Savvy epidemiologist Pisani takes an eye-opening look at who gets AIDS how, when and where.
The “how” hasn’t changed: HIV infects via the exchange of body fluids in sex, in transfusions and contaminated needles and from mother to infant in birth or breast milk. But the author’s revelations are startling. In the course of developing surveys and collecting blood samples to get an accurate reading of HIV prevalence in Southeast Asia, Pisani got to know the prostitutes, pimps, brothel owners, gays, rent boys, drug injectors and a class of transvestites (with or without genital surgery) called waria, as well as their clients. She discovered that some men and boys who consider themselves straight sell sex to other men, that whores sometimes use condoms with their johns but never with their pimps or boyfriends, that drug injectors also buy sex and have girlfriends who may also be prostitutes, that waria have loving “husbands.” All those questionnaires with check-off boxes to distinguish one high-risk group from one another just don’t make any sense, she concludes. Pisani paints likable portraits of many of the contacts she made as she explored the dives and street scenes in major cities. The whores are not actually very wise, she admits, but neither are the donors and administrators of government programs who demand abstinence, oppose family planning, think they can create a drug-free world and often operate in ignorance of what other groups are doing. A further dilemma goes to the heart of AIDS stigma. People give money to forestall the epidemic infection of all those innocent wives and children, but Pisani makes it clear that they are not the most vulnerable, at least on the turf she has covered (Africa is different). She argues that the money ought to go to needle-exchange programs, condom promotion and other preventives.
Delivers a strong, well-told and believable message—would that it makes a difference.