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'

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View from Paisley: How the Conservatives are wooing Labour's Scottish heartlands

Not so long ago, Conservative activists in Paisley could expect doors slammed in their faces. A referendum has changed that.

Tony Lawler, a Labour activist, was recently knocking on doors in the Scottish town of Paisley, when he came across a disgruntled resident. “I’m really disappointed in Douglas Alexander,” the potential voter complained. “I haven’t seen him. He used to be in Morrisons.”

Douglas Alexander, of course, has gone. He was the longstanding Labour MP and onetime International Development secretary who lost his seat in 2015 to a 20-year-old rival, the Scottish National Party’s Mhairi Black. He does not plan to stand again. But when I visit Paisley, a short train ride from Glasgow, I find that memories of him linger on. 

Two years after Alexander’s defeat, I meet Lawler and other local Labour activists in Morrisons, where Alexander used to hold his surgeries. As checkouts beep and trolley wheels roll over linoleum, they point to an empty table in the corner of this hallowed ground: “He used to sit just there.”

In 2015, the SNP’s victory in this former manufacturing town seemed to epitomise the earthquake in Scottish politics. But as the Labour activists know too well, no political fortress is undefeatable. And in Paisley, the home of one of the oldest workers’ festivals in the world, the party with the most to gain is one that previously never dared to canvass in the high street – the Conservative party. 

The town the Brexiteers forgot

In 1988, the historian Sylvia Clarke reflected on Paisley’s lost industries, wondering what was next for the former weaving towns. “Paisley as a tourist centre?” she wondered, in Paisley: A History. “Paisley as a place for visitors to come to, rather than a send-out of goods and emigrants?” 

For all Paisley’s industrial decline, it’s a pretty place. The town is in the running for the 2021 City of Culture, and has the second biggest number of listed buildings after Edinburgh. When I visit in the middle of April, blossom floats on the trees, and a river meanders through a neighbourhood of old, stone houses. It takes a moment to notice weeds tightening their grasp on the window frames. When I try the door of the ancient Paisley Abbey, it’s locked.

Perhaps if Paisley had been located the other side of the border, in Sunderland or Northumbria, it would be voting Leave and flirting with Ukip. But in the most deprived areas here, Labour activists tell me the EU referendum tally was still almost 50-50, and overall the town voted Remain.

There is a view that Brexit is an English concern. “We haven’t picked up anything about the EU referendum,” says Lawler of his doorstep conversations. “What people are talking about is the independence referendum, Jeremy Corbyn and the kids’ ward.” Scotland’s health secretary, Shona Robison, is due to make a decision on whether the specialist ward should be moved to a large hospital in the First Minister’s Glasgow constituency, against the wishes of many Paisley residents. The hospital in question is nicknamed “the Death Star”.  

Another concern, reminiscent of small towns across the UK, is the decline of the high street. When I walk down the historical shopping area Causeyside Street, I find mother and daughter Kate and Linda Hancy packing up what remains of The Pattern Café and Gift Shop. The wallpaper is a glorious Paisley print, but the scented candles are in boxes and a spray soap bottle hangs from a chair. After two years of trying, they are closing down.  

“People just don’t have money to spend,” Kate says. “A lot of people have been on the same wage for more than five years.”

Linda chimes in: “The cost of living going up but wages aren’t the same. I work in a supermarket, and people come in and say ‘How did I spend this much money?’ A lot of people are paying by credit cards.”

The Hancys voted to remain in the UK, and the EU. Although they knew Alexander, they have never met Mhairi Black, and feel devolution, if anything, has made politicians less accountable. “Why are we picking 1,2,3,4,” demands Kate, referring to Holyrood's voting system, which rejected first past the post. “Why can’t we pick one like we used to?”

Without the EU to blame, the most obvious culprits for Paisley town centre’s decline are the out-of-town shopping centres, where cinemas are opening just as historical ones in town close their doors.

Gavin Simpson, owner of Feel the Groove, a new record shop, remembers the 1980s, when a new release would have shoppers queuing round the block. However, he believes the town is over the worst. (As we speak, a customer comes in to reserve such a record and cheerfully warns Gavin that “even if I ask for my money back, don’t give it to me.”)

One thriving business is the longstanding butchers, Wm Phelps. Manager James Peacock tells me it is down to the trustworthy Scottish produce, which is carefully tracked and labelled. But the business has also embraced globalisation.  After noticing a large number of South African customers, Peacock began selling boerewors and biltong.

