Profile: Elizabeth Pisani

Elizabeth Pisani is an epidemiologist, who has spent a decade specialising in HIV/Aids. Lucy Knight

Early Life

Born in 1964 to an American father and an English mother, Elizabeth Pisani found herself placed in a number of different British schools throughout Europe.

Eventually her family arrived in Dorset where she took her O-levels. She then attended a sixth form college in Richmond. It was probably the peripatetic existence while growing up that left Pisani with itchy feet - a desire not be settled. “I’m lucky really to have been able to live in different countries that could make me curious." At 18 her parents moved to the States, where her brother stayed.

And then she became acquainted with the East. “I visited a school friend who was living in Hong Kong and I absolutely loved it. The energy and the bustle were somehow similar to New York where I’d been spending a lot of time, but it was also totally unlike anything else I’d known. Up until that point home had been wherever we were living but here was my first sense of foreignness. I was taken with the idea that there was a quarter of humanity in one country and that I couldn’t communicate with them.” She then later made a bet with someone that she’d read Chinese at Oxford. And what is her Chinese like now? “Well, I can speak it when it comes to discussing the contraction of Aids but then I’ll have trouble remembering the word for spoon.”

Journalism

Once she had her MA she spent time travelling around China and Tibet. It was from there, after considerable ‘wandering’, that she joined Reuters as a graduate trainee in Hong Kong. During the 80s and 90s she work in bureaux in China, Delhi, then Indonesia. “The bureaux I was working in were very small and so I got to cover all sorts of stories.” These ranged from Tiananmen Square to the Indonesian stock market.

And Indonesia got under her skin. She says now it remains a very big part of her life. It was while here that Pisani became interested in population. “The countries I had worked in were three of the then five most populated in the world and I was not enjoying being stuck to a desk. And decided to go learn something new.”

While taking her MSc in medical demography at the London School of Hygiene and Tropical Medicine Pisani discovered epidemiology. “I did both for a while when I went back to Vietnam, writing reports and so on but then I just drifted more and more into the HIV work.” She then also took a PhD in infectious diseases.

Epidemiology

Pisani began a 10 year career working in the field of Aids prevention. “What drew me in? Sex and drugs! Well, I’m interested in politics and how the world works and Aids brings these things together.”

Pisani started at the Centre for Population Studies, working independently for the United Nations (UN), the World Health Organisation (WHO) and then for several Asian charities.

In Asia, Pisani became involved in research of sexually transmitted infections and sexual and drug-taking behaviours in Indonesia, East Timor, Bangladesh, the Philippines and China; discovering that sex and drugs were the major contributory factor to a global epidemic.

“Effective epidemiology is not unlike investigative journalism, the skill base is similar and so I was good at it.”

But the results aren't necessarily that, well, sexy. Pisani feels that her battle has been dealing with governments and publics that want to hear the quirky facts. “In epidemiology you look for the normal. And I cannot tell you how many people have come up to me and said ‘oh men in Africa spread it by fucking virgins because they think it will cure them!’ It drives me mad because that is not the reason why several million people on one continent have it.” As she writes in her book - 'The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS' - "HIV is mostly about people doing stupid things in the pursuit of pleasure or money".

Sex and Drugs

For Pisani the challenge was changing what was driving public policy on Aids prevention. Rather than look at the driving force - sex and drugs - governments instead preferred the sanitised causes like “migration, gender, poverty and development”.

These were the criteria to gain funding. Pisani found an industry hemmed in by political correctness. And she is controversial, refusing to hold back on Africa either. In a recent BBC interview she remarked: “’Africans have a lot of sex’ there I’ve said it!”

On sex workers she is not about to say the oldest profession should be curtailed, rather legalised and regulated. “Plenty of men and women choose to sell sex”.

Pisani is of the belief that Islam and Christianity have been obstructive in the fight against Aids.

The latter, she argues, has been one of the single biggest influences on HIV policy in the US.

And, as she said earlier this year, “policies based in morality, not reality, don’t work”.

The President's Emergency Plan For Aids Relief (Pepfar), has put $65bn into the industry but only for those who sign up to certain conditions, such as condemning prostitution.

