Wednesday, March 4, 2009

The Wisdom of Hacks

When a journalist goes 'in search' of a story, would it be more correct to say that they know what they want to write about but that they need a bit of scenery? Elizabeth Pisani seems to want to find stigma everywhere that she 'researched' her article (or is it a review?), so she just adds the word in at every opportunity. But had she bothered to read through her own article, she would have found stigma aplenty.

Pisani doesn't just write about stigma, she also stigmatises people with HIV, people she considers to be prostitutes and whores, gay men, anyone who has or may one day be infected with HIV. In her time as a journalist, has she never heard that people who have sex with other people are human beings, not whores or prostitutes? Did she never come across human beings in her career as a human being, journalist or epidemiologist?

Yes, she claims to have studied and worked in epidemiology. But don't worry, there is barely a hint of data or scientific reasoning in this article. It's all prejudice and gutter press cant. Where she didn't find the stigma she craved, she certainly left some behind on her way out. And brought some back home with her as well.

But did Pisani ask the woman she was talking to if she was a 'prostitute'? Well, we don't know, but she was in a bar. Certainly in bars in Kenya and Tanzania it is often assumed that women there must be prostitutes. Like any good journalist, she didn't feel the need to leave anything traceable, checkable or testable in her article. And this journalist is not afraid to exploit human misery and, in the process, contribute to that misery.

There are many reasons for not wanting to take a HIV test, aside from fear of stigma. People don't want to find out they are ill, whether it is with something easily treatable, something that will disappear in time or something that is death threatening. It's not pleasant to find you have a virus, cancer or any other condition, regardless of the effects it may have. There's the dependence on others and on unreliable health services to consider, as well.

But people are also afraid of medical professionals, afraid of giving a blood sample or being manhandled by professionals of any kind. This is true in any country, developing or developed. But in developing countries, where most people rarely or ever see a health professional, testing for HIV can be even more traumatic.

There may be some people who don't care whether they are HIV positive or not, they may think it is inevitable that they and others around them will eventually become infected. Maybe it's all the same whether they are infected with HIV or something else, because other diseases could kill them much more quickly. People become very fatalistic when they are in desperate situations.

There are people who believe myths about testing, such as that it is harmful, that it doesn't work for certain blood types, that it always means you will be positive, etc. Where do they get these myths? Well, many of them have been well propagated by newspapers since the epidemic was first recognised. The myth about condoms having holes in them came from some priests and other religious people. The one about condoms not working very well came from American politicians. The myth about using beetroot or having a cold shower came from some South African politicians, the list is endless. If you want to research them, just look through some newspaper archives.

People may not want to take a test because it is too expensive. Ok, the test itself is free but transport to the clinic is not. If a person is found to be HIV positive the drugs are free but the transport to and from the clinic every month, or every few months, is not free. Nor are the foods, food supplements and drugs people need during the course of their treatment, which is for the rest of their lives.

I have spoken to people who were prevented from testing by circumstances they could do nothing about, such as distance from the facility, lack of funding or opportunity, etc. I have also spoken to people who have become infected through circumstances they had no control over and people who are presently in great danger of becoming infected but can't do anything about it. I find it hard to believe that Pisani never came across such people.

And what do people do about protecting themselves, testing and treatment when there is a civil disturbance, a famine, a global financial crisis or all three in the same year? Well, they just about get by. People are used to getting by or dying in the attempt.

But HIV, like malaria, TB, various cancers, intestinal parasites, malnutrition and other endemic conditions, is not pleasant, even if it is treatable. I'm sure Pisani could come up with additional reasons for not wishing to take a HIV test, aside from stigma.

She goes on to ask "Why don't people ask casual sex partners if they have HIV before they strip off?" Just imagine the scene, last thing before taking off your clothes, the person you were considering sleeping with saying, "yes, I am HIV positive". If I was facing my first chance to make a few dollars in days and had no other source of income, I don't think I would ask, nor would I answer honestly if I was HIV positive and the question arose.

Pisani (and I, for that matter) have other options, we have a source of funding for our next meals and other comforts, we are not in a desperate situation. We are probably both HIV negative as well, so the need to lie about our status is not an issue either.

