The Uncounted by Sara L.M. Davis
My rating: 5 of 5 stars
In today’s world in particular, there are days when it seems as though we are drowning in information. Too much data. Too much ‘stuff’ to process and make sense of. That feeling is only partially true, however. Across various areas and arenas, we know far too little, particularly when we focus on issues surrounding health and human rights. All too often we take the absence of information or data or evidence as a sign that we may relax a bit.
We desperately need to shift that thinking. The Uncounted, by Sara ‘Meg’ Davis provides a road map for how we may begin to shift our thinking and perspectives in order to adjust how, amongst whom and what we collect data in a relatively simple way, and in a way which may pay huge dividends, particularly amongst those most in need and previously most neglected in policy planning and financing.
‘The Uncounted’ is a fantastic read, one which profoundly challenges the notion that in the absence of information or evidence we don’t need to worry about issue X. That is, if we carefully examine those variables for which we have no data or evidence, perhaps upon digging deeper and enlisting assistance from those more acutely and intimately aware than we are, we will find previously hidden information and data. And, that data and information are likely to radically shift how we design programmes or policies on various issues. We will no longer be able to simply dismiss an issue as unproblematic. Quite simply, ‘The Uncounted’ provides a profound argument for carefully considering how we examine and apply the absence of evidence as an indicator.
‘The Uncounted’ is rich in ethnographic descriptions, documenting the various assumptions made by multilateral agencies charged with dispersing funding to and establishing guidelines for countries in how they respond to HIV, tuberculosis and malaria (e.g., The Global Fund to Fight AIDS, TB and Malaria, UNAIDS, WHO, PEPFAR, etc) and local-level agencies and individuals best situated to argue for expanding programmes and funding schemes within communities. For those unfamiliar with such agencies, Dr Davis disentangles these various personalities and agencies rather neatly, making it clear who does what and whose voice is perhaps most necessary in deciding upon programmes and policies to address HIV in particular. Following the progress and steps necessary to count the uncounted within the Caribbean region provides evidence for how we can begin to shift our thinking and truly ensure full inclusion of all individuals affected by HIV and specifically those least likely to date to receive crucial services and support.
Reading ‘The Uncounted’ during a global pandemic proved rather surreal,not simply because some of its key characters are also playing a crucial role in current events vis-a-vis Covid-19. As our global health-related realities have been thrown into chaos this year with the emergence of Covid-19, I’m curious to see how various elements of Dr Davis’ careful and thorough work play out. Whilst focused primarily on HIV, and the very real oversights in counting typically hidden populations such as men who have sex with men, transgender people, sex workers and people who use drugs, certainly many individuals, and perhaps the most vulnerable, will go uncounted in the wake of Covid-19. Will health, social, and economic policy makers and planners at local, national, and international levels solicit the perspectives from those at the community levels most intimately associated with the epidemics and acutely aware of problems in providing treatment, care and support to those affected in order to understand who, what, why and where? Or will they rely on the absence of evidence as evidence of absence simply because individuals are not counted by the powers that be? How will key populations be accounted for? Will they?
My hope is that the powers that be across power structures would heed the advice and road maps provided by Dr Davis. The reality is that in some places, that advice and those road maps are not being considered. And, in those places it seems as those Covid-19 is raging unchallenged. [Insert heavy sigh here.]
‘The Uncounted’ provides this cynic with a bit of hope, however, particularly with regards to HIV. Hope that we expand our perspective ever so slightly, yet in a way which we can make a huge difference to communities and key populations who may have previously faced stigma, discrimination and institutional neglect, and who may finally receive the crucial support to transform structures that place them at the response to HIV. It won’t be easy, but it is necessary. And, to my mind, long overdue.
Clearly, we can no longer that that ‘absence of evidence as evidence of absence’.
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Category Archives: Drugs Policy
On ‘The New Jim Crow’, by Michelle Alexander
The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander
My rating: 5 of 5 stars
Michelle Alexander is a voice we need to listen to more. Not for pithy soundbites, but for reasoned, careful and critical perspectives on who we are, what our past and present can tell us and where we have gone horribly wrong. It will not be an easy lesson, but it will be a necessary one.
The New Jim Crow isn’t necessarily ‘new’ information to me. It’s clear just by reading the news and examining life in the US today that the unequal treatment of black and brown men by law enforcement and criminal justice systems proliferates. White men commit a crime and are given laughable ‘sentences’, if any sentence is handed down at all (e.g., Brock Turner, Jeffrey Epstein, etc). Black or brown men are accused of committing similar crimes, even if very little or no evidence exists, and given harsh sentences (e.g., Brian Banks). Whilst my own radar tends to pick up and focus more on cases involving sexual assault, the War on Drugs and its tendrils that weed in and out of various parts of society provides far, far too many examples of the uneven application of the law, and sadly the inability of the law to provide justice in many cases.