Pisani believes the millions of dollars that goes on treatment are also part of the problem.

In an interview with the Guardian earlier this year she said: “You only have to look at the experience of the UK or US gay communities where we've had more or less universal access to ARVs (antiretroviral drugs) for at least eight or nine years, and the number of new infections are rising.

"More people are living longer with HIV, and there is what we call behavioural disinhibition: 'Fuck the condoms; I don't need them any more, because if he's positive he'll be on drugs, so he probably won't infect me. And if I do get infected, it would be annoying, but not the end of the world.'

The book

“It has been, interestingly, essentially big noise but it’s a generalised sigh of relief. I’ve been a bit of a drama queen but there are a lot in the industry that have said it for a long time, it’s just I’ve packaged it in a different form.” The establishment may react by saying that Pisani has said nothing new but she replies with “well why is nothing changing?”

“I don’t think of myself as a campaigner or an activist. There are lots of people working hard and are frustrated. I just get impatient. I’m probably better placed as, well, as a hack.”

And the prevention of Aids? She wants clean needles and condoms, that is her simple solution. As she told the Guardian: “I don't get how it's OK to keep someone alive once they're sick - but not OK to stop them getting sick. I just don't get that."

Elizabeth Pisani is the author of 'The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS'

Picture: David Parkin
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The humbling of Theresa May

The Prime Minister has lost all authority. The Tories will remove her as soon as they feel the time is right.

Being politicians of unsentimental, ruthless realism, the Conservatives did not linger in the grief stage of their collective disaster after the general election. Disbelief, too, was commendably brief.

Currently, their priority is to impose some sort of order on themselves. This is the necessary prelude to the wholesale change that most see as the next phase in their attempt at recovery, which they all know is essential to their career prospects – and believe is vital to a country whose alternative prime minister is Jeremy Corbyn.

For that reason, talk of Theresa May enduring as Prime Minister until the end of the Brexit negotiations in two years’ time is the preserve of just a few wishful thinkers. Some sort of calm is being established but the party is far from settled or united; there is a widespread conviction that it cannot be so under the present leader.

Elements of the great change have been executed, as Nick Timothy and Fiona Hill, May’s former advisers, will testify.

However, this is only beginning, as shown by the debate in the media about how long May can survive in Downing Street. There is dissatisfaction about elements of her recent reshuffle, but it is quieted because few believe that some of the more contentious appointments or reappointments will last more than a matter of months. Her colleagues are also alarmed by the meal she has made of doing what was supposed to be a straightforward deal with the DUP.

The climate in the party at the moment is one in which everything – jobs, policies and, of course, the leadership – will soon be up for grabs. Debate over “hard” and “soft” Brexits is illusory: anyone who wants to be Conservative leader will need to respect the view of the party in the country, which is that Britain must leave the single market and the customs union to regain control of trade policy and borders. That is one reason why the prospects of David Davis, the Brexit Secretary, are being talked up.

Some of May’s MPs, for all their hard-mindedness about the future, speak of feeling “poleaxed” since the general election. Even before the result changed everything, there was dismay about the bad national campaign; but that, it was felt, could be discussed in a leisurely post-mortem.

Now, instead, it has undermined faith in May’s leadership and credibility. “The social care disaster was key to our defeat,” an MP told me. “It wasn’t just that the policy damaged our core vote, it was the amateurishness of the U-turn.” A more seasoned colleague noted that “it was the first election I’ve fought where we succeeded in pissing off every section of our core vote”.

The limited ministerial reshuffle was inevitable given May’s lack of authority, and summed up her untenability beyond the short term. Most of her few important changes were deeply ill judged: notably the sacking of the skills and apprenticeships minister Robert Halfon, the MP for Harlow in Essex, and a rare Tory with a direct line to the working class; and the Brexit minister David Jones, whose job had hardly begun and whose boss, Davis, was not consulted.

George Bridges, another Brexit minister, who resigned, apparently did so because he felt May had undermined the government’s position in the negotiations so badly, by failing to win the election comprehensively, that he could not face going on.

