When in medical school, I found myself drawn to the study of infectious diseases in large part because of the mixture of science and anthropology – infectious diseases are always about the way we interact with the world around us, what we do with whom and when and where and how often. Take the recent examples of the global spread of pandemic influenza (a respiratory virus spread in the air) and the epidemic of cholera in Haiti (which depends on lack of access to clean water to spread), and how in each case the spread of the infection says something about the world and the ways in which the world’s population is connected. Now, the most important infection of our time is HIV, and its predominant modes of transmission are particularly complicated and culturally loaded human behaviors: sex and intravenous drug use.
In her engaging, informative, and fun book, The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS (Norton, 2008), Elizabeth Pisani draws on her experiences doing field work as an epidemiologist in Indonesia and on staff at UN AIDS, the joint United Nations Program on HIV/AIDS, during the time when the world was coming to grips with the fact of an exploding global epidemic of HIV. If you want to design effective interventions, you have to understand exactly who and what those interventions should target. But how easy is it to figure out who has sex with whom and when and where and how often? Or who injects drugs and shares needles? Doing so is loaded with pitfalls, and Elizabeth lays them out for us, exploring how preconceptions, ignorance, and technical problems can cloud our ability to see what’s really happening, to interpret what we see, and, most importantly, to figure out effective ways to intervene. She reminds us that what’s true for Jersey may be completely false in Jakarta. And, on top of all that, how do you convince the people who hold the purse-strings to pay for everything? These are fascinating problems and we thank Elizabeth for sharing her expert insights.
Elizabeth’s blog and website, The Wisdom of Whores, is also a great source of news and ideas in the world of HIV/AIDS and much else.