Review of “The Viral Underclass: The Human Toll When Inequality and Disease Collide” by Steven W. Thrasher

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When Michael Johnson stood trial in Missouri in 2015, accused of “recklessly” exposing several other men to HIV, he embodied what journalist Steven W. Thrasher describes as the “viral underclass.”

The young man had only one ally – his public defender – writes Thrasher in an important new book, “The viral subclass: the human toll when inequality and disease collide.” That lone supporter was an overworked and ill-prepared attorney who wrongly labeled Johnson in remarks to prospective jurors “guilty” of charges that could land the 23-year-old in prison for life.

The prosecutor, for his part, aggressively portrayed Johnson, one of the few black students at the suburban St. Louis University he and some of his accusers attended, as a threat to public health. The jury found Johnson guilty under a 1988 state law that said people with HIV who do not disclose their status to their sexual partners could face felony charges. And the judge ultimately sentenced the young man to 30 years in prison – more than the state’s average sentence for second degree murder.

As a reporter for outlets such as BuzzFeed, Thrasher covered Johnson’s case for several years. In “The Viral Underclass”, the story provides the narrative across the line of Thrasher’s argument: that the “isms” that so define life in America – racism, ableism, capitalism – have not only suffer some disproportionately and unnecessarily, but have also led society to blame individual “bad actors” for the devastating toll of viruses. In other words, members of the viral subclass are not only the most susceptible to contracting diseases such as HIV and covid-19, but they are also disproportionately punished for it, a process that largely absolves the country’s classist and racist policies and institutions.

Thrasher borrows the term “viral underclass” from a 2011 statement by Sean Strub, a longtime LGBTQ equality activist, who coined it as a way to acknowledge the discriminatory effects of legal sanctions and other policies around HIV. Such practices have resulted in “the creation of a viral underclass of people with lesser rights than others, especially when it comes to their gender expression,” Strub wrote.

By expanding the scope of this concept, Thrasher shows that such logic can be self-reinforcing. Instead of fighting for a more affordable and equitable health care system that would expand access to HIV drugs and dramatically reduce the risk of transmission, for example, we are locking up lonely men like Johnson who have had to deal with various challenges, including, in her case, dyslexia and economic hardship. In Thrasher’s tale, Johnson serves as a convenient scapegoat for society’s sins.

The stories of a few brave people infected with the virus living – and sometimes dying – on the margins of society are at the heart of Thrasher’s book. It’s also about Lorena Borjas, a leader of the transgender immigrant community in Queens who has helped countless others, mostly transgender people, cope with police harassment, sexual violence, harassment, and violence. homelessness, HIV infection and other health issues. Struck by covid at the start of the pandemic, Borjas resisted medical care from a system she knew posed distinct humiliations and risks for trans people and Spanish speakers like her. In the end, she became so ill that she had no choice but to seek medical help. Her story tragically shows how the cruelties and inequalities of our society can contribute to increasing individual vulnerability to disease over time – as we concentrate all the various forms of prophylaxis or protection in the hands of some, leaving others almost completely lacking.

Thrasher, who holds a journalism chair at Northwestern University focused on LGBTQ research, notes that America’s response to the pandemic has been defined by unequal access to some of the most well-known forms of protection: masks, drugs and vaccines. Yet he points out that other forms are much more diffuse and grounded – and can be more powerful. These include quality health care, stable housing, jobs with the option to work from home, literacy and computer literacy. “Prophylaxis is often hidden from people in the United States if they are already considered disposable,” he says. “Then, when they are infected with a virus, their diagnosis makes them even more marginalized, even untouchable.” There are, for example, surprisingly higher rates of AIDS in the black population. Two decades after effective drugs became available, in 2015 the per capita rate of AIDS was higher among black people than there was already had been for whites, notes Thrasher. This is a direct consequence not only of unequal access to treatment, but also of all the other factors, large and small, that prevent people from needing these treatments in the first place.

Thrasher structures most chapters around a theme – the dire implications when white people believe they are immune to disease, for example, or unequal access to protection – accompanied by an anecdote or personal story. . At times, the book feels like it’s suspended between the memoirs and the public health tome. Nonetheless, the sometimes sprawling nature of the storytelling, along with Thrasher’s liberal acknowledgment and incorporation of many of his friends and colleagues (as well as his past journalism and connections), ultimately works in the service of one of his main arguments: that we are all more interconnected and dependent on each other than we always realize.

Still, I always wanted more depth in some places and shorter detours in others to keep the focus on what’s freshest and most revealing. I could, for example, have dispensed with a long retelling of the plot of the 2019 South Korean film “Parasite”, which takes up much of its chapter on capitalism.

Ultimately, this book is most searing when Thrasher shows, by numbers and by people, how various public health crises escalated in America to create the viral underclass — and then, too often, to blame for their own suffering. To that end, Thrasher’s retelling of the stories of Johnson and Borjas is particularly powerful. So are his examples of how various inequalities and public health concerns have so often overlapped during covid – with devastating results. He cites, for example, a report concluding that 80% of covid deaths in Texas correctional facilities in November 2020 were in pretrial detention and had not been convicted of the crimes for which they were detained. I wanted a little more original reporting and analysis like that.

Michael Johnson was released from prison in 2019 after an appeals court ruled his initial trial unfair. Real victories on behalf of the viral underclass are rare, however. And Thrasher alludes to how quickly – how virally, in fact – the subclass can grow, especially as climate change increases the likelihood of new (or old) viruses finding a home in the species. human. We are all more vulnerable and intertwined than we realize, he writes in an eloquent epilogue – with the line between the underclass exposed and those who consider themselves “immune” unstable like quicksand.

The human toll when inequality and disease collide

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