Much has been made of how Philip Hammond, the Chancellor, was marginalised and briefed against, yet reappointed. Patrick McLoughlin, the party chairman, suffered similarly. Conservative Central Office was largely shut out from the catastrophic campaign, though no one got round to briefing against McLoughlin, who kept his head down – unheard-of conduct by a party chairman in an election.

As a political force, Central Office is for now more or less impotent. It has lost the knack of arguing the case for Conservatism. MPs are increasingly worried that their party is so introspective that it just can’t deal with the way Corbyn is spinning his defeat. “An ugly mood is growing,” one said, “because militant leftism is going unchallenged.” That cannot change until May has gone and the party machine is revived and re-inspired.

***

Nobody in the party wants a general election: but most want a leadership election, and minds are concentrated on how to achieve the latter without precipitating the former. One angry and disillusioned ex-minister told me that “if there were an obvious candidate she’d be shitting herself. But most of us have realised Boris is a wanker, DD isn’t a great communicator and is a bit up himself, Hammond has no charisma, and Amber [Rudd] has a majority of 346.”

On Monday a group of senior ex-ministers met at Westminster to discuss next steps. It was agreed that, with the Brexit talks under way, the most important thing in the interests of restoring order was securing the vote on the Queen’s Speech. Then, May having done her duty and steadied the proverbial ship, the party would manage her dignified and calm evacuation from Downing Street.

Those who agree on this do not always agree on the timing. However, few can make the leap of imagination required to see her addressing the party conference in October, unless to say “Thank you and goodnight” and to initiate a leadership contest. Many would like her out long before then. The only reason they don’t want it this side of securing the Queen’s Speech is that the result, as one put it, would be “chaos”, with a leadership contest resembling “a circular firing squad”.

That metaphor is popular among Tories these days. Others use it to describe the ­apportioning of blame after the election. As well as Timothy and Hill, Lynton Crosby has sustained severe wounds that may prevent the Tories from automatically requesting his services again.

Following the Brexit referendum and Zac Goldsmith’s nasty campaign for the London mayoralty, Crosby has acquired the habit of losing. And then there was Ben Gummer, blamed not only for the social care debacle, but also for upsetting fishermen with a vaguely couched fisheries policy. These failings are becoming ancient history – and the future, not the past, is now the urgent matter – yet some Conservatives still seethe about them despite trying to move on.

“I haven’t heard anyone say she should stay – except Damian Green,” a former minister observed, referring to the new First Secretary of State. Green was at Oxford with May and seems to have earned his job because he is one of her rare friends in high politics. He is regarded as sharing her general lack of conviction.

Older activists recall how the party, in 1974, clung loyally to Ted Heath after he lost one election, and even after he lost a second. Now, deference is over. Most Tory activists, appalled by the handling of the campaign, want change. They would, however, like a contest: annoyed at not having been consulted last time, they intend not to be left silent again.

That view is largely reflected at Westminster, though a few MPs believe a coronation wouldn’t be a problem, “as we don’t want a public examination of the entrails for weeks on end when we need to be shown to be running the country effectively”. Most MPs disagree with that, seeing where a coronation got them last time.

With the summer recess coming up, at least the public’s attention would not be on Westminster if the contest took place mostly during that time: hence the feeling that, once the Queen’s Speech is dealt with, May should announce her intention to leave, in order to have a successor in place before the conference season. It is then up to the party to design a timetable that compresses the hustings between the final two candidates into as short a time as compatible with the democratic process, to get the new leader in place swiftly.

Some letters requesting a contest are said to have reached Graham Brady, the chairman of the 1922 Committee of backbenchers. One MP told me with great authority that there were eight; another, with equal certainty, said 12. Forty-eight are needed to trigger the procedure. However, engineering such a contest is not how most Tories would like to proceed. “She has had an international humiliation,” a former cabinet minister said, “and it is transparently ghastly for her. Then came the [Grenfell Tower] fire. There is no sense our rubbing it in. I suspect she knows she has to go. We admire her for staying around and clearing up the mess in a way Cameron didn’t. But she is a stopgap.”

