Those of us who came of age during the AIDS-scares of the 1980s did so with Leonard Cohen’s ominous Greek chorus rumbling in our ears:“Everybody knows that the plague is coming/Everybody knows that it’s moving fast/Everybody knows that the naked man and woman/Are just a shining artifact of the past/Everybody knows the scene is dead/But there’s gonna be a meter on your bed/That will disclose/What everybody knows.”

Blue Velvet was the cinematic metaphor. HIV gave us a whole new complex of sexual neuroses.
“I’ve been quite shocked, particularly in the gay community, that we’re almost back to 1978,” says Elizabeth Pisani, epidemiologist, journalist and author of The Wisdom Of Whores – Bureaucrats, Brothels And The Business Of AIDS, over coffee on a Saturday morning in Dublin city centre.
“There is no AIDS anymore in rich countries,” she continues, raising her voice to be heard over the hissing of the cappuccino machine. “We’re now in a post-AIDS world. There’s only HIV, and HIV’s invisible. I had lunch the other day with a friend who’s just turned 20, and he says, ‘Oh yeah, I was diagnosed a year ago, and it took me a year to tell my mother. I was scared she was going to be hysterical.’ And sure enough, when I talked to his mother, she said, ‘Oh god, I want to commit suicide.’ And I had to explain to my friend that it’s a generational thing, and he has to expect that from his mother, because for her, that diagnosis means that in four months time you’ll be shuffling around on a cane with black things all over your face, and in a year’s time you’ll be dead. But to my friend, he’s never seen it, that doesn’t exist, it’s just, ‘Oh bummer, I’ll have to take two pills a day – that sucks.’ And that’s how people are processing it now.”
The experience of writing The Wisdom Of Whores took Pisani from the shiny citadels of the corporatised anti-AIDS industry to Jakarta backstreets populated by he-males, she-males, transgender sex workers and rent boys. Did mixing with the cast of a Lou Reed song give her greater compassion for people, or make her feel despair at the situation they were in?
“I don’t think those are mutually exclusive,” she says. “But actually I came out of it being, I hope, less sanctimonious and more humble. Because you realise that the cast of a Lou Reed song is exactly the same as the cast of a Kylie Minogue song, it’s just people getting on with their lives. And when you’re in the sex and drugs industry, or public health, you tend to categorise people, so there’s transvestites and transgender and gay guys over here and rent boys over there and junkies over there, and actually every single one of them is just worrying about whether they have enough credit on their mobile phone to call their boyfriend, and are they going to be able to pay the electricity bill this month, and what’s for dinner. Everyone’s just living a life.
“And that’s one of the things that makes it so difficult when your community is defined by a behaviour that puts you at risk for a fatal disease. That’s particularly true in the gay community. No one wants to shoot up with a dirty needle, that’s just a logistics problem. It’s not a badge of community to share needles. It is a badge of community to have unprotected sex. The problem is to try and stigmatise risky behaviour without stigmatising a group of people, or the consequence of that risk.
“One of the great dilemmas in HIV prevention is there’s this real mixed message, which is, ‘If you’ve got HIV, don’t worry, you’re just like anyone else, you’re going to have a long and healthy life, it’s all fine and dandy, if you pop your pills you’ll be grand,’ and on the other hand, ‘Don’t get it!’ You’ve people bombarded with direct-to-consumer advertising for anti retro-virals: ‘Ask your doctor for…’ and it’s a guy climbing a mountain or absailing down a cliff, showing his tight arse in a harness and his bulging pecs, and you think, ‘Hang on a sec, that’s the image people have now.’”
One of the most thought-provoking points in Pisani’s book is her assertion that if everybody had sex with people their own age, AIDS would eventually die out. Sexual intercourse between, for example, Lolitas and sugar daddies, allows AIDS to jump the generation gap.
“We always paint that Lolita scenario as a predatory thing, the older guy exploiting the young girl,” she says, “but I put it to you that sometimes it’s the girls who are being pretty predatory. It’s interesting, the World Bank is still in negotiation, but they’re about to back a programme in Tanzania where people are essentially being paid to stay HIV negative. And I’m all for the use of bribery, financial incentives, sexual incentives or whatever, to achieve goals. I don’t have a problem with that, but I do have a problem with choosing your incentive badly, and they’re essentially saying, ‘We’re going to pay people under 30 the equivalent of $45 a year if they sign up and come in for testing every six months.’ And this is going to reduce HIV because it’s going to empower girls so they’re not going to have sex with sugar daddies anymore because they’re going to have money of their own? I think back: I never had a cash problem, but when I was in my late teens I was fucking guys in their early 30s because they took me to nicer restaurants, because they gave me more kudos, because they didn’t stammer, because they didn’t have spots, and because they were better lays.
“People are going to have sex, and people are going to have unprotected sex, but I think the more you can get people to make the risk calculations, the better off we’ll be. And sometimes the public health establishment has this super anti-risk way of looking at the world: ‘Always use a condom, even in oral sex, because there is a chance of transmission, blah-blah-blah’, and I’m like, ‘Y’know, suck don’t fuck, you’ll be grand!’ We’re going to do this anyway, so let’s just enjoy it as much as we can, and not die from it, which is not that hard to do.”

The Wisdom Of Whores is published by Granta. www.wisdomofwhores.com