for it. But I would apply the first rule of public health to sex as well: "First, do no harm".

BTTS: Thanks Elizabeth.



Elizabeth’s book, ‘The Wisdom of Whores’ (published by Granta) is in the shops now. She has a great blog where you can here more arguments and also here opinion on the very latest news (daily) on this subject. Steve Jones (no, not the gurning twat from T4 or the guitarist from The Sex Pistols) reviews the book in The Telegraph.