MPs believe, with some justification, that the last thing most voters want is another general election, so caution is paramount. None doubts that the best outcome for all concerned would be for May to leave without being pushed.

Her tin-eared response to the Grenfell disaster shocked colleagues with its amateurishness and disconnection. “I’m sure she’s very upset by Grenfell,” someone who has known her since Oxford said. “But she is incapable of showing empathy. She has no bridge to the rest of the world other than Philip.” Another, referring to the controversial remark that torpedoed Andrea Leadsom’s leadership ambitions last year, said: “You would get shot for saying it, but not having had children hasn’t helped her when it comes to relating to people. Leadsom was right.”

***

May was quicker off the mark on Monday, issuing a statement condemning the appalling attack at Finsbury Park Mosque swiftly after it occurred, and going there shortly afterwards to meet community leaders. No one could fault her assurance that Muslims must enjoy the same protection under the law as everyone else, or the speed and sincerity with which it was made. She is learning what leadership entails, but too late.

Her administration has become unlucky. This happened to John Major, but, as in his case, the bad luck is partly down to bad decisions; and the bad luck that comes out of the blue simply piles in on top of everything else. Grenfell Tower, lethal and heartbreaking for its victims and their families, was merely more bad luck for the Prime Minister because of her slow-witted response and failure – presumably because shorn of her closest advisers – to do the right thing, and to do it quickly.

But then it turned out that her new chief of staff, Gavin Barwell, had in his previous incarnation as a housing minister received a report on improving fire safety in tower blocks and done nothing about it. That is either more bad luck, or it shows May has dismal judgement in the quality of people she appoints to her close circle. Form suggests the latter.

The idea aired last weekend, that May had “ten days to prove herself”, was a minority view. For most of her colleagues it is too late. It was typical of Boris Johnson’s dwindling band of cheerleaders that they should broadcast a story supporting Davis as an “interim” leader: “interim” until Johnson’s credibility has recovered sufficiently for him to have another pop at the job he covets so much.

They also sought to create the impression that Davis is on manoeuvres, which he resolutely is not. Davis has been around long enough to know that if he wants to succeed May – and his friends believe he does – he cannot be seen to do anything to destabilise her further. It is a lesson lost on Johnson’s camp, whose tactics have damaged their man even more than he was already.

Andrew Mitchell, the former international development secretary and a close ally of Davis, told the Guardian: “. . . it is simply untrue that he is doing anything other
than focusing on his incredibly important brief and giving loyal support to the Prime Minister. Anyone suggesting otherwise is freelancing.” That summed up the contempt Davis’s camp has for Johnson, and it will last long beyond any leadership race.

There is a sense that, in the present febrile climate, whoever is the next leader must be highly experienced. Davis qualifies; so does Hammond, who before his present job was foreign secretary and defence secretary, and who has belatedly displayed a mind of his own since May was hobbled. Hugo Swire, a minister of state under Hammond in the Foreign Office, said of him: “He’s got bottom. He was very good to work for. He is an homme sérieux. I liked him very much and he would calm things down.”

But, as yet, there is no contest. Calls for calm have prevailed, not least thanks to Graham Brady’s steady stewardship of the 1922 Committee, and his success in convincing the more hot-headed of his colleagues to hold their fire. Yet MPs say the 1922 is not what it was 20 years ago: ministers have become used to taking it less seriously.

However, many MPs expect Brady, at a time of their choosing, to go to Downing Street and deliver the poison pill to Theresa May if she is slow to go. Some who know her fear she might take no notice. If she were to play it that way, her end would be unpleasant. As the old saying goes, there is the easy way, and there is the hard way. Remarkably few of her colleagues want to go the hard way but, like everything else in the Tory party at the moment, that could change.

Simon Heffer is a journalist, author and political commentator, who has worked for long stretches at the Daily Telegraph and the Daily Mail. He has written biographies of Thomas Carlyle, Ralph Vaughan Williams and Enoch Powell, and reviews and writes on politics for the New Statesman

This article first appeared in the 22 June 2017 issue of the New Statesman, The zombie PM

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