Complaints that the U.S. health care system is broken and must be fixed or replaced have been a common lament across the country for decades.
But one aspect of this crisis, the perpetuation of a so-called “viral underclass,” has received less attention. As the guest speaker at a recent Poynter Lecture sponsored by the Yale Schools of Public Health and Medicine and several other campus organizations, journalist and social justice advocate Steven Thrasher discussed the concept of the viral underclass, which he described as a class of people, mostly from marginalized groups, who bear a disproportionate burden of illness due to systemic racism, stigma, and other factors.
Thrasher, the inaugural Daniel H. Renberg Chair of social justice in reporting and an assistant professor of journalism at Northwestern University, addresses this concept in a new book, The Viral Underclass: The Human Toll When Inequality and Disease Collide.
In his Yale lecture on Sept. 28, Thrasher said the term “viral underclass” was coined by HIV activist Sean Strub in 2011, when he wrote: “Nothing drives stigma more powerfully than when government sanctions it through the enshrinement of discriminatory practices in the law or its application. That is what happened with HIV, resulting in the creation of a viral underclass of persons with rights inferior to others, especially in regard to their sexual expression.”
Thrasher said he sees the viral underclass as both a group of people who are experiencing the compounding effects of marginalization and increased vulnerability to viruses and as a population that, as it is made vulnerable to viruses, those viruses are also used as justification for policies against them.
Thrasher named 12 specific vectors that he believes comprise the viral underclass, which he said have been perpetuated by government leaders regardless of their political affiliation. He cited both Trump administration policies and President Joe Biden’s declaration last month that the pandemic was over (despite “a 9/11’s worth” of deaths still occurring weekly) as evidence supporting the government’s missteps.
Racism
The first vector Thrasher talked about was racism – one that intersected with other vectors in his book. He talked about Michael Johnson, a Black college student in Missouri who was accused in 2013 of criminally transmitting HIV to two men and exposing four others to the virus. Johnson, who was facing life in prison, was convicted in 2015 and sentenced to 30 years; he was released on parole in 2019 when an appeals court found his trial “fundamentally unfair.” Thrasher began reporting on Johnson in 2014.
A year later, when Michael Brown was killed in Ferguson, Missouri, Thrasher’s editors sent him to Missouri in what turned out to be a pivotal moment in his career.
“When I asked the HIV people, the activists, and the service workers for some advice when I was going to Ferguson ... they said that they had been in this Canfield Green apartment complex where Michael Brown was killed because there had been some new cases of HIV in the complex and Ferguson had this higher rate of HIV and AIDS,” Thrasher said.
It was then that he began to connect the dots. Thrasher said he noticed that the maps where workers and activists were conducting interventions for HIV were also areas with high concentrations of Black poverty, violence, and police activity.
“I started thinking about Michael Brown and Michael Johnson through the vector of racism,” Thrasher said.
Thrasher saw other connections in the death of George Floyd in 2020.
“One thing many people forget, if they ever knew it in the first place, is that when George Floyd’s autopsy was performed, he had the novel coronavirus,” Thrasher said. “So had the police not killed Floyd, would the virus – the biggest killer of Black men at the time – have done so? And had city and county financial resources been made available to people who lost their jobs in the pandemic, like Floyd, would he have used that questionable $20 bill at that convenience store?”
“With Floyd and Michael Johnson and Michael Brown …racism was gonna get them one way or the other,” Thrasher said. “The virus or police violence is the way that they come into our purview, and to my purview, but racism was grabbing at them. If we care about doing things with people who are living with viruses, we cannot just care about the virus in them – we have to understand that’s just one of the vectors that are leading to them having a too-short life.”
Shaming
Thrasher cited individual shame as another vector contributing to the viral underclass. He used Gaetan Dugas – the French-Canadian flight attendant wrongly labeled as “Patient Zero” in the AIDS epidemic by journalist Randy Shilts – as an example.
It turned out that a CDC researcher was primarily talking to people with AIDS in California and identified Dugas as “Patient O” – as in letter O, to identify him as a patient outside of California. Due to Shilts’ mistake, compounded by him calling Dugas a “monster,” the man was demonized as a main spreader of an epidemic that killed millions. In 2016, researchers debunked the narrative by proving, via blood samples, that Dugas’ virus was unrelated to others in his cluster. But the damage had been done.
