The Wisdom of Whores

I’ve been taken to task for not commenting on the ink-blot of corruption that is spreading inexorably across the Global Fund for AIDS, TB and Malaria. But really, the revelation that dosh sloshed out by the GFATM gets swilled into politicians’ pockets is about as exciting as the discovery that FIFA board members accepted a free dinner or two from Russian oligarchs before awarding the World Cup to Moscow. As the AIDS mafia has joked for years, it’s not called the “ATM” for nothing.

So instead, I’ll have a rant about something that is somehow still shocking to me: the lengths to which loopy anti-abortion groups in the United States will go to deprive women of safe contraception and sexual health care. The target, once again, is Planned Parenthood. Over a one-week period last month, men went in to the sexual health service providers clinics in 11 cities, claiming to be sex traffickers seeking services, including abortions, for the underage girls they’ve enslaved. That would be a really dumb strategy for a real sex trafficker — in the US, even more than in Britain, the authorities are under pressure to find the army of enslaved girls that the abolitionists conjure up at every turn. It’s a well-hidden army; though a massive UK crackdown led to over 500 arrests related to selling sex a while back, it didn’t yield a single trafficker. Not that that has stopped the abolitionists’ conjuring. Shame on The Guardian for not referring back to its own excellent investigative work in this area.

Planned Parenthood immediately suspected that no trafficker would be that dumb. Certainly not 11 traffickers in different cities in a week, when such a thing had never happened before. Though it smelled like a hoax, they dutifully reported the alleged trafficking to the FBI and asked for an investigation. Now Loopy anti-abortionist group Live Action has admitted, with some pride, to their juvenile prank. They’ve released two of their “undercover” videos, to which they’ve they added juvenile-prank-style title screens.

My personal favourite: “Planned Parenthood Gets the Pimp Discount for His Underage Sex Slaves”. I will say that the clinic manager in New Jersey sails pretty close to the wind. But then which of us who has tried to provide services for people in need who have nowhere else to go does not bend the rules? As Planned Parenthood says: “Falsely claiming sex trafficking to health professionals to advance a political agenda is an astoundingly cynical form of political activity.”

Compared to this, the standard operating procedures in the AIDS world — using Global Fund money to buy 4x4s for officials — seem somewhat tame.

Update: (or rather backdate). Steve sent me this interesting reminder of an earlier assault on Planned Parenthood. Sigh.

On the one hand, Canada bans Dire Straits. On the other, it fills the streets with posters aimed at extricating sex workers from social non-existence. Halifax group Stepping Stones is running an ad campaign reminding people that hookers are mothers, daughters, brothers, friends. They are also PhD students, civil servants, dental hygienists, actors and many other things when they’re not with a client, and shiatsu therapists, shrinks, grief counselors, actors and many other things when they are. Oh, and criminals (though it is my burning hope that this won’t be true in Canada by the end of the year).

It’s that criminalisation which creates stigma and the need for campaigns like this; the stigma in turn makes it hard to run these campaigns. The Chronicle Herald reports that ad agency Extreme Group‘s staff used their own grandmothers and Sepping Stones employees for the campaign because “regular” models didn’t want the job.

Also fighting invisibility are sex workers in Ottawa. There, Chris Bruckert and Frederique Chabot worked with members of prostitute group POWER to publish a synthesis of what sex professionals said about their work, and (perhaps more importantly) their work-life balance. Many of the comments reminded me just how hard it is to maintain that balance in any profession which society deems an identity rather than an occupation (film star, Royal, hooker). Here’s Janette, talking about how the police treat her when she’s not working:

“I was showing my new neighbour around, walking him up to the food bank. And as we were walking, one cop turned around and told the young man I was with ‘Do you know you are with a prostitute? You could get in trouble for that’. He yelled at the cop ‘She is my neighbour and I don’t care what she does for a living, she is helping me out. She is still a person’. I was so embarrassed. That did bring tears.”

You can read the whole (.pdf) report here. Stepping Stones have published a similar volume, which I haven’t yet read, called Sex Workers Talk Back.

It’s not that I think Canada is an over-protective nanny state full of cry-babies who had their sense of humour excised at birth and wouldn’t recognise irony if it bit then on the bum or anything. But really, scrubbing the airwaves of Dire Strait’s “Money for Nothing” because it uses the “F”(aggot) word is a bit much.

