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10 Aug 2012

"You can choose not to get HIV": Elizabeth Pisani

HIV expert and author Elizabeth Pisani has been on a mission for over a decade to get policymakers to understand how real-world behaviours influence HIV transmission and to overhaul antiquated, ineffective prevention strategies. She speaks to Fridae about her work in Indonesia, trends in gay Asia, and more.

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Ask Elizabeth Pisani what she does, and she’ll tell you it’s “sex and drugs.” Specifically, she’s an epidemiologist: one of the pioneers of UNAIDS who’s worked on four continents, researching, documenting and trying to control the deadly HIV epidemic.

She’s described her work in The Wisdom of Whores, a rather brilliant book released back in 2008. It’s surprisingly funny: much of it is an eye-popping, deliciously witty account of her time working on HIV in Jakarta, hanging out with warias (Indonesian MTF transgender women), drug injectors, activists and bureaucrats. But it’s not all laughs – the book’s also terribly informative, laying out a series of damning conclusions about what worldwide AIDS organisations are doing wrong, and what could in fact be done to fix things.

Her no-nonsense attitude has got her in trouble a few times. She’s been hounded out of a Presidential press conference in Kenya and nearly been lynched at a public health presentation in New York City. Fortunately, it’s also won her some praise, as when she delivered a highly rated TED talk in 2010.

Currently based in London, the 47-year-old has also embarked on a series of voyages around Indonesia, researching her next book, in which she attempts to identify the “darah merah”, the authentic red blood that binds together the sprawling archipelago nation she loves so much. This is why I had the luck to meet the lady herself at the Makassar (Indonesia) International Writers Festival in June, where she switched effortlessly between English and Bahasa Indonesia on her panels. (She also speaks rather good Mandarin.)

As it turns out, she’s just as awesome a lady in person as she is in writing, and a good deal more potty-mouthed. She doesn’t go easy on gay men, either – she insists that we should hold ourselves accountable for the high rates of HIV prevalent in our communities.

æ: How did you get involved in HIV/AIDS advocacy?

Elizabeth: By mistake, really. I guess I happened to be in New York at an impressionable age. I was in my late teens, and it was the beginning of the AIDS crisis, and I happened to have quite a lot of gay friends, so I was extremely aware of that.

But I went away and I was a journalist and foreign correspondent for several years. And then, for several reasons too boring to relate, I found myself in a school of public health. There I discovered a great interest in the study of diseases. That was in the mid-1990s, and it was just the time when it the extent of the HIV problem in the developing world was becoming obvious. But it was also at a time when HIV was most heavily laden with the prejudices associated with the way it developed in rich countries – “the fags’ disease”, basically. Oh, throw in some junkies and maybe some hookers.

It was a political bloodbath, really, and that made it very, very interesting to me. And so having discovered the joys of epidemiology, I concentrated on this field, and got to hang out in brothels and gay bars, which is never a bad thing to do.

æ: When did you first come to Indonesia?

Elizabeth: I first came to Indonesia because I was posted here as a journalist. That was in the dawn of time, the late ‘80s – that’s giving away my age – and I really loved it.

After I finished studying epidemiology, I went to Geneva [to work in UNAIDS]. With the arrogance of the “newly educated”, I helped them to write “cookbooks” for how to track HIV epidemics and measure risk behaviour. Then I found a job in Indonesia, and those cookbooks I made, I had to take into the real world. And there was a fair clash between the theories and the realities of the field.

æ: Could you tell us about your work there?

Elizabeth: I worked in a US funded program with the Indonesian Ministry of Health to help them to strengthen their HIV surveillance system. So I did the first studies of HIV in gay men and male sex workers and revived a moribund surveillance system in transgender sex workers. I think we were pretty shocked by some of the early results. The first study that we did in transgender sex workers. When I calculated the sample size, [we predicted] 4% HIV prevalence, ad my worst-case scenario in was that it couldn’t be worse than 10%.

I remember going to the lab to pick up the first wave of 250 samples that I sent in [for syphilis and HIV tests]. They had very helpfully colour-coded the results: red was the positives and green was the negatives. And they gave me the sheet, and a quarter of it was red. And I thought, “Fuck me, that is a lot of fucking syphilis.” And then I hold out my hand and asked for the HIV results – and she said, “Those are the HIV results.”