A 'quality' newspaper like the Guardian (and its readers) should realise a few things that they may not learn from their journalists: people who have sex with other people are not prostitutes and whores. Most people have sex with other people, Pisani's parents had sex, even if she doesn't. All over the world people have sex, yes, even unprotected sex.

But there is not a serious HIV epidemic in every country in the world. The Western country where Pisani lives doesn't have a problem with shortages of fuel or basic food (to the extent that people's health and lives are threatened on a daily basis), there just aren't as many desperate people there. Not yet, anyhow. So there will not be such huge numbers of people coming to Western cities to find work and, not finding it, turning to transactional sex. But that is the case in Nairobi and many other African cities.

There is not the same problem of having to move to a country like Botswana to work in terrible conditions in mines for very little money, away from home and family, where men are forced to live with other men, with no entertainment or comforts for long periods of time. But these problems exist in Tanzania, South Africa, DRC and other countries.

There were no serious episodes of post election violence in Western countries recently and there were certainly no conflicts like the ones in DRC, Sudan and Somalia. Not that Western governments didn't have a part to play in those conflicts, but the disturbances didn't occur in those Western countries. There are only serious HIV epidemics in some countries in the world, yet in all countries people have sex, even (the horror!) unprotected sex.

Don't the Guardian and their readers want to know about some of the many reasons for this?

Despite her alleged background in epidemiology, Pisani seems to adhere to the Victorian prudishness about HIV that assumes and sometimes even states that it is all a matter of people having sex and behaving stupidly. So all they have to do is to behave smartly and things will be ok, right?

But people in Western countries waste more food than people in developing countries eat, that's stupid. What they can't eat, they now want to burn in their cars, that's stupid. There are enough armaments produced in the West to wipe out everyone several times over, that's stupid. Contributions to global warming by Western countries (or in developing countries on behalf of Western countries) threaten the future of humanity, that's stupid. But HIV in Western countries is not the major threat that it is in developing countries.

Pisani is right about one thing, there is a lot of stigma. But her article merely adds to this. And as long as HIV is seen as just a matter of sex and stupidity (or any other simplistic explanation), we will make little progress in preventing the spread of the virus or providing treatment for those who are infected.

There are high rates of HIV in developing countries because people there are extremely vulnerable, whether it is through poverty, poor health, lack of education, labour practices, inequality or exploitation. Vulnerable people are more directly and more immediately affected by disease, global warming, financial crises, famine, water insecurity and anything else that's going around, whether these originated among vulnerable people or not.



Marion Hose said...

Readers of this post may be interested in Elizabeth Pisani's blog ( There they will find extensive discussions of many of the objections raised here. Readers will also find details of Elizabeth Pisani's qualifications at the "About" page (

A brief perusal of the site (and of her remarkable book about HIV/AIDS and the AIDS industry (on will give a different perspective on her review of the Steinberg book.

Having read the book and her blog, I think it's safe to say that she is certainly not subject to Victorian prudishness. The book does make the point, forcefully and eloquently, that HIV is transmitted in very limited ways, and that unprotected sex is one of those ways. Sorry, but it's true. The scientific data is very clear, just being poor or hungry or illiterate will not let you contract HIV.

If we are to move out of this epidemic we must deal with the facts. Scientifically provable data does this, nothing else.


Simon said...

Hi Marion
Thank you for your email. I was not addressing Pisani's book as I have not read it. I could only judge the article on what was written there. Pisani may not suffer from Victorian prudishness but it's hard to explain her stigamatising attitude in the article in question unless it stems from some kind of prudishness.

Despite Pisani's considerable learning and her other writings which you draw attention to, the article in question is prejudiced and stigmatising and based on something other than the data that the author clearly has access to and understanding of.

My point is that most people have sex and some people have sex for money, security, power, many reasons. This does not make them prostitutes or whores, the terms that Pisani is so fond of.

Of course HIV is transmitted by sexual intercourse, in most cases, but under what circumstances does sexual intercourse take place? Are you saying that poor, starving or desperate people don't ever have to resort to sex for some benefit? I think you have never visited a developing country.

