The Wisdom of Whores, by Elizabeth Pisani

Sex, lies and Aids prevention
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There are many things to like about this book, beginning with the title. The Wisdom of Whores is racy enough to make one pause before flashing it around on the Tube. The press release is similarly direct: "This is a book about sex and drugs," it says, and the contents do not disappoint. I have seldom read at such length and in such graphic detail about the sexual practices of junkies, prostitutes, transvestites, and clients, some of which were hard to comprehend. (Double anal sex? Foreskin soup? Really?).

Written by a former Reuters reporter turned epidemiologist, it powers along at a breakneck pace, leading the reader on a crazy tour of brothels and pick-up joints, massage parlours and gay clubs from Nairobi to Jakarta, by way of Thailand and Hong Kong. Wherever Elizabeth Pisani has found herself over the past couple of decades she appears irresistibly drawn to the underworld of pimps and whores, dealers and users, who have helped incubate the Aids epidemic.

She has a writer's eye for lurid detail and a reporter's curiosity that has led her into encounters with a gallery of exotics – Waria (transvestites) in Jakarta's slums, with flowing hair and painted nails, who flash their penises as readily as their purses; prostitutes who turn tricks for a bottle of perfume or a ride in a Mercedes, and drug abusers, who have the highest level of HIV infection, and the lowest level of condom use, in all Asia.

Her pursuit of the sexually extreme and her fluent prose makes for an absorbing read, even for one who has spent 20 years reporting on Aids. The blurb describes it as an "urgent and entertaining book", and it is unquestionably both.

Alongside her accounts of seamy, and steamy, sexual practices runs a parallel narrative about her work for various Aids agencies, trying to gather accurate figures on the epidemic, and understand what drives it – which behaviours practised by whom, with whom, how often and in what context.

Here she usefully punctures a few myths. For example, an increase in pre-marital sex does not necessarily increase the risk of Aids – contrary to the conviction of the American right – and may actually reduce it. This is what happened in Thailand, when young men who had been accustomed to visit prostitutes (high risk) found increasingly liberal attitudes among young Thai women to sex meant their advances were more often successful (low risk) so they no longer needed to visit prostitutes.

She explains well, too, how the wall of money that has moved into Aids treatment over the past decade has created a feeding frenzy among organisations competing to grab a slice – and may end up fuelling the epidemic by creating a larger pool of infected people able to transmit the virus. This is not an argument for denying treatment, though it does raise difficult questions about opportunity costs, but it is an argument for re-doubling efforts on prevention.

And it is on prevention that she delivers her cry of anguish. Why, despite 25 years of blood, sweat and tears by thousands of committed workers such as herself and the expenditure of billions of dollars, has the world failed so utterly to curb the spread of the epidemic? Especially when we have the tools – condoms and clean needles.

It ought to be so simple – if they were used reliably, there would be no epidemic. Pisani blames the failure on ideology and politics. Both have undoubtedly played a role – from George Bush's insistence on abstinence programmes to Thabo Mbeki's denial that HIV was the cause of Aids. But Pisani is a victim of her own ideology in insisting she alone has a clear vision of what needs to be done and others have failed to grasp the essential truth about Aids.

Her deeply egocentric and simplistic analysis fails to take account of the political, social and human complexities of the epidemic. If we cannot persuade people to throw away their cigarettes to defend themselves against lung cancer, to protect their children with bed nets from malaria, to reduce the carnage on the roads by driving their cars less recklessly, how much more difficult is it going to be to persuade them to change their sexual habits, bound up as they are with deeply instinctual, cultural and hormonal drives?

In Pisani's world, you only have to want something enough to make it happen. Human frailty is not a problem. Political, economic, cultural and religious pressures – all these are swept aside. If we flooded the world with condoms and clean needles and exhortations to use them, the epidemic would be over. Problem solved.

As an extended piece of rhetoric, her book has freshness, charm and innocence, reminding us of the core elements that remain at the heart of this epidemic. But its attempt to provide, as the blurb says, "a clear-sighted analysis of where we have gone wrong" is hopelessly unsatisfactory. It tells us a lot about whores but, sadly, contains very little wisdom.

Jeremy Laurance is health editor of 'The Independent'