And I cried. I sat down and cried. One and four of transgender sex workers in Jakarta, people whom I’d been having my toenails painted by again and again for the last few months of the study, were HIV-positive. And it was so much worse than our worst expectations.

The reason why we did this study was a leader of the waria (transgender or “third gender”) community, had come in with this proposal for IEC – Information, Education, Communication for transgender sex workers. So when I got the results, I got on my motorbike and went to her salon where she was busy giving somebody big hair. And I said: “Len, here are the results. 1 in 4 is already infected. What do you think?” And she was very, very calm. She was quiet for quite a long time. And she said: “We don’t need an IEC program then, we need a treatment program. We need to help these people.”

æ: What did you do then?

Elizabeth: We set up a clinic as well as a prevention program to care for people already infected. And what was interesting was that it wasn’t just Lenny saying. “We need a treatment program”. Lenny said, “We need to get people together to discuss what we need.” (The transgender community in Indonesia is extremely well-organised. They have these cells and each section has a leader and a hierarchy, so it’s very easy to get community responses going. If the government were as well organised as the waria, this country would be a lot better off.)

So we organised a community meeting for each of the five areas of Jakarta. And I said, “I’ll make a presentation with the data.” And I make this presentation with pie charts and bar charts, and I took it to Lenny, and she just laughed her head off. Instead, we spent a long, long night drawing penises instead of pie charts to show distribution of condom use. We drew 100 penises on a poster and covered 15 of them with condoms to show the condom use. And we drew 100 waria and then coloured in 22 of them at random. (Penises are easy to draw, but waria are not easy to draw.)

And it was very interesting, when we put up our poster. Everybody looked at each other. Everyone was saying, “Yang mana?”, “Which one of us?” I think it was very powerful. We didn’t plan it like that, but everyone was like, “It could be me. Everyone should go and get their test results.”

When research is designed with the community – I hate that fucking word – but when it’s designed with people who are part of the research, when they’re part of the design from the start, you’re much more likely to get results that are meaningful and interpreted correctly. So it was quite a lesson for me. You don’t just make your plans in a vacuum; you actually make them on the basis of the needs of a community.

æ: What trends would you say are taking place in LGBT Asia now?

Elizabeth: I’m very out of date on the data, so I would not put myself out as an expert on this, but what I’ve observed over the last decade or so is that there is a homogenisation of the gay scene in Asia. It’s becoming more and more similar in more and more countries.

Even 10 years ago, there was virtually no gay scene in Beijing. There was something going on in Bangkok, but you didn’t really know what. There was much more obviously a transgender sex worker thing which was much more diverse, but that was a separate story. A gay scene as such was still pretty rare.

But now you could blindfold me and put me in a gay club in almost any major metropolitan area in Asia, and it would take me at least six minutes to figure out where I was – whereas before, you would know where you were in a nanosecond. There’s a homogenisation of behaviours: drugs are becoming more available and common throughout the scene, the music is more universally “doof-doof” – but that was ever thus. And the Internet is being used in much more similar ways as a site for hookups. And I think there’s a much greater similarity with basically the international gay scene that’s American and Australian.

æ: I wouldn’t know. I don’t go clubbing much anymore.

Elizabeth: Shit. I spend more time in gay clubs than you do. The tragedy of my life. Or maybe of yours.

æ: How does this translate into trends in HIV?

Elizabeth: It translates very interestingly. And this your editor will hate, because it isn’t politically correct, but it is epidemiologically correct: HIV comes with gay liberation. HIV comes with the scene. Why did HIV emerge in New York City and San Francisco in the early 1980s? Because gay clubs emerged in New York City and San Francisco in the 1970s.

HIV is not a very infectious virus: it is only very infectious for short periods of time when viral loads are high, and that is principally for six weeks after you first become infected, and then during periods when you have high viral loads associated with other sexually transmitted infections.