Being hungry makes you vulnerable, vulnerable to violence, unprotected sex, disease, degradation and other things.

Being illiterate makes you vulnerable because it limits your options to reduce your vulnerability and dependency on risky jobs, such as prostitution, mining and others.

Scientific data can and often is manipulated to suite those who collect it, for example, epidemiologists and journalists. But the problem with the article in question is that there is very little data and there is a lot of journalese.

I do not understand someone with the gifts you cite writing an article that wholly misrepresents the situation in developing countries. And the effect of such articles is to convince clearly gullible people like you that people in developing countries do stupid things and also that it is acceptable to refer to people as prostitutes and whores.

If you are not capable of examining scientific data, try and use a bit of human feeling and sympathy and you will realise (possibly) that only certain circumstances give rise to high levels of risk, especially risky sex, and that people like Pisani, myself and perhaps you are not driven to taking such risks.

People are human beings, not pieces of scientific data and the great thing about realising that is that it allows you to reexamine the scientific data and gain insights that have been ignored by too many people, governments and institutions.

Some of Pisani's views may be various and interesting but there are now a lot of Guardian readers who have been influenced by an article that is not based on anything but some kind of perverted need to use the plight of people in developing countries for titillation.

I find it hard to believe that someone in a position of power can take advantage of vulnerable people in this way. It is particularly reprehensible in view of the fact that she is so well educated, multitalented, rich and whatever else.

And if you want to defend her disgusting behaviour, don't hide behind a pretence of support from scientific data. Ask yourself what circumstances surround the generation of the data, the data that is not being collected and the data that cannot be collected because it is not data, it is human emotions, needs, thoughts, feelings, things that relate to the number of times one has sex, with whom, why, etc.

It's time to be a bit more critical, people's lives depend on it. said...

I am impressed by issues related to HIV in this blog from Rwanda

Siobhan Mc said...

This debate is interesting. I'm new to the subject, but beginning to work with people using a complexity science approach to modeling HIV epidemics. I've just ordered the book, to give it a fair go.

I have a big problem with the title, however. If 'the wisdom of whores' was a common metaphor I wouldn't have had to look it up & have to read the explanation on Tyler Cowen's Marginal Revolution blog. It looks like a cheap shot to get 'whore' into the title to make it sell - it wouldn't sell so well if it were just 'Bureaucrats, Brothels and the Business of AIDS'. I understand why science writers and academics try to jazz it up - cf 'Freakonomics' - it's an entertainment business after all. But selling the message shouldn't get in the way of the message, and clearly it's a fine line. I do feel uneasy at the associated marketing - e.g. the website publicising 'the buzz' surrounding the book, like it's a new band.

Secondly, the blurb and website promise that the solutions are 'simple' but face massive political obstacles. In that case, they aren't simple. People are annoyingly complex, bounded rational (which doesn't mean stupid or irrational by the way) and unfortunately generally have rights, for example, not to be tested if they don't wish to be. As someone said, democracy is the worst system of government except for all the others. Policy-makers have to work with the world as it is, rather than how they wish it were. I also noted Michael Fitzpatrick's review of the book in the Guardian with interest.

Simon said...

Hi siobhan, thanks for your comment. Complexity science for modelling HIV epidemics sounds interesting, I'd love to hear more. Modelling I've seen so far tends to simplify epidemics in order to model them.

And as for Pisani's claim that the solution to HIV is simple, it assumes that most HIV is transmitted as a result of transactional sex of some kind and this is not true for most African countries.

Pisani simultaneously trivialises HIV and stigmatises those with HIV and does this with the apparent aim of amusing people with her erudition.

Most HIV experts disagree with her analysis but as a popularising journalist, far more people will form opinions based on her articles than on more balanced articles that don't have entertainment as their sole aim.

Well, it wouldn't be the first time a journalist has confused an already difficult set of problems and made many people's jobs more difficult!
Regards S

Simon said...

Hi ebchib, thank you for the support. Hope you continue to follow HIV in Kenya. Regards S