The song was banned by the Canadian Broadcast Standards Council after a solitary Eljibiti radio listener whined that it bruised their fragile soul.

Every reader my age knows the “MTV” song virtually by heart — boneheaded delivery men being grumpy about the absurd amounts of money made by boneheaded musicians with more mullets than talent. The offending lyrics include the following:

“See the little faggot with the earring and the makeup
Yeah buddy that’s his own hair
That little faggot got his own jet airplane
That little faggot he’s a millionaire”

Our Sensitive Soul found this “extremely offensive” and labeled it “discriminatory”. Since the complainant says they are a member of the Eljibiti Community, I’m assuming they consider it to be offensive to gays rather than to rock stars. But that confuses me. A pop classic which won the Grammy for record of the year in 1986 portrays homophobia as a sentiment expressed by bigoted and resentful boneheads. One person in Newfoundland, who apparently has not mastered the skill of switching off the radio, considers the association of homophobia with stupidity to be offensive. And six adults of sound mind meeting on behalf of the Canadian Broadcast Standards Council spent I’m not sure how much time coming up with a 5000+ word decision that boils down to this: “The song contained a word that referred to sexual orientation in a derogatory way.”

Give me strength.

The decision makes for amusing reading, dredging as it does through the history of similar complaints. It seems that even more sensitive souls have in the past been upset by songs and skits about cigarettes (fags, to a good British sometime smoker such as myself). Of course the way Canada is going, it’s not impossible that cigarettes will soon be outlawed, with all evidence of their existence digitally excised from old Humphrey Bogart films.

In fairness, I should note that the overwhelming majority of Canadians of all sexual hues commenting on the Globe and Mail’s report of the ban think it is just plain silly. But I think I’ll try be more careful about my “hookers, fags and junkies” shorthand when I next visit Canada, just in case. I wonder if any radio listeners in Newfoundland are offended by any of these words: Big. Girl’s. Blouse.

Today, the world of public health research changed for ever. Or so I hope. The institutions that fund most health research in developing countries (and a good deal of research in rich countries too) have finally launched an assault on Data Hugging Disorder. They are pushing the scientists they fund to put any data they collect in the shared scientific domain.

The broadside against the culture of data-hoarding that dominates in public health is published today in a joint statement on data sharing signed by 17 institutions, including the three biggest funders of public health research globally: The U.S. National Institutes of Health, the Bill and Melinda Gates Foundation and the Wellcome Trust. Other signatories include the World Bank, the U.S. Centers for Disease Control, national research councils from the UK, France, Germany, Canada, Australia and New Zealand. (Here’s the full list.)

I’d like to have had a more bombastic introduction. “From this day forth, all data collected by researchers who are paid by taxpayers or tax-exempt charities will share those data with the world”. I implied as much in a comment in the Guardian. Actually, the statement doesn’t go anything like that far. Indeed it’s pretty fluffy, couched in terms of principles and goals rather than requirements. But having helped draft the fluff, and been part of nearly three years worth of discussions leading up to it, I think it is a damned good start. Perhaps surprisingly, many of the key institutional players would have liked to go much further, but they were shouted down by their legal departments.

So the statement doesn’t actually commit institutions to do anything concrete. But implicit in its goals are important changes to the culture that makes us researchers so mean with our data. These mega-funders say they aim to reward us for publishing data, not just papers. They aim to support data management, so that data can be shared practically. Data management has always been the most neglected and undervalued part of the research enterprise in public health (something I’ve ranted about before in print (pdf) and on air; I’m looking forward to researchers rewriting their budgets so that the funders can put their money where their joint statement is. And they aim to make sure that the scientists in developing countries who do a lot of the grunt work of collecting data of interest to global health do not get “scooped” by data munchkins sitting in Seattle or Geneva with squigabytes of processing power and a constant electricity supply. The equity principle was firmly stressed in a commentary about data sharing published in The Lancet today to go with the Joint Statement.

