It’s not that often that I sit reading the FT on a Tube full of morning communters. Even less often that the Pink Paper (no, boys, not THAT Pink Paper) carries full page ads from the Purveyors of Porn. The ad is pimping a new internet domain ending: .xxx (Slogan: Coming, now!)

The porn industry is positioning itself anew (they don’t excuse the pun, so I wont either) as responsible citizens, protectors of children and the integrity of your credit card details. Re-registering your porn domain with a .xxx extension will make it easier to filter, keeping it away from kids and the easily-offended. Since all .xxx domains will be screened daily by Mcafee, they will be virus-free. The xxx admin folks will also enforce standards of financial transaction probity, apparently. In the meantime, they stand to make an awful lot of money themselves. But here’s my question: what does it say that the ad was placed, as a FULL PAGE, in the world’s most prominent financial organ? Perhaps that purveyors of porn have more to invest than the rest of us?

Certainly, the porn industry could do with brushing up its image after the recent kerfuffle over HIV transmission on porn film sets. Though plenty of people are demanding the introduction or enforcement of condom-only porn shoot rules, I suspect they are on a hiding to nowhere. Isn’t the whole point of porn that is is a bit transgressive? If condoms were sexy, we probably wouldn’t have reached over 60 million HIV infections to date. Goody-two shoes safe sex is rarely enough the stuff of our reality; it is almost never the stuff of our fantasies.

The Salon piece acknowledges this. It fails to stress another important point. Most of the on-set transmission of HIV occurs right after the infected person themselves became infected. This is a time when there is tonnes of virus floating around the body and it is very easily transmitted. It is also a time when antibodies have not yet developed. Since the standard HIV tests are for antibodies rather than the virus itself, they will miss these very new, very dangerous infections. Indeed it was a classic case report from the porn industry that confirmed in life what we suspected from lab work about the dangers of early viral load.

Possible solutions: set a minimum time between shoots of six weeks. That way, if someone gets infected on one shoot, they’ll test positive before the next one. Another solution would be to invest some of the massive profits of the porn industry in testing actors for the HIV virus itself, rather than for antibodies. Both of these solutions seem unlikely, given the profit imperative of porn, but in my mind they are both less improbable than condom-only porn.

One thing that interested me about the .xxx ad was that they are offering, for a small, one-time fee, to BLOCK names from being used with an .xxx extension. Do you think I should sign The Wisdom of Whores up to prevent our good name from being abused?

Apologies if this post looks odd. My first attempt to post from an iPad.

I used to be proud to have worked for Reuters. It was an organisation of clever, brave people dedicated to reporting the truth in often difficult situations. I continue to be proud to have spent 10 years living with David Fox. His determination to give a voice to the men, women and children who are the pawns in conflicts not of their own making definitely took a toll on our marriage. I learned to recognise the lock-down mood that followed yet another assignment in Rwanda, Ethiopia, Iraq, Albania, Afghanistan. I laughed at the sick jokes that go with the daily reporting of incomprehensible grimness. As anyone who has worked as a surgeon, doctor, cop, undertaker or soldier knows (and as comments on Reuters’ imperious behaviour reflect) gallows humour helps you cope with shitty situations. I work on a sexually transmitted infection that has killed 30 million people; I can do a tasteless joke or two of my own. But along with the wisecracks came top quality journalism. I never failed to be moved by the stories David filed for an employer increasingly short of brave people who could be dropped in to a disaster area with equipment charged, functional, and ready to file. Read his coverage of the refugee crisis in Zaire and try not to weep.

So short is Reuters of people with David’s experience and competence, that they pulled him from his new post as bureau chief in Indonesia to help out with the coverage of the tsunami in Japan. He crunched his great height into an economy seat on an overnight flight and went to work on not enough sleep. An old mate, chatting with him on line in the middle of the night, made a crack about the effect radiation might have on the already bald David. David responded to a fairly classic disaster crack more or less in kind, although bringing women and Brazilians into the comment definitely upped the level of vulgarity. Most of the reporting of this incident has pussied around what David actually said and he will doubtless be appalled if I’ve let the cat out of the bag. But I feel the need to say that I can see why women might be upset; we’re all in a total quandry about our pubic hair these days. Though the subject is virtually taboo even in girl-talk, we spend inordinate amounts of time agonising in private: to wax or not to wax, landing strips yes or no? The constant dilemma of whether to disclose your status before you take your clothes off, the shocked looks if you strip before you tell. For the record I believe that men will soon lose interest in having sex with women who have tortured themselves into looking like pre-pubescents. In this context alone, I’m a proud defender of bush.

