The Wisdom of Whores

14 08 2009

(Book Review)

The Wisdom of Whores, bureaucrats, brothels and the business of AIDS, by Elizabeth Pisani, 2008

No two words can capture a reader’s attention as effectively as the words free and sex. I think the word whores should be added to the list. The title of Elisabeth Pisani’s book is more focused on grabbing a reader’s attention than in it about the wisdom of whores, bureaucrats, brothels or the business of AIDS. But once you do start to read it: the book is an interesting and easy study, albeit a little repetitive.

Based on her experiences working as an epidemiologist and consultant to FHI and UNAIDS among others, her book encourages policy makers and programmers to take a closer look at what works and what does not, in the fight against AIDS and to base interventions on scientific research and evidence. She encourages leadership within governments and in UN to take on the tough issues, the unpopular issues, even though they won’t get them the votes.  Experience has shown that a few key actions have been successful in preventing the spread of HIV in the region and these should be the priority for action.

For those working in the field, her messages are nothing new: harm reduction works, particularly in prison settings, abstinence programmes are a waste of money, preventing HIV transmission among sex workers and their clients is the best way of preventing the spread of the virus to the general population and that Asia will not face a generalized epidemic like the one in Africa.

However she does touch upon a few interesting issues such as the effectiveness of peer based education and outreach programmes; they don’t always work, especially among groups of sex workers who are actually in competition with one another rather than part of a community. Peer based outreach works best among communities who consider themselves part of a collective, like the gay (and lesbian) brotherhood. Her description of and interaction with the waria community in Indonesia is also interesting and strikingly similar to the Hijra community in India. Waria, a term for transgender people is derived from the words wanita (woman) and pria (man). Many waria sell sex for a living, mainly because of the high stigma against them and the limited job options open to transgendered people. As long as society looks down on such persons, they will have limited livelihood options, and they will continue to sell sex to survive. One cannot address HIV without looking at this aspect of society as well.

However, The book is contentious on some counts: Firstly, the author believes that women are not trafficked into sex work. While I believe this to be true to some extent, one cannot ignore the fact that in south Asia, many minor girls are trafficked into sex work. In fact globally, an estimated 800,000 people are trafficked each year, of which women account for 80%. Of this 80 % over one fourth are minor girls. Majority of women and girls are trafficked for sex making them increasingly vulnerable to HIV; and the younger they are the more vulnerable. Those who continue to stay in sex work by choice when adults, is a different issue, but the number of young girls being trafficked into sex work is real.  Further studies such as one by J Silverman[1], on HIV Prevalence and Predictors Among Rescued Sex-Trafficked Women and Girls in Mumbai, India, it was found that the mean age of girls trafficked into sex work from Nepal to India had fallen from 14-16 years old in 1986 to 10-14 years old in 1997. Of these, the younger they are, the more vulnerable they are to HIV with 60% prevalenace amoung rescued sex trafficked Nepalese girls and women aged 7-14years compared with 31% prevalence amoung the 18-32 age group.

Secondly, Yes HIV is a health issue, but it is also a development issue and it is fuelled by poverty and inequality. Unless these foundations change, unless the way men and women relate to one another change, HIV is not likely to disappear. By introducing HIV and sex education into school curriculums, this change in gender norms and the foundations of the relationship between men and women is being challenged. It may not help prevent new HIV infections in the short term, but it is a long term investment in society and particularly in women: so what if it is using HIV money. After all, there is money in HIV unlike in women’s health, maternal mortality or women’s sexuality.

Yes there is big money in HIV and we are constantly reminded of this in the book. The money may be a little less than there was a few years ago, but still there is money. Along with money comes the corruption, the under hand deals and kick backs. But this is true of any sector, not just HIV.

I can’t help thinking that the book is a westerner’s perspective of an issue meant for western readers, and any persons referred to as experts are also of that genre; with the expertise of the region edited out. As a South Asian working on HIV in the region, I have seen my fair share of western experts, most overrated and over paid, fly in for a few days, do their “magic” and write up reports that have no relevance to the complex reality of the region. The other big mistake is to generalize one Asian country’s experience to apply for the rest. Her main perspective of Asia comes from Indonesia and I would be cautious in generalizing the Indonesian experience to apply to the sub continent.

Although the wisdom of whores isn’t really their wisdom, but rather an interpretation of the lessons the author has learnt from travels in the region and interaction with marginalized communities, for someone who has not worked in HIV, the book comes across as an eye-opener and is worth a read. Full of politically incorrect words such as whores and drug addicts, the books is written in a popular anecdotal style with easy to understand language that a non development professional can easily relate to, pick up and enjoy.

If you work in HIV however, be warned – it may irritate you.  Not only could it have said exactly the same thing in less than half the length, but you may also land up feeling like me: a little patronized.

[1] HIV Prevalence and Predictors Among Rescued Sex-Trafficked Women and Girls in Mumbai, India, Jay G. Silverman, PhD,* Michele R. Decker, MPH,* Jhumka Gupta, MPH,* Ayonija Maheshwari, MD, MPH,† Vipul Patel,‡ and Anita Raj, PhD§



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