Some researchers will feel queasy about sharing their data; it is hard not to feel ownership when, night after night after exhausting night, you’ve driven your motorbike at 4.30 am through the entrails of the red light district in the rainy season to get them to the lab in good order. But the truth is that “my” samples, and the data they produce, are first and foremost owned by the people who gave them to me — and data tied up on my hard drive waiting for me to get around to writing that third paper about the study (when I’ve finished my next grant application and the IRB paperwork for my current study) are not doing those people any good at all. The other thing that we’re all worried about is that other people will get to see how filthy our data really are. But that’s surely a reason to let more light in, not less.

So today’s statement, fluffy though it is, is a cause for major celebration. The funders say they are putting together working groups to start developing the infrastructures and data standards we need, as well as to change incentive structures so that universities as well as funders support data sharing. It’s up to us researchers to muscle in to those working groups, to make sure that an Open Data world works for us as well as for our paymasters and, most importantly, the people who we prod, poke and bleed in our studies.

Seasonal silliness from my family. I’d like to claim to be the stylish one on the ski-bob, that odd bike thing with skis where the wheels should be, but I’m afraid that accolade goes to my father. He’s on the bike in the final video clip (I precede him on the sled). But for the fact that he dropped his cigar in the snow, you’d never know he was 75…

Happy Christmas to everyone kind enough to read this blog, whatever your religion, thoughts about gift-giving, tolerance for sappy music etc. Extra thanks to people who’ve taken the time to post responses (including and perhaps especially critical responses) , or to write to me with comments and suggestions.

Year-end tends to be quiet on the work front: the time all those neglected peer reviews float to the top of the To Do list. Like so many others, I review out of a sense of duty. That same sense of duty often obliges me to say horrid things about papers or grant proposals that people have slaved over, but that just don’t make the grade. One is always worried that one is ruder than other reviewers, but more worried about allowing money or trees to be wasted on tosh. So I was delighted to find that other reviewers are just as rude.

The editors of Environmental Microbiology have published a year-end round-up of some of their more notable reviews. (pdf)

A couple that made me feel better about some of the things I’ve said:
“I suppose that I should be happy that I don’t have to spend a lot of time reviewing this dreadful paper; however I am depressed that people are performing such bad science.”

My personal favourite, because it mirrors how I feel today:
“The writing and data presentation are so bad that I had to leave work and go home early and then spend time to wonder what life is about.”

In the spirit of year-end cheer, let’s pull out some praise, too:
“Many spend much more time and space to say considerably less.”

It’s funny, isn’t it, that well-honed criticism seems so much sharper a weapon in attack than fullsome praise does in defence. It’s not just in peer review. I’ve recently been enjoying dipping in to a glorious collection of reviews of perfumes, published by Profile in the UK and Penguin in the States.

Here the rapier:
Desir deRochas Femme (Rochas) bleached rose
Thoroughly unpleasant fresh-rosy floral that whines like a dentist’s drill and hurts almost as much.

Here the back-handed compliment:
Deseo (Jennifer Lopez) coconut melon
Deseo is a clever mix of sauvignon blanc and Bailey’s, or in perfumery terms, Envy and Rush. Separately, its components would cause, respectively, a toothache and tooth rot. Together they work happily to produce a shortlived but superbly trashy fragrance for eighteen-year-old girls on the prowl.

And here the fullsome praise:
Le Feu d’Issey (Issey Miyake) milky rose
Whoever did this has that rarest of qualities in perfumery, a sense of humour…A reminder that perfume is, among other things, the most portable form of intelligence

Thanks to First Among Peers Mark Zip for the head’s up on peer review, and to Andrew Franklin for causing me to spend hours of my life buried in reviews of a product I don’t even use.

Clearly someone in the New York City health department believes that HIV sucks, even in a post-AIDS world. Here’s their brave new ad, targeted at the gay men among whom the majority of new infections in the city occur in this age of treatment. Pity about the Hollywood trailer soundtrack.

Predictably, most of the comments on the YouTube site are of the “This stigmatises gay men, especially those with HIV” ilk. More nuanced views over at Towleroad, one of the most consistently rational and informative gay blogs.

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.

The East London Borough of Hackney is trying to wipe lap dancing clubs and sex shops out of my back yard. I’m pleased to see men of the cloth joining me in pointing out that since the businesses are perfectly legal, it is not the goody-two-shoes local councilors’ job to abolish them.

