A few years ago, I commented to an HIV-positive friend of mine that I had just received the results of my own HIV test. I was negative and not particularly surprised by it. He made some comment about how it isn't a good idea to be too smug, and how could I be so sure I wasn't going to test positive. My reply surprised even me.
I have a number of friends living with the virus. Until I moved to San Francisco six years ago, all of my HIV-positive friends had been infected in the first 10 years of the epidemic. In short, prevention efforts and education had a very long way to go during that time. Since living here, I have met a few people who have become positive after we became friends. Shock doesn't begin to describe how it feels to learn a friend has become positive.
I think a lot of people would find it ironic that rather than pity or sadness (those emotions came later), I felt disappointed and angry. HIV is no mystery to a young man living in San Francisco. The ways you get it are intimately familiar to anyone who has even a modest awareness of his community.
After relating my results to my friend, and receiving his caution about being smug, I said to him that if I got infected at this stage I would be deeply embarrassed and ashamed because I have lived alongside the virus for 25 years and I have seen it take the legs through severe neuropathy of my dearest friend. I have seen his body deform before my very eyes from the toxic drugs he has to take to stay alive. For me to become infected would be shameful and no one's fault but my own. To that my friend replied, " Well, HIV is really no one's fault."
To that I held my tongue. But of course, I knew that it is the fault of the person who does "stupid things" and gets infected because of it.
Elisabeth Pisani's new book, Wisdom of Whores, is to be published next week and the Guardian of London has a nice write up about it. Her book would appear to neatly encapsulate my conversation with my friend. The whole world is saying AIDS is nobody's fault when in fact it is somebody's fault. Prevention rests with the individual. And to the extent that prevention fails, the fault rests there.
What is difficult about Pisani's position as she postulates it on her website WisdomofWhores.com is that she seems to think circumcision is ok. No big deal. Not at all major. Of course, the opposite is true. Yet her broader position is in fact supportive of skipping the circumcision and going straight to the condoms and needle exchange. It's a disconnect probably influenced from not thinking about it too much with so many other things on her plate. (I'm trying to be generous here to a promising philosophical fellow traveler, much like I feel for Helen Epstein's work.)
Among the interesting quotes in the Guardian article:
"We could knock this epidemic in the rest of the world on the head - just like we've knocked so many things on the head in the rest of the world - but we're not doing it, largely because of the paradigm that we're developing in Africa. The Aids industry has become an island unto itself, in a sea of common sense. That's the tragedy of it. It's unsayable."
...
Even the 20 cents in every US dollar allowed to be spent on prevention is wasted, Pisani argues. A third of the prevention budget has to be allocated to faith-based organisations, which refuse to distribute condoms and will promote only abstinence before marriage. The failure rate of "virginity pledge" programmes among young Americans in the US is about 75%; condoms' failure rate is roughly 2%. Yet Pepfar, Pisani laughs, "claims its policy decisions are 'evidence based'".
...
"You know, it's one of the difficult things about arguing for a more targeted response. You're basically saying, 'Look, people are getting infected now because they're doing dumb things.' But people do dumb things all the time. I do. We all do. Why is it OK to be judgmental about people who smoke? But not to be judgmental about people who take crystal meth and fuck 16 guys in a weekend without condoms?"
Yet, she also says on her website that where people don't wear condoms anyway, why not circumcision? But how is this different from abstinence only programs that she doesn't like? Circumcision may slow down the virus, but it doesn't stop it. No study has even come close to making that absurd claim. And no study has adequately addressed the longitudinal outcomes of circumcision. So how is it that where men aren't wearing condoms anyway, the solution is a massive, messy, complication-prone, and expensive campaign to get them circumcised rather than to get them to wear a condom? It's internally inconsistent and of course more doomed-to-fail policy trickery.
While Pisani's thesis seems allied with the reality we espouse on this website, she has slipped into name calling, as we do here as well from time to time, by referring to skeptics of the circumcise-them-all school of thought prevention as "denialist" -- with a link to NOCIRC.org. And it's a pity that she does so.
[Minor edits for clarity and context in last two paragraphs.]
Link: 'People do stupid things - that's what spreads HIV' | World news | The Guardian.