Mass incarceration stems not from an inherent quality in black and brown communities, but from perceptions and the specific focus placed on those communities by law enforcement and criminal justice systems. Drug use rates have remained relatively steady amongst various sub-groups for decades in the US, whereby white folks tend to use various drugs more (not less) than black and brown populations. Crime rates are tied to poverty, not race, contrary to popular perceptions and media portrayals. Yet, up to 90% of traffic stops in some parts of the US involve cars driven by black men. Law enforcement resources are placed in black and brown communities to ‘police’ for drugs and crime. In areas where both white and black individuals peddle drugs on street corners, blacks are stopped and searched (and ultimately) arrested more than whites. Hence, the perception that communities of colour are involved in more crime, simply because they are stopped more often and at higher rates than whites. It’s a systemic pattern and it has unreal and lasting consequences for those communities already burdened by being poor or less advantaged.
Perhaps one of the more tragic aspects of the War on Drugs is the long-term, lasting consequences for those caught in its web. Once arrested, rather than convicted, job prospects become less likely. Hiring discrimination persists amongst those who have faced charges (not necessarily convictions) related to drugs crimes, often for life. And, this discrimination is not only legal, it may stem from any actual wrongdoing. Public housing, education including acceptance to a university to securing financial aid to attend, social benefits, military service. All of these various means to improve one’s position and escape a cycle of poverty (and ‘crime’) are cut off from those who have sometimes done nothing more than smoke a joint. They are not violent offenders nor are they trafficking or dealing drugs. They have simply been caught with something less dangerous than drunk driving. Yet, the sentences are harsher and the consequences last a life-time. And, disproportionately, these consequences affect young, black and brown men.
It’s hard not to feel a bit hopeless after reading The New Jim Crow; as a book, it offers very little hope. However, knowledge is power, and understanding the pervasiveness of a racialised social control measure such as mass incarceration and the role of the War on Drugs in creating it can help us to finally address the nation’s troubled history vis-a-vis race. By addressing this trouble history, the aim is not to attain colourblindness, but to become colour conscious. From slavery to Jim Crow to mass incarceration, the connections are clear. Ignoring them will not eliminate our race-related tensions. Throwing shade on those historic tensions and the various systemic biases related to them, whether intentional or not, will help to finally reach something akin to genuine equity and justice.
This book deserves widespread distribution and careful thought and discussion, not simply for the brilliant and thorough research of crime statistics and legal decisions for much of the last 150 years in the United States. But, because it allows us to understand our collective social flaws and provides hope that we can actually address these issues, if only to tackle the hard tasks. At a time when we see those racial tensions intensifying thanks to an administration hell-bent on demonising the other, this may be the hardest task of all. But, it is also incredibly necessary for the future for all of us.
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If the people lead…
The Leaderless Revolution is one of the many books that sits in my to buy / to read list of books. It sits there largely because several folks I respect immensely rather simultaneously and independently posted their reviews of it, and how it has them thinking of what we could accomplish if only unconstrained by structures which inhibit us.
Colour me intrigued.
Last night, also rather randomly, The Cuban queued up for our nightly dose of television a BBC Storyville documentary featuring none other than Carne Ross, the author of this intriguing book. I finally bought the book after about 15 minutes into this documentary. And, I plan to read it immediately upon its arrival.
Communities can not just offer but provide solutions. But we overlook such opportunities because these solutions can’t possibly be that easy or can’t possibly work because no one has ever tried them. Communities often remain unconsidered or an after-thought by those who make decisions, decisions which profoundly affect them. And, by far more often than not, those decisions are made without representatives of specific communities in the sodding room.
No wonder so many projects fail to reach their achievements or to produce the results others have intended or to meet the needs of those they should be helping. As someone who worked in development aid for a number of years, this was and remains all too obvious and tragic. Yet, precious little appears to change.
By contrast, a few indefatigable individuals I am honoured to know have extolled the virtues of anarchist activism for years. They don’t just sing its praises; they are anarchist activists in action.
Currently, through their efforts aimed at reducing opioid overdose deaths in their communities (in this case, Toronto), they are demonstrating just how incredible community-level activism alongside a little anarchism can effect change, hugely and positively impact local-level communities, and confront power structures we typically cower to or eventually relent to.
Briefly, as city-level structures (pardon the pun) drug their feet to implement any action as overdose deaths continued to not just occur but increase, these harm reduction policy activists sprung into action and opened a pop-up injection site in a community park. This action resulted from inaction and in part out of desperation. They were tired of seeing their friends and community members die. And, they knew definitively what to offer the community in order to prevent further deaths. By supervising injecting drug use, they can help prevent deadly overdoses immediately and call for medical assistance if necessary or needed. An added bonus is the on-the-spot outreach to those who may otherwise exist beyond the reach of health and social services. Services and the space are provided without judgement and without conditions placed on those seeking them, all within the community where it is most needed.
