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Home » Sex, Drugs and HIV — Let’s get rational by Elizabeth Pisani (Transcript)

Sex, Drugs and HIV — Let’s get rational by Elizabeth Pisani (Transcript)

Full text of Elizabeth Pisani on Sex, Drugs and HIV — Let’s get rational at TED 2010

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“People do stupid things. That’s what spreads HIV.” This was a headline in a UK newspaper, The Guardian, not that long ago. I’m curious, show of hands, who agrees with it? Well, one or two brave souls.

This is actually a direct quote from an epidemiologist who’s been in field of HIV for 15 years, worked on four continents, and you’re looking at her.

And I am now going to argue that this is only half true. People do get HIV because they do stupid things, but most of them are doing stupid things for perfectly rational reasons.

Now, rational is the dominant paradigm in public health, and if you put your public health nerd glasses on, you’ll see that if we give people the information that they need about what’s good for them and what’s bad for them, if you give them the services that they can use to act on that information, and a little bit of motivation, people will make rational decisions and live long and healthy lives. Wonderful.

That’s slightly problematic for me because I work in HIV, and although I’m sure that you all know that HIV is about poverty and gender inequality, and if you were at TED ’07 it’s about coffee prices… Actually, HIV is about sex and drugs, and if there are two things that make human beings a little bit irrational, they are erections and addiction.

So, let’s start with what’s rational for an addict.

Now, I remember speaking to an Indonesian friend of mine, Frankie. We were having lunch and he was telling me about when he was in jail in Bali for a drug injection. It was someone’s birthday, and they had very kindly smuggled some heroin into jail, and he was very generously sharing it out with all of his colleagues. And so everyone lined up, all the smackheads in a row, and the guy whose birthday it was filled up the fit, and he went down and started injecting people.

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