Still, it’s not a subject that most people want to engage with, least of all when facing an overwhelming human tragedy in the middle of the night. David can be a bit of a lad — it goes hand in hand with volunteering to report from the front line — but he is neither a sexist pig nor an insensitive idiot. He thought he was replying only to the mucker who had made the crack about his hair falling out. Fatally, though, he sent the comment by mistake to a Reuters-only chat room, populated at that hour by a couple of dozen people. Everyone’s worst nightmare. He realised his mistake right away and called the IT people within minutes to try and get the comment erased. It seems the techs at one of the world’s foremost electronic communications agencies were unable to help.

For an unintended slip of a keystroke conveying a silly, laddish comment to a small number of staffers in the middle of the night, a slip which he tried instantly to rectify and for which he apologised without reservation, David was fired. Let me repeat that. Thompson Reuters fired a brave, loyal journalist who has put himself on the front line for the company time after time after time for 20 years, because he mistakenly shared a gallows-humour joke with an internal audience.

Is that a company to be proud of?

Okay, okay, I’m more than two years behind schedule. But we’ve finally managed to upload links to most of the papers, documents and visuals referenced in The Wisdom of Whores.

You can find anything referenced in the Footnotes here (that’s the notes labeled with asterisks which appear at the bottom of pages in the text). You can find anything referenced in the Endnotes here (that’s the notes labeled with numbers which appear at the end of the book). Links to full text versions of most of scientific papers and reports referenced in the book are also provided in the Bibliography.

Happy Christmas, and all other holidays. And thanks to MP and NL for their help with this, as well as for enriching my life.

As far as I can tell from the file downloads for December, over 5000 people downloaded the book. Many of you were kind enough to write to thank Granta, and some of you copied me. Comments include:

“I’m a 22 year old student from India and I just wanted to thank you and your
publisher for giving the ebook for free, making it more feasible for people like
me, who don’t usually have the same financial means to purchase ebooks,”

“Knowledge and awareness is the best present anyone can
receive this holidays.”

“Congratulations on this wonderful move from Granta — how fabulous of them!”

“I just wanted to thank you for offering the eBook version of Wisdom of Whores online, for free, for the month of December. People WILL want paper copies after reading it in this format…”

“I think a number of students and my mother and some others will benefit highly, and it gives those of us with paper copies the warm fuzzies toward you and Granta. And I can take your book with me every time I travel – this is a huge boon for those of us who do much of our writing in hotel rooms!”

“I realize that making an ebook available for a free download is a complicated tradeoff between mindshare and revenue for the publisher and author, and I’d like you to know that in my case, at least, I think the tradeoff worked.”

“Thank you so much for allowing us to download this book. I read the hardcover
version over a year ago, and the information I learned still informs my research
and discussion on HIV/AIDS today.”

“Your decision to make The Wisdom of Whores available in the form of e-book is much appreciated. I write from Nepal and for us first it is a challenge to get a copy, and second the price of books printed abroad is significant.”

The eBook is no longer available on this site, but you can find information about e-readers here.

I’m very grateful to my publisher, Granta, for allowing readers free access to the eBook of the Wisdom of Whores for December 2010. A little disclosure: I had a bet with Granta staff about how many people would download the eBook. The bet was made in second bottle territory so the details are hazy; one of said we expected a maximum of 15 downloads, the other did not venture beyond single figures.

As far as I can tell from the file downloads for December, over 5000 people downloaded the book. Many of you were kind enough to write to thank Granta, and some of you copied me. Comments include:

“I’m a 22 year old student from India and I just wanted to thank you and your
publisher for giving the ebook for free, making it more feasible for people like
me, who don’t usually have the same financial means to purchase ebooks,”

“Knowledge and awareness is the best present anyone can
receive this holidays.”