Within one week of opening up the pop-up site, they had reversed five likely fatal overdoses. They had also distributed overdose prevention kits to many, many, many others.
This may seem rather small-scale. But, imagine: within a single week, five of your friends died. And, you had the tools to help prevent those deaths but they were locked away by someone beyond your own community.
What would you do? Would you wait for public (e.g., city, state or national level governmental) action? Or would you do what you could to prevent any further deaths?
I’m not necessarily convinced that government is entirely bad. Indeed, I still believe in public institutions on various levels. But, clearly, we—all of us—face some serious obstacles given how power structures currently overwhelmingly favour those with power and money. Those who are already in the room. Given that so many decisions are made which impact those of us not in various rooms, something clearly needs to change. Perhaps we need different rooms with fewer ‘big men’ and ‘important women’ standing at the front.
Perhaps, if the people lead, the leaders will follow.
Crushing hope
The worst crime we adults commit is not murder or theft or the bodily harm of another. It’s crushing the hope and dreams of children, particularly those who look to us as members of their immediate and extended families and to whom they look as role models and guides.
It’s tragic enough when adults lose all hope of a better tomorrow; but, destroying that belief in a better life, a promise of tomorrow among children is unconscionable.
This weekend, we caught a documentary from Appalachia which leaves little room for hope—for parents or their children. Oxyana, a brilliant crowd-funded documentary directed by Sean Dunne, is gut-wrenching in its honest talks and unfiltered intimacy with residents of Oceana, West Virginia, a small town nestled deep in the Appalachian mountains. It is a film which provides very little in the way of hope.
Oceana has been renamed ‘Oxyana’—an indication of just how much of the town has been impacted by oxycontin dependency. Members of the community recount how Oceana was a different place a mere 12 to 15 years ago before oxycontin was commonly prescribed to residents for pain and ‘anxiety’. Now, oxy dependence is epidemic. Person after person tells of their own oxycontin dependence, or the horror of watching their family and friends fall into prescription pill addiction. As one interviewee recounts, no one in the town has been spared the loss of at least one person close to them to overdose. Indeed, one such individual who appears on camera and is incredibly lucid and open about his use and distribution recounts how his own father committed suicide after first killing his wife and other son over what appears to be the mother’s prescription drugs. It’s a rather chilling moment in the film for obvious reasons.
The town’s dentist weeps as he talks of his own girls growing up in a town amongst good people who have no hope. His girls’ friends have lost parents to overdose. And, yet, he remains in the town and tries to hold on to hope for himself and for his girls. A physician from the local hospital explains rather dispassionately of the number of overdose deaths they encounter in the hospital each day (not week) and how 50% of all babies born in the hospital are on methadone to combat the dependency with which they are born.
In the final moments of this compelling documentary, a young woman, herself dependent upon oxycontin for pain and ‘anxiety’ talks of how she just wants a better life for her daughter, for herself. It’s when talking of her daughter that she truly breaks down.
The cycle of poverty, joblessness, and a life in which dope offers an escape from the physical and mental pain provides very little in the way of hope. Dope and a sense of overwhelming despair largely resulting from poverty and hopelessness have a vice-like grip on this small mountain community. If an individual doesn’t work in the mines, they are most likely already dependent upon on oxy. And, so, the cycle continues.
Diane Sawyer, a native of Kentucky, also used the power of journalism in a documentary ‘A Hidden America: Children of the Mountains‘ to bring to the masses the crushing weight of poverty which is characteristic for more than a half million residents of Appalachia and which for most of the rest of America is unimaginable. That she focused on the lives of children in incredibly desperate situations added yet a further blow.
Drug use and dysfunction feature in this second narrative prominently. But, mostly, crushing poverty provides little in the way of hope for a brighter future for any of the children. ‘Faith’ helps one cling to the idea that the future will be better — for her and her troubled mother. Yet, watching, hope is largely absent. As a young girl describes the only two contents of their fridge at times being mayo and ranch, you want to weep. At least I did.
What have we done to leave these communities in such situations? What have done that a physician describes the current generation as the ‘lost generation’? Are they well and truly lost? Or have we and with us they simply lost all hope?
We have failed these communities and more importantly those individuals who despair in such situations. Whilst we have the tools to help them medically, what will we do to assist them medically or socially? Because they are nestled away in an isolated community, will we continue to turn a blind eye and ignore their pain and suffering and relegate it as their problem alone? What message does that convey to the children who live in such situations?
And, what hope are we offering them, any of them? Or, have we simply crushed all hope for Oceana?
A Tropical Fish Out of Water 