The Business of AIDS

In southern Africa, the most dangerous thing an uninfected man can do is get married. Elizabeth Pisani explains why, and debunks other conventional wisdom about HIV and AIDS. Pisani is an epidemiologist and the author of “The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS.” She spoke with New America Media editor and UpFront host Sandip Roy.

The numbers of reported AIDS patients were recently dramatically downsized for different countries. Why was this?

Downsizing the numbers was actually related to getting better data, particularly in India, the second most populous country. Small differences there can make very big differences in the numbers. The data is improving, and so they’re getting better estimates.

The World Health Organization’s department of HIV/AIDS also said there would be no generalized epidemic of AIDS in the heterosexual population outside of Africa, so there wouldn’t be a big, ticking time bomb in China.

We now know that HIV is not going to rage through the general populations of any continent outside of sub-Saharan Africa. Frankly, we’ve known that for 10 years or more, but we haven’t been able to say so because there are huge vested interests in keeping people worried. We have to face the fact that it’s essentially concentrated among men who have sex with one another, among people who buy and sell sex and among people who inject drugs.

None of which are popular government constituencies.

Exactly. Unless we can pretend it’s going to affect innocent women and babies, it’s very difficult to get governments to take an interest. That’s one side of the story. The other is that if it’s not everybody’s problem, then UN agencies, NGOs or government agencies that don’t want to deal with sex and drugs, can’t get a crack at that huge and ballooning AIDS funding.

In cities like San Francisco and New York, activists, gay men mostly, really forced the establishment to pay attention to the disease. But you’re suggesting that it has also created its own brand of orthodoxies that have been exported around the world and don’t necessarily fit the way HIV is spreading in different parts of the world.

That’s exactly right. One of the things that activists did was they forced governments to take it seriously. They also turned it into an issue of individual rights, and the rights of people who may be in marginalized communities.

How was it different for someone getting diagnosed with HIV in the 1980s compared to today?

In the mid 1980s, an HIV diagnosis was like having ‘wicked person’ branded across your forehead. It meant that you were quite likely to lose your insurance, your job, possibly be thrown out of your family, rejected by your friends and there was not a single thing we could for you, because there was no treatment.

Today, we have quite effective treatment in much of the world. So the idea that we shouldn’t test people unless they specifically ask to be tested is one that we now call into question.

So what is the message we are giving people today?

We’re really giving people mixed messages. We’re saying, ‘Don’t worry, HIV’s completely normal, you can live healthfully with it for many years.’ But on the other hand we’re saying, ‘Don’t worry, if we test you, you don’t have to tell anyone, and it can be a big secret.”

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