What does that mean? That means that HIV only spreads easily in communities where people have more than one partner in that six-week window. So if you’re a gay guy or even an MSM, whatever the fuck that means, and if your sexuality is confined to wet dreams about other guys but never get a chance to exercise that sexuality because you’re sitting in a small town somewhere in central Java or Zhejiang province, or even because you’re sitting in an HDB in Singapore living with your parents and don’t get to go out after 10 o’clock at night, or even if you do get to go out at 10 o’clock at night but there’’s nowhere to go to meet other partners – then HIV isn’t going to get very far.

But as soon as you have a critical mass of people in physical space or in virtual space to have the ability to meet partners and turning over partners, and you have a culture that allows that, you create conditions for the spread of HIV.

That’s the downside of a gay scene – it’s about alcohol, it’s about clubbing culture, it’s about a go out and what the fuck culture; a go out and fuck culture. It’s not the fact that you’re homosexual that increases your risk; it’s not the fact that you have anal sex. It’s the fact that you have sex with a number of partners in a short space of time.

Which is why I don’t buy the MSM thing. I don’t’ care about “pasangan yang setia”, faithful partners among gay men, any more than I care about them among heterosexuals. I do my prevention program among sex workers and young people in the party scene who are getting high and getting laid. I’m not going to the HDBs and banging on doors and telling old married couples that they should be using condoms, and that’s true of homosexuals as well as heterosexuals. And that’s true about the scene.

The problem is that virtual scene, the Internet scene, creates significant difficulties. Because if people are meeting partners in a physical space then I can meet them too. But if people are meeting partners in a virtual space.... I can get a condom into a sauna, into a cruising space, into a bar. But I can’t get a condom onto the Internet.

Now the upside, the part that your editor might like a bit more. The upside of the emergence of a gay identity and the tolerance that allows for gay clubs to exist – the upside is that it does come with a sense of community that also allows for a shared sense of responsibility and a shared sense of caring together about sexual health and all kinds of other things. And it was certainly that sense of community that created the first and to date the most effective response among HIV, which is among gay men in rich countries: the US, Australia, UK, a lot of Europe. Those responses did not come from the government; they did not come from health agencies. They came about from the communities. (That sense of community has diminished in various countries, and so has the HIV response.)

My observation – and you may disagree – my observation in the gay communities in Asia with which I’m familiar, is that that sense of community is not well developed. Basically it’s still at the stage of “Hurrah, finally there’s somewhere I can go to party, get drunk, get laid.”

æ: I’m sure you’ve suffered a lot of flak from your statements.

Elizabeth: It’s kind of a joke, that hate mail thing. My favourite bits are the ones that call me homophobic. Let’s see: my roommate is a gay hooker, 70% of my friends are gay, I never get laid because I do nothing but hang out with gay guys… I’m the world’s biggest fag hag.

But I do think the gay community has got a bit precious. Anything you say against them has become homophobic. And I don’t give a fuck who you screw, but if you do dumb things I’m going to say so. We sometimes have rates of HIV that are 10%, 20% or 30%, even where there is 100% availability of knowledge, 100% availability of condoms. And yet we are not allowed to say that maybe there is something that is wrong in the gay community. That gets censored.

Homophobia cannot transmit a virus. You can do all the whingeing you want, but there comes a point where the community has to look at itself and display some responsibility for its actions. We’ve managed to take personal responsibility out of the equation entirely, because it is strongly negative to say, “Actually, you know what? If you get infected these days, quite often it’s because you did something really dumb.”

æ: But we all do dumb things.

Elizabeth: And what would your life be if you didn’t fod really dumb things? That was how I started my TED talk: “People do stupid things. That’s what spreads HIV.” But I just think we tiptoe around this.

æ: Are there any other HIV myths that you want to clear up?

Elizabeth: There’s something that is a very major concern now, and I don’t know how much of a concern it is in Singapore – probably not much compared to Europe and the US. But there’s this whole belief that treatment is prevention: that because there are drugs out there, drugs lower your viral loads, and therefore if you’re on drugs you’re not going to infect someone else.

