Elizabeth Pisani likes talking about sex. She says that she and most other people enjoy having sex, too. Pisani, an epidemiologist and author of The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS (Viking Canada, $35), also feels political leaders must acknowledge publicly that sex is pleasurable in order to win the war on AIDS.

“HIV is about sex and it’s about drugs,” Pisani said in a recent interview at the Georgia Straight office. “Those are things we do because we like to do them.”

She wryly added that AIDS, which results from HIV, is about sickness and death, which everyone wants to avoid. Pisani, an iconoclastic pixy with a PhD, worked for more than a decade in HIV prevention and surveillance, including several years as a consultant with UNAIDS, the joint United Nations program on HIV/AIDS. She noticed that world leaders didn’t want to talk about the relationship between HIV infections and sex and drugs. Instead, they would focus on poverty, testing pregnant women, talking to schoolgirls—anything to avoid a frank discussion about fucking without condoms. Pisani believes that this is one reason why there has been a 38-percent increase in HIV infections over the past decade—despite billions spent fighting this scourge.

In 2005, Pisani, a former journalist, quit her job in the “AIDS industry”, as she puts it, and decided to tell the story of two epidemics. Outside of sub-Saharan Africa, she writes that the virus is concentrated in sex-trade workers, intravenous-drug users, men who have sex with men, and women who have sex with members of all of these groups.

She believes that HIV transmission can be contained, citing in her book the example of Thailand’s successful crackdown on brothels that allow unprotected sex. Pisani said that prevention must focus on high-risk groups in Asian countries instead of adopting a scattergun approach based on the false premise that HIV will spread into a generalized epidemic.

In sub-Saharan Africa, where there have been more than 40 million HIV infections, the disease has taken hold in the general population and requires a different approach. “How did we get into this appalling situation?” Pisani writes in her book. “In large part because most African politicians found it easier to watch hundreds of thousands of young adults die than to say what everyone was secretly thinking: HIV is spread by sex. Most HIV is in Africa. Ergo, Africans must have a lot of sex.”

In her interview with the Straight, Pisani said that in East Africa and southern Africa, people have traditionally been less likely to use condoms and far more likely to have two or more partners simultaneously, in part because of a history of polygamy and in part because of other factors. “They may have fewer partners over their whole lifetime than I will, but they’re more likely to have two or three at any one time,” she said.

If men are working in the mines and their wives are living in villages hundreds of miles away, it increases the likelihood of people developing a web of sexual relationships. Men might visit sex-trade workers or have a girlfriend near work and then bring the virus home. Poor, unmarried girls might hook up with older sugar daddies who give them not only gifts but also HIV. Pisani writes that in several African countries, data show that unmarried women are significantly more likely to pass HIV to their newlywed husbands than the other way around.

She told the Straight that in Uganda—one country where the HIV infection rate bucked the continental trend and fell sharply—President Yoweri Museveni “drew a straight line between sex with multiple partners, HIV infection, AIDS, and death”.

“It seems obvious, right?” Pisani said. “But most African leaders have still not done that—to this day!”

The result has been an HIV infection rate greater than 43 percent among adults in Swaziland and 9.4 percent among girls aged 15 to 19 in South Africa. Even though the AIDS industry continues to grow, it doesn’t appear to be having an appreciable impact on infection rates.