The other referendum campaign

If Paisley has been spared the divisions of the EU referendum campaign, its “buddies” – as residents are known – are still reeling with the repercussions of an earlier referendum, that on Scotland in the UK. In 2014, the town voted for independence, although the county overall opted to stay in the UK. 

The town is home to a particularly brash strain of indyreffers, including the “Smith Commission burners”, three SNP councillors who gathered in front of the council headquarters to burn a copy of the report setting out new powers for Scotland. One of them, Mags MacLaren, went on to manage Black’s constituency office.

But if the Paisley independence movement has been well covered, less is known about its opposite - the rise of pro-unionism. 

Of the three mainstream parties opposed to independence, it is the Scottish Conservatives, with their unconventional leader Ruth Davidson, who have most effectively capitalised on the pro-union message. In the 2016 Scottish Parliament elections, the Tory Jackson Carlaw captured the West of Scotland constituency of Eastwood, which had been held by Labour since its creation. 

In Holyrood, the Scottish Tories benefit from proportional representation, which allows voters to choose a constituency MSP but also rank parties. 

According to Paul Masterton, the Tory candidate for East Renfrewshire, and the secretary of the Renfrewshire and Inverclyde Scottish Conservative Association, the Conservatives are now getting huge numbers of first preference votes, including in neighbourhoods like the suburb of Ralston, where both Black and Masterton are from. So who are these voters? Masterton describes them as “New Labour voters who were happy with Tony Blair and Gordon Brown but didn’t like Jeremy Corbyn and get tied up into knots by [Scottish Labour leader] Kezia Dugdale flipflopping on the union stance".

The 2016 election saw the Scottish Conservatives surge to second place in Scotland – a superb comeback for a party once ridiculed as being rarer than pandas. The next electoral test is the local council elections. In Paisley, even Labour activists acknowledged the Conservatives were likely to be the most notable winners.

“For a long time we simply didn’t go out in Paisley," says Masterton. "We were written off and we allowed ourselves to be written off.”

But the referendum has changed this. “What I found was that last May, people weren’t shutting the door in your face," he adds. "Once you started the conversation they were far more receptive to that.” 

Like the Labour activists, Masterton argues that the constitutional question matters more than Brexit. “When Theresa May said ‘now is not the time’, I think a lot of people across Paisley did a small quiet fist pump,” he says of a second independence referendum.  

Ironically, after the early election is called, the Scottish Conservatives do everything they can to mention the prospect. “Don't mention the 'i' word,” crows a recent press release about the “SNP indyref ban”. Davidson tweets: “Nicola doesn't want to stand on her record. She knows the country doesn't want her #indyref2.” A Panelbase survey commissioned by The Sunday Times Scotland published shortly after the early election was announced finds support for the Conservatives at Scotland at 33 per cent, 18 percentage points higher than in 2015. 

What you stand for

For now, Paisley remains a Scottish National Party stronghold. George Adams, the MSP with an office off the high street, proves elusive – Labour activists confirm his reputation as a hardworking local. Black’s aide turns down my request for an interview for similar reasons, but I bump into her that evening at a protest against cutting child tax credits in Glasgow’s George Square.

Black, an admirer of the left-wing Labour figure Tony Benn, once said she feels "it is the Labour party that left me". I ask her if she, like her Labour predecessor, holds surgeries in supermarkets. Black says she’d considered it, but given the sensitivity of some of the issues, such as benefit problems, she thought her constituents might appreciate a more private space. “The main thing that crosses the door in my offices is Universal Credit changes,” she explains. She says she has raised her concerns about the children’s ward.

As for the independence debate, she argues that the Scottish government have been “incredibly compromising” since Brexit, but adds: “A lot of folk want another chance at the question.”

Black is standing for re-election. With a majority of more than 5,000, and neither of her previous challengers in the running, she’s likely to keep her seat, even if buddies' discontent over local issues rumbles on. 

Still, as I have discovered, the 2014 referendum continues to reverberate in towns like Paisley. It has divided friends and neighbours on constitutional lines, galvanised new strains of politics, and brought a Labour heavyweight crashing down, with no appetite to return. 

The Tories believe their unionist message is enough to flip seats like East Renfrewshire, once Conservative, then Labour, and now an SNP marginal. As the SNP's shine wears off, could Paisley, with its long tradition of the left, one day follow? It no longer feels implausible. “The one thing about the Scottish Conservatives - and this is true whatever you like us or not,” says Masterton. “You know what we stand for.”

 

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines. 

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