The Vicar of St Leonards Shoreditch, says it is not for the local government to impose a moral code on its citizens. I agree with Paul Turp that it’s inappropriate for the council to decide which (absolutely legal) businesses may and may not operate in an area already desperately short of jobs. But I myself am especially infuriated at the way they are trying to do it.

I stumbled on the council’s clumsiness a couple of months ago, when I was responding to a call for opinions about a new one way system. There on the website was a “Consultation” asking for our opinions about a new sex shop licensing regime. Along with a paper telling us why they’ve already decided what they are going to do, there’s a draft of what they are planning to do, and a questionnaire.

Here’s the key paragraph from the planned policy:

1.5 The Council has considered the character of its wards and determined that the appropriate number of sex establishments for each ward is nil. It will not allow further licences to be granted where the appropriate number is exceeded. Please refer to paragraph 5 for more details.

There follows another nine pages of gumph before one gets to the critical paragraph 5. What that does is list the total number of lap dancing clubs, sex shops and erotic cinemas the council has deemed appropriate per ward:

…and so on, for all 19 wards. And then the coup de grace:
“5.1.4 There is no right of appeal against a decision based on this element of the Policy.”

So all that precedes and follows it, including the detailed description of the appeals process should your application get turned down, is null and void. It appears that the “consultation” itself may be null and void. Despite putting forms on its web site, the Good Governors of Hackney have decided that “Any unsolicited comments will not be taken into consideration”. And just to hedge their bets even more fully against undesirable opinions such as those of the highly respected vicar of one of the most socially engaged parishes in east London, we have this:

“2.4 The Licensing Authority will give due weight to the views of those consulted and amend the Policy where appropriate following responses received. In determining what weight to give particular representations, the factors to be taken into account will include:
• who is making the representation (what is their expertise or interest)
• what their motivation may be for their views
• how many other people have expressed the same or similar views
• how far representations relate to matters the Council should include in its Policy.”

Having spent many a long year living in countries where I am allowed to pay taxes but not allowed to vote, this is my first real experience of grass roots democracy at work. I’m looking forward to seeing whether our concern that men and women in Hackney ought to be allowed to do whatever work they please within the limits of the law is upheld in this process. Any readers who live in Hackney, or know anyone who does, are urged to respond to the consultation before December 13th.

At a conference in Mexico recently, I ran into Wired editor Chris Anderson. His essay on the petabyte age, published a couple of years ago, sounded the death knell for scientific method. I was seduced by the argument at the time, as well as by the beautiful graphics that accompanied the piece. Visualising Big Data can be a pleasure, as this graphic of edits of Wikipedia pages shows.

But when I started to dig around, I found that there’s nothing new about Big Data. People have been complaining about the data deluge since the 1600s.

“One of the diseases of this age is the multiplicity of books; they doth so overcharge the world that it is not able to digest the abundance of idle matter that is every day hatched andbrought forth into the world,” thundered Barnaby Rich in 1613. He himself contributed 26 books to the multiplicity and eventually gave his name to the Barnaby Rich effect: “a high output of scientific writings accompanied by complaints on the excessive productivity of other authors.”

What about the fact that new technologies are allowing us just to throw gobs of data at the wall, see what sticks, and turn that into a new theory, rather than starting with a hypothesis and laboriously collecting the data to confirm or refute it? In an essay just out in Prospect I’m forced to conclude that hypothesis driven science has always been a bit of a myth, shaped more by the way science is funded than by the need to create or maintain rigour.

I had fun writing the essay because it gave me an excuse to sit in the rare manuscripts room of the glorious Wellcome Library, rummaging through books written 300 years ago by the fathers of data mining and scraping, John Graunt and William Petty. As I note in the essay:

In one of his “Essays on Political Arithmetick,” Petty took death rates collected for another purpose, stirred them with a couple of wild assumptions on population, and seasoned them with a dash of prejudice to conclude that British hospitals were much less likely to kill their patients than French ones, where “Half the said numbers did not die by natural necessity but by the evil administration of the hospital.” In a precursor to the World Bank’s habit of pricing productivity lost by ill-health, Petty goes on to calculate the cost of the unnecessary deaths, valuing the French at £60 each, “being about the value of Ariger Slaves (which is less than the intrinsik value of People at Paris).”