Very often now, even in communities where one in three people is infected, people hook up and don’t even discuss HIV and condom use – the logic being that if he’s infected, he’s probably on meds, so he’s not that infectious anyway. But here’s the thing: over 50% of transmission happens within six weeks of someone being infected, when they don’t know they’re infected and they’re certainly not on meds. It’s actually safer to fuck someone who knows they’re HIV-positive and is on meds than to fuck someone who says they’re HIV-negative.

æ: Wow. Perhaps a word about your upcoming book?

Elizabeth: I’m trying to explore right now what brings me back to Indonesia, what it is about this country, although this country is endlessly infuriating and frustrating and drives me mad, yet I keep on coming back for more. Sometimes it feels like it’s a bad boyfriend: it makes you laugh and make you smile and make you feel warm and fuzzy inside, and you know it’s all going to end in tears but you keep on coming back for more.

So I’m trying to figure out why that should be. I’m spending a year travelling around the outer reaches of Indonesia, hoping to define this indefinable beast. And if all goes well, the book will be published by Granta in 2014. My working title is Taking Tea with the Dead.

æ: Is there anything else you’d like your readers to know?

Elizabeth: You are responsible for your own behaviour. You are responsible. HIV is a choice nowadays. And you can choose not to get it. And don’t come whining to me with stigma, etc, etc. If you’re having sex with another guy then you’re not in a situation where stigma is an issue. You may experience stigma in other areas in your life, but if you’re about to take it up the ass, you’re not facing stigma. You can use a condom.

Elizabeth Pisani’s book, The Wisdom of Whores, is available from major bookstores. She also blogs about HIV issues at wisdomofwhores.com. She is also documenting her travels and reflections on Indonesia at her new blog, Portrait Indonesia, at Portraitindonesia.com


Reader's Comments

1. 2012-08-10 21:06  
That's a brilliant Ted talk at the foot of the article. I got to the section which says "What a party boy thinks is rational" and it froze, so now I'm in suspense as to what that might be.

Her no nonsense approach is a breath of fresh air.
2. 2012-08-10 21:06  
Excellent interview! I love Pisani's voice in this, she's excellent, gloriously assertive, and well-informed with direct, on-the-ground, interpersonal field work and epidemiological evidence for her claims.

Her TED talk is great too, and her book is also an excellent read.

Thank you Yi-Sheng for doing this interview!
3. 2012-08-10 21:07  
Tim1975: "Her no nonsense approach is a breath of fresh air."

YES.
4. 2012-08-10 23:01  
fucking great article. Love her. Be responsible. use a condom. always.
5. 2012-08-10 23:31  
Why are interviews like this, interviews that talk directly, clearly and powerfully to a major issue affecting LGBT, why are they not translated by Friday into the major Asian languages to ensure they are more easily shared with members? Sure, many users speak English. But reading with understanding is not universal amongst the members, nor the friends and family of members. Just saying....
6. 2012-08-11 00:45  
@slingtown - Sometimes the Chinese editor does translations. If enough folks (especially Chinese-speaking Fridae readers) leave comments saying they want it, he probably will.

Unfortunately we don't have translators for other Asian languages, but we'd be happy for other news sources to reproduce this interview, as long as they give proper attribution to the site.
7. 2012-08-11 03:11  
Tremendous interview. The magazine I work for has run stuff by Pisani but of a more scientific/medical nature; we couldn't run stuff like this. It ought to be circulated far and wide
8. 2012-08-11 08:17  
very well said... with or without condoms it's absolutely a choice... we could still have fun with out the hardcore thing...
9. 2012-08-11 09:26  
one of the best interviews/articles ever publishec here.
10. 2012-08-11 11:14  
Hats off to Pisani, and an article like this - yes to the comments above - should be translated into other languages, especially Indonesian.

Being born and raised in Indonesia, I never actually heard of Pisani's work. Even when I was in the gay community in Jakarta, not a bit of information about HIV - especially of what she had done over the years - was really out there for the public to read and comprehend, sans the agonizing stigma.

And yes, the awareness for HIV is depressingly low, due to, again, the stigma and the whole talk about Indonesia being a religious country.
When I confronted the society about coming out of the closet, they were shocked. And when I stated that I wanted to learn more about HIV, they were silent and quietly left. I'm negative, but that's all the more reasons why I need to understand the matter, and it's seriously hard to find words about it on print. Thanks to the Internet of course.

