Tuesday, February 16, 2010

my secret love for stats revealed

here i go again.  insisting that you read a book that i loved.  and this time, it is called Wisdom of Whores.  don't let the title put you off, nor the fact that Elizabeth Pisani is an epidemiologist who wrote a book about statistics and preventing the spread of disease.  it really is fascinating and part of that is due to Pisani's ability to call it like it is, humbly take credit for good work, but also to admit when she (and the development world, in many cases) was wrong.

the book talks about how our hiv prevention strategies as donor governments, un agencies, and ngos has typically been ass backwards.  instead of putting money toward the greatest transmitters of the disease, commercial sex workers and injecting drug users (especially those in prison), the enormous amounts of money that have been donated/lent by the american government, the canadian government, unaids, and the bill and melinda gates foundation, among so many others, has largely gone to useless programmes targetting women, children, and the general public, who are not the hotspots of transmission.

hiv is not really that infectious, if you look at the science.  we know how it is most easily transmitted (and it is not heterosexual sex) and who is transmitting it (with minor variations between countries and cultures), but we continue to spend money on saving the poor women and children.  oh, the women and children.  the poor, poor women and children.  who don't spread hiv nearly as often as others...

another fun fact that book came out with is that timor leste (where a good friend of mine lives and works, no doubt spending money given by the americans) had a grand total of 7 people who tested positive for hiv at the time of their independence (they were the first new state to be formed in this century), but the americans threw money at the country to deal with their 'hiv problem.'  7 people does not a problem make.  but oh my god, the poor women and children, what will they do if we do not address the impending epidemic hanging above their heads!

we have been force fed the idea that poverty will equal hiv transmission rates going through the roof and Pisani shatters that nonsense as well, demonstrating that being poor does not necessarily make you any more likely of contracting the virus, but it is how we fail to address the most common ways it is passed from one person to another (man to man, man to woman, woman to child, woman to woman...) in our programming that is failing millions of people.

for example (and there are many), the us will not allow any of its money to be spent on needle exchanges for drug users, the us claims to be a saviour of those living with aids by providing drugs (shipped from the states when other generics are avilable and do not need to refrigerated) but won't fund any programmes that keep sex workers safe rather than forcing them to leave the trade.

we continue to try and fit people into boxes of 'female sex worker,' 'positive man married to uninfected woman,' and 'sex buyer,' to name a few.  but in reality, people do not fit into these, or other, boxes very nicely and Pisani makes a great case for the changing of research and reporting to better reflect this, which could result in better prevention programmes that might actually work.

there are many problems as to why hiv has taken off in some regions of the world.  african governments refuse to acknowledge that there are men who have sex with men in their countries (ahem... kenya, nigeria, uganda) and their politicans speak out against proven science that hiv leads to aids and that you can cure aids with thorough washing and herbal supplements (yes, south africa and the gambia, i am looking at you...).  so while we are pouring money down the drain, and there is certainly a lot of money in the aids business thanks to bono, pepfar, and do gooders like myself, in providing education and voluntary testing to wives, mothers, and children, we have lost the plot on what really needs to be done.

and did you know that canada is among the worst offenders for tying our aid? it means that when we give money to other countries or organisations, we have an expectation that a certain percentage of it is spent on canadian goods, canadian services, and canadians themselves in the form of hiring our nationals.  i knew we were no aid angels, but i was surprised to see that we were behind only the us, the international pariah of untying aid activists.

i take no credit for these ideas.  i have thought them in varying shades of clarity and articulation, but Pisani really deserves credit for writing a book about statistics and science that is fascinating, infuriating, and inspiring in equal measure.  go out and read it (and her blog, now listed here), you will certainly be smarter for it.  or you can go out and buy a red ipod or a cup of starbucks red coffee...

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