“Congratulations on this wonderful move from Granta — how fabulous of them!”

“I just wanted to thank you for offering the eBook version of Wisdom of Whores online, for free, for the month of December. People WILL want paper copies after reading it in this format…”

“I think a number of students and my mother and some others will benefit highly, and it gives those of us with paper copies the warm fuzzies toward you and Granta. And I can take your book with me every time I travel – this is a huge boon for those of us who do much of our writing in hotel rooms!”

“I realize that making an ebook available for a free download is a complicated tradeoff between mindshare and revenue for the publisher and author, and I’d like you to know that in my case, at least, I think the tradeoff worked.”

“Thank you so much for allowing us to download this book. I read the hardcover
version over a year ago, and the information I learned still informs my research
and discussion on HIV/AIDS today.”

“Your decision to make The Wisdom of Whores available in the form of e-book is much appreciated. I write from Nepal and for us first it is a challenge to get a copy, and second the price of books printed abroad is significant.”

The eBook is no longer available on this site, but you can find information about e-readers here.

In respect of the paperback cover pictured above which I whined about and now love, I would like to offer to Granta the nine words that are so hard to come by in the English language:

I was wrong. You were right. I am sorry.

It´s official. Taking antiretroviral drugs when you don´t have HIV cuts the risk that you´ll get infected. It´s exciting news, if not unexpected. But it´s going to be a major headache for politicians.

The results of the iPrEx trial, were published today in the New England Journal of Medicine (with pdf but not the supplementary bits here). The trial was among 2470 gay men and 29 transgendered women in six countries. Everyone took a pill a day; half were randomly assigned to take a combination of tenofovir and emtricitabine (sold by a now very happy Gilead under the brand name Truvada), the other half got a placebo. Neither participants nor researchers knew which was which.

The published headline: people who took Truvada were 44% less likely to contract HIV than people who took the dummy pill — an encouraging result, if not stunning. The real headline: people who actually took Truvada nearly all the time were 73% less likely to get HIV: a huge victory. It´s a smaller protective effect than using a condom all the time, of course. The thing is, we know that people aren´t good at using condoms all the time. And what these study results show us is that people aren´t very good at taking a pill every day, either, though they are keen to tell researchers that they do. One of the most striking things about the results was the mismatch between self-reported pill taking and measured levels of active drugs in people´s bodies.

The researchers cleverly did a study within a study to try and figure out how important it was that people dilligently took their pills. Among people who actually got Truvada, they compared intracellular and plasma drug levels in those who got HIV with a random sample of those on Truvada who didn´t get infected. They found that only 9% of those who got infected had measurable levels of the active drugs in their bodies, compared with 51% of those who didn´t get infected. To put it very bluntly, pre-exposure prophylaxis dosn´t work it you don´t take your pills.

Let´s remember that this was a group of men who were poked, prodded, bled and counselled by study staff every FOUR WEEKS, and they still weren´t taking their pills every day. It´s not all that clear why, though men who got the real drug were more likely than those on the fake pills to report nausea. It´s possible that people were less motivated to take their pills if they weren´t sure that they were actually getting real drugs, or even that if they were, the drugs would actually work as prevention. That may also be why guys in the study didn´t report any rise in risk behaviour (though it´s hard to imagine that they could; 80% of them reported at the start of the study that they´d had unprotected anal sex with someone who might be HIV infected). But it´s a worry; if PrEP goes mainstream for gay men, we´ll need a lot more work on how to get people to take their drugs more diligently.

Another major worry: 10 people who tested negative at the start of the study were actually in the very early stages of HIV infection. Both of the 2 who happened to be assigned to the Truvada group developed resistant forms of the virus, suggesting that giving these drugs in the early stages of infection when the virus is replicating very rapidly may fertilise resistant strains. More shocking to me (though less worrying) was that half of the men who had acute early HIV infection at the start of the study had symptoms of the infection, but none were picked up by the study physicians. This is a pet peeve of mine; bad enough in routine health services but nothing short of a disgrace in a study designed specifically to look at HIV infection in high risk men.