And as I left Jakarta last year, the biggest gay club there just opened the first dark room in the city. Honestly, I just hope that it didn't turn to be a can of worms in particular for STD diseases, including HIV.

I guess what I can do now is to pass this article to those I care the most, and if necessary, I'll translate it in Indonesian.

Thank you, Pisani.
Thanks, Fridae.
11. 2012-08-11 15:54  
anyone who does HIV should read her "Wisdom of Whore". It is brutally honest and remind us that HIV work is not printing nice colourful leaflets that noone except the authors understand or piled them in your storeroom but reporting 25000 leaflets distributed.

It is very hard to buy it anywhere though.
12. 2012-08-11 16:34  
One great article on Fridae that also serves as the timeliest and loudest WAKE UP CALL. The Lady is a Champ.
13. 2012-08-11 18:07  
This is the only article on Fridae which is worth reading. Honest, truthful, direct. So, what are the local gay communities doing about stopping HIV?
14. 2012-08-11 19:01  
before we get excited. let's ask ourselves. does the HIV virus really exist?

let us do our individual research and base our actions on the facts and simple truth of this elusive virus.

check this link: http://www.theperthgroup.com/

There is nothing to stop simply because there isn't a virus.

cheerios.
15. 2012-08-11 20:21  
This is a great article to send (potential) partners, fuckbuddies, etc, especially if one finds it difficult to talk about using protection, safe sex, STDs/HIV and such.
Comment edited on 2012-08-11 20:22:59
16. 2012-08-11 20:58  
I'm grateful to Fridae for drawing my attention to Elizabeth Pisani, and it's great to debate ideas.
However, in the video, she reminds me of a stand-up comic, and the wry, knowing tone throughout (and in the Fridae interview) grates on me.
Unfortunately, scientists find it hard to see behind the surface of things, and how complex our motivations are. She throws the audience her unused condoms, but she's never had to struggle with opening a foil wrapper when her fingers are covered in lube, and then put the thing on inside out - all likely in a haze of alcohol or part drugs.
And she never will, which is perhaps why I'm so irritated as well as impressed
17. 2012-08-12 00:48  
Could all readers report @14 has offensive comment please. Ignorant HIV denialists have nothing to do on Fridae.

It is unbelievable that someone who is in a most at risk population can contribute to the spread of conspiracy theories.
18. 2012-08-12 01:18  
@16 here is a tip: open the foil BEFORE you get to use the lube!
19. 2012-08-12 01:20  
if i see you someday in person Pisani, i'll give u a big tight hug. thank you for keep coming back to Indonesia, yes i know you're feeling, Indonesia is a big raw jewel covered in mud.
Also more important, thanks for loving us gay community.

20. 2012-08-12 01:24  
Hey @16, Ms Pisani has a reply for you - she wants you to know that she *has* had to deal with drunken condom fumblings, and that she fully intends to continue doing so in the future.

http://www.wisdomofwhores.com/2012/08/11/i-will-never-use-a-condom/
21. 2012-08-12 02:01  
@16

Firstly, i am quite appalled by how you claim my comment was offensive. I see in no measurable way that sharing a knowledge can be offensive.

just because i shared a different side of the story on AIDs makes me a denialists. How judgemental of you. Blatant disrespect for others believes and conviction. It is from people such as yourself that have a narrow mind. Makes it hard to hear and accept other plausible alternatives to the AIDs epidemic.

And the notion that i am in the at most risk population is totally rude and uncalled for. Let me clarify that i do not engage in promiscuous sex. 5 to 10 partners a week. And i certainly do not use intravenous drugs or any sort or recreational drugs that will allow me to lose my judgement and start having an orgy fest.

So before you judge others. Please at least have the decency and respect for others views and believes. Do not simply call me a denialist.

Thank you.

It is true that ignorance is bliss.
22. 2012-08-12 02:54  
@21. I think you meant @17

It is offensive because what you spread is not knowledge, information or a different side of the story, but because it is unfounded nonsense about "does the HIV virus really exist?"

The Perth group is a well known bunch of AIDS denialists whose claim have no scientific ground and have long be debunked. By spreading their unfounded claims, you become part of their conspiracy.

Should you want to share information you would have looked at http://www.aidstruth.org/ which has gone into great details to expose the Perth group and other denialists.

And you don't need to be promiscuous or to use drugs to be "at risk". A lot of people got infected by their regular partner.

I am affraid I have no respect for the views of those who say that HIV does not exist or does not cause AIDS, because such views are just irresponsible and plain dangerous and should not be a given a plateform.

Yours.

EDIT: In South Afriica, AIDS denialism is estimated to have caused the uneccessary death of 300,000 people. Just because some pseudo-scientists had "alternative" explanations to the epidemic. Do your homework.
Comment edited on 2012-08-12 03:04:19
23. 2012-08-12 10:06  
Blaming the victims has to be stopped for they are also our friends, brothers, and sisters. We humans are proud of compassion, care, and understanding.

Rather, scientists should figure out how to develop effective strategies to prevent the spread of all kinds of STDs, treat their patients with respect and dignity, find out the essential causes of high mortality rates (for example, poverty, inequality, poor nutrition, and uneven distribution of available medical resources) in the hope that one day, people would neither fear each other nor live in an atmosphere of mutual distrust :-)
24. 2012-08-12 10:42  
Very good article.
25. 2012-08-12 11:25  
I don't think Ms Pisani was blaming 'victims', read what she's saying carefully -- and I don't even think people living with HIV/AIDS should even be called that.
26. 2012-08-12 16:45  
clear, direct and to the point. a must-read....
27. 2012-08-12 19:51  
I love the "lpark" just said, it's everyone's responsibility to protect oneself and the others. HIV denialist is totally bashing the current effort the doctors and experts have made.

28. 2012-08-12 20:22  
@18. Thanks for your advice, but are you assuming there's only one use for lube during sex?
29. 2012-08-12 20:38  
I'm still smarting at her saying there are things wrong with the gay community...I feel I'd like to remind her of a few things wrong with the Heterosexual community. And that gay men add value to whatever we do.
She sounds like an anthropologist rather than an epidemiologist, looking at us through a microscope. I'm from Yorkshire, where 'we call a spade a spade', so I know that sometimes bluntness does more harm than good.
Don't all us gay men need to take more care of ourselves and our lovers in terms of STI's? But sex and being rational have never gone together and probably never will
Comment #30 was deleted by its author on 2012-08-12 21:05
31. 2012-08-12 21:11  
Peace
Comment edited on 2012-08-13 07:37:30
32. 2012-08-12 21:57  
This article is pure GOLD!Yay for Elizabeth Pisani!
33. 2012-08-12 22:24  
She is a courage lady, takes no nonsense & speaks right from her heart. She seems to understand well LGBT issues as she has lots of LGBT friends and put homophobic politicians to shame! Her delivery of language is also fackingly interesting!
@14 - It's still early to say about the perthgroup's discovery..some other scientists also said the same thing..although we hope it's true the devil doesnt exist, let the world best scientists sort out the truth!
34. 2012-08-13 01:07  
@statictoast: I must admit that I am not certain I understand your point about HIV. For sure, I don't really understand whether or not you also believe that AIDS doesn't exist. If so, then I think there is little point even addressing your perspective. However, if you agree that there is are a number of illnesses that can be grouped together as AIDS and that there may be one or multiple causes, then let's consider your perspective; let us assume for a moment that there may or may not be viral or other factors that result in what is commonly termed AIDS. So what?

