Elizabeth Pisani

“Yes, our social and economic circumstances shape decisions we make about all sorts of things in life, including sex. Sometimes they rob us of the power to make any decisions at all. But of all human activity, sex is among the least likely to fit neatly into the blueprint of rational decision making favoured by economists. To quote my friend Claire in Istanbul, sex is about 'conquest, fantasy, projection, infatuation, mood, anger, vanity, love, pissing off your parents, the risk of getting caught, the pleasure of cuddling afterwards, the thrill of having a secret, feeling desirable, feeling like a man, feeling like a woman, bragging to your mates the next day, getting to see what someone looks like naked and a million-and-one-other-things.' When sex isn't fun, it is often lucrative, or part of a bargain which gives you access to something you want or need.

If HIV is spread by 'poverty and gender equality', how come countries that have plenty of both, such as Bangladesh, have virtually no HIV? How come South Africa and Botswana, which have the highest female literacy and per capita incomes in Africa, are awash with HIV, while countries that score low on both - such as Guinea, Somalia, Mali, and Sierra Leone - have epidemics that are negligible by comparison? How come in country after country across Africa itself, from Cameroon to Uganda to Zimbabwe and in a dozen other countries as well, HIV is lowest in the poorest households, and highest in the richest households? And how is it that in many countries, more educated women are more likely to be infested with HIV than women with no schooling?

For all its cultural and political overtones, HIV is an infectious disease. Forgive me for thinking like an epidemiologist, but it seems to me that if we want to explain why there is more of it in one place than another, we should go back and take a look at the way it is spread.”
― Elizabeth Pisani, The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS