The AIDS-research merry-go-round

Bureaucrats, Brothels
and the Business of AIDS

By Elizabeth Pisani

W.W. Norton. 372 pp. $29.95

Why don't we know more about the world?

Here's a simple answer: Wonderful writers aren't where they should be.

That is, in banks, hospitals, factories, amusement parks, hair salons, racetracks, car washes, delicatessens - explaining their peculiar institutions to the rest of us.

Most writers hang out with other writers: in MFA programs or book clubs, in newspaper and magazine offices, at readings, blogger conventions, and hip-looking cafes.

If mainly literary, they blather too much about writers trying to write, or domestic scenarios so dull any self-respecting plot would refuse to be identified with them.

If journalistic by bent, they gravitate like robots to standard beats such as politics, business or sports.

Then, on top of the writer-maldistribution problem, there's the hitch that self-anointment as a writer doesn't make you a good one. Most self-proclaimed writers, like self-proclaimed singers, are bad at what they do.

You see? It's a wonder we know anything about anything.

A hearty welcome, then, to Elizabeth Pisani, holder of a Ph.D. in epidemiology, who perfectly incarnates the link that should exist between writers and the world.

The Wisdom of Whores

, her rollicking, eye-opening, hilarious account of the underbelly of international AIDS research, awaits the Hollywood producer smart enough to make it into a Brangelina vehicle.

Pisani began with a leg up. She's a former Reuters reporter in Asia who retooled herself into an infectious-diseases specialist. Having grown "tired of trying to reduce human experience to 600 words on a two-hour deadline," she decided to leave the gung-ho foreign correspondence to her future husband, also a Reuters reporter.

But Pisani still exhibits the chops of a wire-service veteran, topped by a wry voice and the irreverent style of a '60s New Journalist. Forget everything you've ever gleaned from boilerplate stories about AIDS research:

The Wisdom of Whores

vibrates with "I've been there" authenticity.

Epidemiology, Pisani explains at the outset, is "the study of how diseases spread in a population," but, like all science, it's much, much more: "a world of money and votes, a world of medical enquiry and lobbyists, of pharmaceutical manufacturing and environmental activism and religions and political ideologies. ... "

As she "lounged in the library's leather armchairs" during her graduate-school makeover, an idea kept gnawing at her: that "we could save more lives with good science if we spent less time worrying about publishing the perfect paper and more time lobbying, more time schmoozing the press, more time speaking in the language that voters and politicians understand."

"If we behaved more," she quips, "like Big Tobacco."

She opted for "the issue that makes politicians most squeamish" - AIDS - and the "AIDS industry itself, a world where byzantine international bureaucracies fight turf battles with one another. ... A world where money eclipses truth."

Starting in the safe environs of UNAIDS in Geneva, Pisani and colleagues "wrote guidelines and toolkits, manuals and handbooks, instructing people how to measure their epidemics better."

Along the way, she learned how "all those health statistics you see in your newspapers every day" make things look simple, but are "boiled up out of cauldrons of uncertainty, of best guesses, of spilled samples, of errors corrected on the fly."

In addition, Pisani confides, AIDS researchers frequently find themselves having to "walk the tightrope" between rival messages: "It just gets worse and worse" and "We know how to stop this thing."

Pisani's passages on Geneva's international AIDS bureaucracy in the early '90s bristle with spiky tone and tactile detail: "The sober WHO [World Health Organization] lifers with whom we shared our corridors must have been startled by UNAIDS staff with nose rings and Jean-Paul Gaultier shirts, running around and yelling, 'I'm coming, I'm coming. But I can't find the anal sex stuff.' "

Soon Pisani is off to Indonesia and what epidemiologists call "surveillance" work: tracking how a disease actually spreads, though she lacked experience at the job ("Like so many 'experts' the world over," she says, "I was going to have to fake it").

Her portraits there and later in the book of colleagues and sources in the international AIDS industry bring flesh-and-blood concreteness - emphasis on "blood" - to a world we largely view through statistics.

Yet for all the lively color in her prose, and her acknowledgment that AIDS workers occasionally "beat up" truth to make the epidemic scarier and thereby shake loose money, Pisani regularly reminds us that the whole industry truly seeks to battle a terrible illness with effective programs.

In line with that, the always serious core of

The Wisdom of Whores

offers plenty of useful information and policy thinking about AIDS. Science, Pisani asserts (while endorsing clean-needle programs and other strategies), "rather than ideology, religion or the self-interest of bloated institutions," should "dictate what we do about HIV."

The book's title highlights a theme Pisani emphasizes throughout: Workers in a specific locale know much more about AIDS transmission and how to combat it than bureaucrats back in Old Europe, who try to squeeze the whole world into "an organizational chart of boxes and arrows." It also implies that AIDS researchers and government officials can pick up some street moxie from the people they encounter.

In one lively tale midway through the book, Pisani races through Jakarta at 3 a.m. on her motorbike, rushing 41 iced blood samples from a grubby gay disco to a lab. She hits a police roadblock and thinks: "The cops want evidence of drug-related activity and I am carrying forty-one used syringes."

The cops impound her cooler, telling her she can pay a "fine" (read "bribe") and pick it up the next day.

Pisani, knowing the samples won't keep, thinks fast. She fishes out "a handful of latex gloves" and offers them to the police, explaining that they'll need to be extraordinarily careful in handling "HIV-infected blood."

The police hand the samples back and allow Pisani to go on her way.

Join her on the much longer trip here. AIDS may be no hoot, but Pisani's book, remarkably, is.