English commentator trashes French health system. Indeed, there’s nothing new about the way we use data…

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.

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.

The kerfuffle surrounding the Pope´s comments on condoms continues. As the gender of hookers allowed to use condoms switched in translation, the Pope´s spokesman was asked to clarify. Apparently, HIV-infected people can use condoms to protect their partners:

“Whether it’s a man or woman or a transsexual.”

Of all the men I know who regularly wear dresses, Benedict was the last I expected to be embracing the rights of transgenders to protect themselves and their partners from HIV infection.

Many people have commented that as long as reproduction´s not in the picture, he can say whatever he likes about condom use. I´ve yet to hear of a transgendered woman giving birth, so that might be part of the equation here (though note that women who sell sex to men are also encouraged to “take responsibility”). But I’m in an optimistic mood today, and I think the Vatican could be trying to ease open the door to a more rational existence. Miracles just might happen.

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.

So our old friend Pope Benedict has come round to the idea that there are times when wrapping one´s penis in latex will not consign one to eternal damnation. According to the New York Times, he cited just one instance when it might be ok to use a condom.

Benedict said condoms were not “a real or moral solution” to the AIDS epidemic, adding, “that can really lie only in a humanization of sexuality.” But he also said that “there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.”

Some are excited that the Pope seems to be opening the door, if only by a hair´s breadth, to a greater acceptance of condoms. Could this be a turning point in HIV prevention? I´ve been asked. I´d say certainly not. Catholics do all sorts of things the Pope forbids, including using contraception extremely liberally, as long as it suits them. The only time they really take any notice of what he says is when it gives them an excuse to do what they would probably rather do anyway, like not use condoms.

I´m much more excited that the Pope has opened the door for discussion of one of the most neglected issues in the sex trade: male prostitution. It´s not clear from his comments if the Pope had any specific gender of client in mind when he said rent boys would be taking a step towards holiness responsibility by using condoms. Since he is a virgin, of course, any suggestions that male sex workers sprung to mind because of personal experience would be thoroughly scurrilous. But I´ll leave the discussion of the potential consequences of the papal embrace of male sex work to those far better qualified to comment than I.

One friend suggested that perhaps the Vatican should start marketing its own brand of condoms, under the brand name “Swiss Guards”. I like it.

For the news that really does have the potential to change the face of the HIV epidemic, watch this space. Tomorrow sees the release of the results of the first large trial of the use of antiretrovirals among uninfected people, to protect against HIV. Expectations are running high.

In passing, let me say that I think the Pope has more to worry about than latex. I went to mass yesterday in a small village church in the foothills of the Sierra Nevada de Santa Marta, in northeastern Colombia. I expected the tiny church to be packed, and, arriving only 10 minutes after the appointed mass time, sat about half way back. By the time mass started 15 minutes later, there was only one other person on my side of the church. The whole congregation totalled fewer than a dozen, including the choir and the two dogs that spent the mass licking my toes. This did not stop the young priest barking at us through a massively over-amplified sound system, reminding us that to sin was to walk naked through the streets.

Really, these Catholic clerics. Each to their own fantasy…

I’ve just spent an interesting couple of days at the Cuidad de las Ideas festival in Puebla in Mexico. I spoke of sex and drugs as usual; Puebla being one of the more conservative towns in this still overwhelmingly Catholic country, some were perhaps shocked by the directness of my language. But I was more shocked still by the absurdity of some of the responses.

One woman, who tends as many in the audience towards the well-preserved Russian hooker look, asked me afterwards whether it was true that HIV could pass through a condom. I get that a lot, so I just explained how daft the idea was. “Ah! I’m a Doctor of Psychology and I didn’t know that,” she said. That slightly floored me, but it was nothing compared with what followed: “You said there was not much good news around HIV. But my colleagues tell me there is, that nowadays homosexuality is 80% reversible.”

This in a country whose capital already allows gay marriage. Apparently there is still a long way to go…

Para los Hispanofonos, aqui la presentacion. Tampoco uno de mi mejores, pero se hace lo que pueda.

