Sex. Drugs. Excel spreadsheets?

Elizabeth Pisani does it all. A journalist-turned-epidemiologist who has worked to fight HIV/AIDS all over the world, Pisani is the author of one of my favorite global health books, The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. Her book achieves that rare, wonderful thing when it comes to epidemiology: it's actually interesting.

You'll laugh (her descriptions of female condoms are laugh-out-loud funny). You'll cry (she puts a poignant, human face on the HIV statistics). And above all, it's based on sound science, which as she reveals in her book, isn't always the case when it comes to the big-bucks international HIV/AIDS industry.

She was kind enough to answer a few questions for me about her book and global HIV/AIDS policy.

Mara Gordon: To start off... What are you up to now? Your book is a wild ride that takes us from the brothels of Jakarta to the stuffy UN offices in Geneva. Where are you working? What could possibly top what you've done thus far?

Elizabeth Pisani: I'm trying to settle for a while in London, which I find wildly exotic. I've never really got over my frustration with the mis-match between the effort we put into data collection and the attention we pay to the results. If you look just at developing countries, we spend hundreds of millions on disease surveillance... and then we ignore the result... So right now I'm working with some of the big funders of health research to encourage researchers and even governments share their data. We've learned from genomics on the one hand and the open source software movement on the other that the more brains you get working on the same problem and sharing their findings, the faster you reach a solution. We ought to be able to bring that same approach to research that affects people's lives and well-being.

MG: One of the most important ideas I took away from your book was that we should stop looking at people affected by or at risk for HIV as victims. Instead, you seem to argue, if we equip people around the world with the tools, education, and resources to make healthy decisions, they often will. Why is the global health establishment so wedded to the first line of thinking? How can we change that?

EP: Do you want the polite answer, or the one I think is closer to the truth? If you want the latter, I have to preface it by saying that I love my work and most of my colleagues. But let's face it, most people don't go into public health policy work because they are by nature wild party animals who live lives of competing and highly unpredictable risk. And the pay is pretty crap, so you have to believe that most also don't do it because they have a very sophisticated understanding of the incentives that motivate a large part of humanity. You have to want to make the world a better place to be in public health, and that means that the profession attracts a higher goody-two-shoes quotient than, say, banking or drug-dealing or major league sports. A lot of people in public health are extremely rational, and extremely concerned about health. They expect other people to be rational and health-conscious too. The fact is that most of us ARE rational, but not always about our long-term health. Have really good sex right now (a dead certainty) or possibly come down with an annoying but treatable disease ten years from now, if I'm still alive. What's the rational choice?

As for how to change that, hmmm, don't know. Though I will say that the HIV epidemic itself has changed it quite a bit already, because it did bring into the field of public health a lot of people who ARE naturally party animals, or once were -- gay men and drug users and people who like sex principally but by no means exclusively. That's one of the reasons that HIV is such a fun area to work in, even though it obviously has its deeply depressing side.

In Part II of the interview, I talk with Dr. Pisani about where she thinks global HIV/AIDS funding is headed — and why we've made so many mistakes so far.

[Photo credit: JonRawlinson]