“This phrase [Patient Zero] is used over and over again, particularly by journalists, to talk about individuals as if there is an able-bodied community free of disease, and this one bad actor comes into play,” Thrasher said. He mentioned recent attempts to demonize transgender people as another example of stigma and shaming.
Capitalism, Law, and Austerity
Three other key vectors identified by Thrasher were capitalism, which he said has historically contributed to the global movement of pathogens, with one of the most distinct examples being the Atlantic slave trade; law, in terms of outdated legal concepts that don’t reflect the latest scientific facts and perpetuate social stigma and public misperception; and austerity in that reductions in public health funding can lead to increased vulnerability to disease among marginalized populations. Thrasher used recent Greek history as an example. He said that when Greece scaled back funding for HIV prevention and distribution of sterile syringes during a severe economic crisis a few years ago, HIV cases went up around 3,000 %.
“We could see when austerity measures are brought in, that things happen that actually open up the pathways to people’s bodies to become more affected by viruses,” Thrasher said.
Thrasher said border policies are another vector. He cited a former U.S. policy restricting entry into the U.S. for people diagnosed with HIV as one way border policies have perpetuated a viral underclass. This approach was seen more recently in U.S. testing policies for COVID-19, where testing requirements were stricter for people entering the country than for the people already here. “So, the United States will continue to think of borders as something that is protecting us from viruses, while doing things that increase viral transmission inside borders and outside of them,” Thrasher said.
The Liberal Carceral State
Another vector contributing to a viral underclass is the “liberal carceral state,” Thrasher said. He said that jails play a major role in spreading viruses as people enter incarceration and then return to their communities after completing their sentences.
“Once people are incarcerated, it’s much more unlikely that they’ll ever get stable housing, it’s very, very difficult for them to become employed again, it’s much more likely they’re going to end up homeless and chronically ill,” Thrasher said.
Unequal Access to Prophylaxis
While we understand prophylaxis on a physical level – face shields, masks, condoms – Thrasher said there are conceptual forms as well, such as sex education, housing, and freedom from incarceration. Marginalized populations have been historically impacted by unequal access to prophylaxis. Thrasher cited higher ratios of HIV positivity for Blacks than whites – 3-1 in the 1980s, nearly 6-1 in 1995 (the year before medications), and almost 9-1 in 2015, as an example. Rates of COVID infection and monkeypox have likewise been higher among Blacks than whites in America, Thrasher said.
Ableism
Thrasher called ableism “one of the biggest vectors” for the viral underclass in the United States. He said this is seen in the perception by some that able-bodied people are worthy of care and should be helped and other people, whose bodies are too weak, should be left to die.
Speciesism
Speciesism, Thrasher said, is how we, as human beings, tend to imagine ourselves as being superior to all other animals. This vector comes into play, for instance, as the planet warms. Animals migrate to new habitats to survive, and humans encounter more creatures, increasing the potential spread of pathogens.
He said the role of food production, especially meat production, “is going to play an increasing role in how sick we become as a species.” One of the prominent theories on the spread of AIDS, Thrasher said, links back to people cutting bush meat in open fields in the Congo. “That is, in essence, the same action that happens in slaughterhouses, and slaughterhouses are a major way that viruses move between beings,” Thrasher said. “If we imagine a different relationship between us and other beings, it might help us be able to balance these things better.”
White Immunity
In Michael Johnson’s case, four of his six accusers were white men who didn’t use condoms and thought nothing would happen to them if they just asked if their partner was clean, Thrasher said. This attitude, he said, is reflective of how some white people imagine they have absolute immunity, which is another vector for the viral underclass. “That myth of immunity ends up creating decisions around public health and around individual risk in ways that end up being very harmful,” he said.
Collective Punishment
The last vector noted by Thrasher was collective punishment. He mentioned how the losses of prominent HIV activists like Zak Kostopoulos of Greece, who was killed by a group of eight men in 2018, and Lorena Borjas, a trans and Latinx activist in Queens, New York, who died of COVID in 2020, were devastating to the communities they represented.
“Zak Kostopoulos was a really important figure in Greece for queer people, for transpeople, for migrants, and he did things to help people in the viral underclass find solace and help,” Thrasher said. “Same thing with Lorena Borjas. She’d stand on the street, she would hand out sterile syringes, she would hand out food and condoms, and give people referrals to health places. And when those people are gone, it’s not only a disaster for the people who love them and are very close to them, it’s a disaster for the entire community. Their loss creates more pathways of potential transmission for marginalized groups.”