The New York Times has cottoned on to the unpredictable glories of Indonesia. But they’ve got it just that little bit wrong. Here’s what they have to say about US President Obama’s childhood minder:

“His nanny was an openly gay man who, in keeping with Indonesia’s relaxed attitudes toward homosexuality, carried on an affair with a local butcher, longtime residents said. The nanny later joined a group of transvestites called Fantastic Dolls, who, like the many transvestites who remain fixtures of Jakarta’s streetscape, entertained people by dancing and playing volleyball.”

If Obama’s nanny was playing volleyball on teams like those that now take on the cops behind the Melia hotel, he was not an openly gay man, she was a waria, or transgender. As you can see from the photo above, waria live as women — they even do the whole beauty pageant thing. She probably didn’t carry on an affair with a butcher — it’s more likely she was “married” to him. Indonesia’s attitude to homosexuality in the late sixties was not relaxed, it was unbelieving. Waria, on the other hand, are just a part of society; in some provinces, though not Jakarta, Waria is an accepted gender on the all-important national ID cards. Finally, transvestites don’t hang around the streets singing. They hang around the streets cruising for people who will pay them for sex.

Still, nice to see the Times ticking the “exotic diveristy” box as best it can.

My parents were among the 200,000 people who gathered in Washington DC at the weekend in the Rally to Restore Sanity. Best banner of the march? This gets my vote:

Thanks to AW for supporting the cause.

Can you protect your nation from HIV by testing immigrants for the virus? Even the United States now thinks that’s a daft idea; it finally dropped its HIV testing requirements for immigrants earlier this year. Now South Korea has followed suit, sort of. The country will drop HIV testing for some, though it has announced different rules for teachers and entertainment industry workers.

Should the International Union of Sex Workers start girding their loins to fight for equal rights for hookers? No. Seoul has decided that people applying for entertainment industry visas do not need to be tested for HIV. People wanting to teach English do. An official of the Ministry of Education, Science and Technology explained the decision thus: “Education is considered a very intimate relationship. According to an unofficial survey by the Prime Minister’s Office, the majority of parents wanted solid evidence of their children’s teachers’ HIV status.”

The implication — that English teachers from Wisconsin are more intimate with their clients that hookers from Vladivostock are with theirs — is clearly absurd, and the Korean authorities are squirming a bit about the silliness. But it reminds me of a piece of ancient history in the HIV industry’s cooking up of Stigma Soup.

Many years ago, we were trying to come up with ways of measuring HIV-related stigma in international surveys. We suggested three questions: Should HIV infected nurses be allowed to treat patients in hospital? Should HIV infected teachers be allowed to teach? Would you buy cooked food from someone with HIV? To everyone’s surprise, a lot of respondents in African surveys replied no, no, yes. So was HIV stigmatised, yes or no? A bit of qualitative work shed more light. HIV-infected nurses shouldn’t be allowed to treat patients because they had compromised immune systems and it was better for them not to be around sick people. Not all that stigmatising, then. Food sellers? What? Everyone knows you can’t pass on HIV in a pot of stew! No stigma there, either. But teachers, what about teachers? Well they’re always having affairs with the pupils; we don’t want our daughters to get anywhere near a positive teacher. It strikes me that’s stigmatising of teachers, though not necessarily of HIV.

While we’re on the subject of HIV and immigration, I do think it remains the great untouched subject of the UK HIV epidemic. A first glance at figures provided by the soon-to-be late and very much lamented Health Protection Agency shows us a great wave of heterosexual infections in the UK.

If you take away the infections that are diagnosed in people who were born in a sub-Saharan or Caribbean country with high HIV prevalence, the picture looks very different indeed:

The difference is assumed to be the infections that are “imported”. In fact, there may well be quite a bit of transmission within communties of African-born people in the UK. But there’s virtually no effective targeted prevention programmes for that group, because we’re all so scared of two things. [Note comment on this point] Firstly, the Daily Mail getting hold of the issue and beating up support for a “test the immigrants” campaign. Secondly, the idea that targeted prevention would be stigmatising. Imagine, it might engender a backlash from all those Pentacostal Churches in East London. And then we’d be in the same situation that so many African countries are in: community leaders choosing to deny a problem rather than help their people by dealing with it.