Worries about resistance aside, the news seems pretty good. So why do I say it´s a political nightmare? Because antiretroviral drugs are expensive; a lot of people who need them to prolong their lives can´t get them. Now we´re talking about giving them to gay guys so that they can go out and screw around as much as they like without having to think about using the cheaper and potentially more effective (but generally more bothersome) option of condoms. I´ve been a bit sniffy about this myself in the past, though I did spend about 15 years taking a pill every day so that I could have as much sex as I liked without contracting that long-term, life-changing sexually transmitted condition called pregnancy. But in many countries it is still very hard to give out condoms because it is seen to promote promiscuity. If we could figure out a way to improve adherance, putting ARVs on the public tab will probably save money overall. It´s certainly something we should be trying out in all sorts of different ways. That includes the possibility of “disco dosing” — taking pills only on the days when one has a pretty good idea that one´s going to end up barebacking. But as condoms have taught us, the fact that things work technically doesn´t necessarily mean they work in real life, let alone in politics. Even if we can find a better way to deliver pre exposure prophylaxis (implants? it´s what I do instead of pills these days against that other STD, and I love it) I think it is going to be a hard sell in many countries.

For more, see Roger Tatoud´s reflections on the wisdom of taking a pill every day to avoid taking a pill every day.

Still, for now the news is good. Click on the image at the top of this post, add your own positive Truvada story, and get 5 free mp3 downloads. I think it´s worth celebrating a bit while we can.

Illustration by Fernando Vicente

This week, the Great and the Good of the AIDS industry gather in Vienna for the biennial AIDS circus. With delicious irony, the conference, held right next to the barracks of the UN’s Drug Warriors, will focus in part on getting more countries to do the one thing that really works in HIV prevention — providing clean needles to drug injectors.

That means that there will be a lot of talk about the evidence base. There’s always a lot of talk at these conferences, and although I escaped Vienna just before the start of the conference (to see the inimitable Grace Jones play Lovebox), I’m as much of a windbag as anyone. While pontificating in the BMJ video (below) about the evidence base for harm reduction, I think there’s a more important point to be made to the small coterie of scientists who wash around in the larger tide of 20,000 AIDS junkies, Poz Professionals, singing orphans, dancing hookers, jostling NGO workers, bewildered journalists and UN PR-wallahs that floods these conferences.

The point, made at greater length in an essay in the Lancet (pdf), is that we can’t look at scientific evidence in isolation. [The collage at the top of this post comes from the essay. For works of both anatomical and philosophical beauty, do browse Fernando Vicente's illustrations]. Yes, there’s lots of scientific evidence that harm reduction saves lives. But there’s a huge body of political evidence, too. And that evidence suggests that politicians do what voters want, or, at very best/worst, what politicians think they can get away with. For many politicians in many countries for many years, that has meant not spending voters’ money on helping people take drugs more safely.

As long as that is true, the scientific evidence will continue to be secondary. No matter how many well-spoken epidemiologists do their bit on YouTube.

Or, for that matter, how many nice people stand at the entrance to festivals such as Lovebox handing out orange wristbands that read “Nice People Take Drugs”. As I wandered in with my happy band of blue-tongued smurfs, I reflected that if ever there was a case of preaching to the converted…
But I also take issue with the statement, which has a UNICEF lobbyist ring to it. “Most people at risk for HIV are young” does NOT translate into “Most young people are at risk for HIV”. Nice people take drugs, certainly. But are we to believe that most people who take drugs are nice? Maybe yes, maybe no; since a majority of young people in the UK take drugs, it rather depends on your view of human nature.

Still, the folks at Release who run the campaign have come up with some fun ideas. I especially like the “Politicians Drug Confessions” playing cards.

You can buy them here.

SANGRAM has long worked constructively with sex workers, to the fury of Congressman Mark Souder who stomped on USAID until they shut down funding for SANGRAM. In a letter to USAID as bombastic, self-righteous and threatening as any I have seen, Souder pontificated about the Bush administration’s record in promoting family values and women’s rights.

