Back in 1985 I was an inpatient at a drug rehab in the West Country and had genital warts that required regular and painful treatments.
Each week I went to the STD clinic at the nearby hospital, where a middle-aged consultant applied an acidic preparation to the glans of my penis. One day, while he was actually holding the afflicted portion, he remarked — quite casually — that the best way to rid the country of HIV/Aids would be to “castrate all you junkies — and the queers, too”.
You didn’t need to have a well-developed persecution complex — which I did, anyway — not to find this a little aggressive.
At the time, Aids was the nasty new kid on the infectious diseases block; the first few cases had appeared in England, but those of us in the high-risk groups could already see the battle lines being drawn across the Atlantic: the blameless sheep with “good” Aids — haemophiliacs, faithful heterosexual partners — being sectioned off from those with “bad” Aids — gay men, IV drug users, prostitutes — and the field day that the so-called “moral majority” were having.
I’d already been tested for Aids a year earlier when I’d been in hospital and, so far as I knew, I was HIV negative. Perhaps because of some early hard-drubbing into me of the basic facts about hygiene, or possibly because — in this aspect of my malady, at least — I was less chaotic than my peers, I was never a big sharer of needles. Needless to say, although I can only think of two or three occasions when I did so, of the five other people involved, two are now dead, while the other three may not have Aids but did contract the almost as nasty hepatitis C.
Elizabeth Pisani’s thoughtful and necessary book, at some length, and by following her own picaresque journey through the international Aids prevention industry, explains the evolved consequences of experiences I’ve limned in above. The message of her book is simple: no matter how much money the global community (another priceless oxymoron) chooses to throw at stopping this killer disease, entrenched attitudes — and practices — will ensure that the spectre of “slim”, as it’s known in sub-Saharan Africa, just keeps getting fatter and fatter, as the virus gorges on human life.
When Pisani — a journalist initially — became interested in epidemiology, qualified, then began working in the Aids field, the big battle was to secure funding for prevention campaigns. In part because of the chronic wonkery of the UN, in part because of the activism of the US gay community — vital as it was at the time — but mostly because of the practices that spread the disease, and their unacceptability to the Jerry Falwells of this world (and, presumably, the next), the most obvious and practicable ways of stemming the epidemic were neglected.
Instead we were given campaigns like the Thatcher government’s countrywide mailshot, warning maiden aunts in the Cotswolds not to “die of ignorance”, when the truth was that if public health had been managed effectively, they could’ve died happily ignorant of what Aids was at all. Apart from in sub-Saharan Africa — where, as Pisani plainly states, sexual mores have allowed for rapid transmission through the heterosexual population — your chances of contracting HIV/Aids remain small, unless you are an IV drug user, a prostitute or engage in anal sex.
But as Aids, because of the African epidemic, moved up the agenda of righteousness, and precisely those “moralists” who were happy for whores, queers and junkies to be shovelled out with the rest of the trash seized upon the new “good” sufferers as worthy aid recipients, so their entrenched attitudes ensured that their efforts were as useless as a condom that looks like a colander — because condoms is where it’s all at; condoms and clean needles. US government aid is not only tied to programmes that Bush and his fundamentalist backers approve of, but the recipient governments and NGOs must spend that money on anti-retroviral drugs, needles and condoms made in America.
As Pisani so elegantly establishes, this is the public health equivalent of burning taxpayers’ money in a brazier and magically expecting people on the other side of the world not to contract the virus.
It is, though, only the most glaring example of the waste, profligacy and wrong-headedness that undermines the worldwide effort to curtail a disease the transmission of which is — compared with TB, or cholera, or flu for that matter — relatively easily to guard against.
Pisani’s training as an epidemiologist leads her to commonsense conclusions — which is not to dismiss the hard, committed work she did establishing HIV/Aids prevalence across Asia, or campaigning for funding to fight its spread.
Nevertheless, it turns out that the consultant burning my warts and talking eugenics was on the money all along. He may not have expressed himself sensitively or humanely, but completely curtailing the sexual — and injecting — activity of gay men, drug users and prostitutes would certainly put the mockers on the epidemic; short of that, there are free condoms — with incentives to use them — and free sterile needles.
You can feel Pisani’s frustration as she details the idiotic lengths politicians will go to in order not to be seen to endorse the practices that pass the virus on. The provision of needle exchanges in British prisons is one obvious way of stopping them being Aids factories — and a complete political no-no.
But, I ask Pisani, weren’t things ever thus? When it comes to Aids, polio or diphtheria are not the relevant comparisons — it’s syphilis. Nothing is rational when it comes to sex, and everything really goes tits-ups when you throw drugs into the mix. Pisani isn’t exactly jolly-hockey-sticks but she’s still a ewe when it comes to Aids; unfortunately, it was already clear back in the mid-1980s, to those of us who were in high-risk groups, that this is a ram’s world.
The Wisdom of Whores is published by Granta at £17.99