The overall data suggests that it really doesn't matter about the causative agent or agents of AIDS. What matters are outcomes for individuals that have taken simple precautions of practicing safer sex or drug used compared to those that do not. Empirical data suggests that education and outreach promoting condom use for anal intercourse significantly reduced the incidence of AIDS within the gay community, while similar programs targeting use of new, sterile needles reduced the incidence of AIDS with addicts and even casual intravenous injection drugs users. There are numerous statistical studies of these two methodologies proving, within medically-accepted statistical tolerances, their effectiveness in reducing the incidence of AIDS in both groups. Similarly, these studies also highlight the increased incidence of AIDS in groups where use of these prevention methodologies become lax after a period of increased adherence (see Thailand as a case study)

As such, regardless of the causative agent, it is clear that condom use significantly reduced the chances of contracting what agent or agents contribute to AIDS. If you can't agree or accept the results of this data, then I suggest you volunteer to be infected with HIV as a control group test subject for one of the HIV vaccination trials. After all, you seem quite certain that you will not develop either an HIV infection or any of the life-threatening AIDS-related illnesses purported to arise from an HIV infection. It would your be chance to prove your point conclusively. If you'd like, I'll be glad to put you in touch with someone running trials. After all, it's much better to give advice when you have walked the talk already.
Comment edited on 2012-08-13 02:03:54
Comment #35 was deleted by its author on 2012-08-13 07:17
36. 2012-08-13 03:02  
@ 31: Yep, you're old-fashioned. :) I was going to say it was sexist, but I guess you wouldn't appreciate it if she were a man, swearing like that, either.

I did want to tell you that Pisani doesn't actually swear much in her speeches and in her writing. This is just the way she spoke to me during a very intimate interview we had in her hotel late at night, after we had already become friends. I really liked the kind of voice she used, so I didn't cut the swearing out. You should really check out her book - I don't think you'll be offended by the language.
37. 2012-08-13 06:21  
@36:
I'd still say #31's comment was pretty damn sexist.
Comment #38 was deleted by its author on 2012-08-13 07:37
39. 2012-08-13 11:36  
please just let @14 live in his own denial. the only one he's damaging is himself.

every broadly accepted science theory (or actually proven science fact) always has its set of conspiracy theorists. stop wasting your time arguing with them.
40. 2012-08-14 08:07  
Well said, Ms. Pisani. Thank you for your work and for your bluntness ... perhaps if we could get past the politically correct speech that so "infects" society, more guys would connect with this message, take the time to think and make better choices!
41. 2012-08-14 19:02  
@14 AIDS denialism isn't offensive, in my opinion, it's a crime, or should be. It was responsible for the deaths of hundreds of thousands of people in South Africa because it led the government to delay access to antiretrovirals and HIV denialists are responsible for the death of every person they seduce with their crackpot theories into not taking treatment when they need it. The Perth group is run by a lab assistant who thinks they're a genius. I'm not going to argue about it because in my experience arguing with denialists is like arguing with and HIV denialism does.
Comment #42 was deleted by its author on 2012-08-14 19:14
43. 2012-08-14 19:18  
As for Pisani: here's the comments I stuck on another site (the IRMA/rectal microbicides people): [PS I real life my name is Gus Cairns and I work for an HIV org in prevention]

People who lump Pisani in with the Larry Kramer ‘use a condom of else’ brigade get her completely wrong. She’s not into moral exhortation, she knows why people don’t use condoms, and she’s bang on about let’s stop using stigma as an excuse (it’s a reason, but not an excuse – combating stigma is a useful structural long-term approach to HIV prevention, but it works over decades, and meantime you need something fast to stop individual infections).
The problem with her is not that she’s wrong, but that she is right, but only about half the picture. She has no interest in exploring why people don’t like condoms (not don’t use them, don’t LIKE them)..
In terms of whether she’s right or wrong on tratment as prevention, I think we need to understand the epidemiological evidence better first. She may be right and it simply won’t work in gay hyperepidemics, or she may be wrong as the herd-immunity (aka community viral load) effect eventually starts to smooth down incidence.
If her views on TasP are anything to go by, she’s unlikely to think PrEP will make much difference as I’d imagine she’s in the ‘if they can’t be bothered to use condoms why would they use PrEP?’ camp. Is she right on that one? We are going to find out very soon.

G


44. 2012-08-22 06:42  
@14

I wander if you have been into a hospice with many really sick people diagnosed with HIV? I wander what you would say that they are dying of?
I wander that you would say to them to cheer up as there were no HIV virus after all?

Pisani spoke about educating people in general not to get infected so that there will be less people dying at hospices. Your belief about the existence of HIV or not is quite irrelevant.


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