“There is a tragic irony in the fact that this administration seeks to elevate women in the United States to some of the most important positions in the country…; yet, USAID has funded groups outside the United States that promote the ultimate degradation of women.”

Souder might know something about the degradation of women. Six weeks ago he resigned as congressman after 15 years, admitting to having an affair with a staffer. He started off on script, apologising for the pain he had caused his supporters. But then, with breathtaking arrogance, he stuck up for his own hypocrisy, saying “The ideas we advocate are still just and right.” I’m sure his wife agrees.

Here’s the pompous windbag being fake-interviewed by his girlfriend about the importance of abstinence-only education programmes.

Of course abstinence-only programmes are only meant to work until people get married. Since both Mark Souder and his squeeze Tracy Jackson are married, they hardly count as failures of morality-based sex ed, do they?

(Thanks to Paddy Woodburn for pointing out the Seshu profile and setting me off wondering whatever happened to that windbag Souder…)

If you’ve only got four minutes, I would also thoroughly recommend spending it with comedian Julia Sweeney, as she has the “sex talk” with her daughter.

These groups look to Sweden as their model, or at least half of it. Arguing that all prostitution is violence of men against women, the Swedes in 1989 made it illegal to buy sex (even from men and transgenders, go figure). Arresting and fining punters was supposed to strike a blow against partriarchy, advance the feminist cause, and, of course, reduce violence against women. Here’s what has happened since the law was passed:

At a cost to the Swedish tax payer of over US$ 7 million a year, Sweden has, over the last four years, convicted an annual average of three people for trafficking and 18 for pimping, and has fined an average of 75 men a year for buying sex. Street-based sex work did nose-dive soon after the law was passed, then stabilised and remains constant. There’s no information about what’s happened to women selling sex in other venues, including apartments, clients’ homes, neighbouring Denmark… What we do know is that convictions for rape have increased by 28% since it became illegal to buy sex, and convictions for sexual crimes overall have increased by 68%. Some of this may be because the hoopla surrounding the law did effectively advance the Ice Queen agenda, and more women are successfully prosecuting men under the country’s incredibly vague “rape” laws. But it hardly fills one with confidence that “end demand” campaigns will reduce violence against women overall.

Chicago’s abolitionists are a strange miscegenation of paternalistic feminists (I’ll tell you when you can and can’t consent to sex, dear) and tub-thumping moralisers (extra-marital sex is bad, and convenient, no-strings, paid extramarital sex is much, much worse). They have both failed to grasp the logic that underlies the Swedish approach. If all sex workers are victims by definition, then it is hardly fair to bang them up in jail for the violence that is done to them. And indeed, in Sweden, people who sell sex can’t be prosecuted. In Chicago, on the other hand, we’re busy increasing the penalties for both the buyers and the sellers of sex. So we are:

1) depriving women (and men, and transgenders) of their right to consent to sex, if payment is involved

AND
2) depriving women (and ditto) of a living

AND
3) depriving women (and other prostitutes) of their liberty, if they get caught.

You’d think from the Chicago police department’s Rogues’ Gallery that the only people who get arrested for soliciting and prostitution are blokes and the odd trans. But that just reflects a policy decision only to put up photographs of people with Y chromosomes. If you delve into the stats a bit, you’ll find that women bear the brunt of prostitution-related arrests right now. Look at this:

It’s already illegal both to sell sex and to buy it in Chicago, and indeed all of Illinois. Making it MORE illegal on both sides, which is what HR6195 is proposing to do, is not going to change that. What it may change is the overall volume of arrests, since a felony is more likely to lead to a court case than a misdemeanour, which is what most prostitution charges currently qualify as. More court cases mean more police time in court. And since Illinois cops are paid time-and-a-half with a three hour minimum for showing their face in court, that rather increases the incentive to arrest. And as you can see from the graph above, it’s easier to arrest women than men. So my question to the good feminists of End Demand is this: How, exactly, do they think HR6195 helps women who choose to sell sex for a living?