On ‘The Uncounted’ by Sara ‘Meg’ Davis

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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On ‘The New Jim Crow’, by Michelle Alexander

The New Jim Crow: Mass Incarceration in the Age of Colorblindness

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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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?

The Madness of Mandatory Minimums

The Scales of Justice

In a former life, I spent many a holiday and break from school hanging with the ‘long-haired hippie freaks’ who, like me, enjoyed a few hours spent grooving around various venues to the meandering and magical musical madness of the good old Grateful Dead. Oddly, not all of us at the shows were long-haired, and many, like me, were basically budding or full-fledged professionals.

Hippie freaks? Perhaps. Gainfully employed and fully engaged members of the broader society? Amongst my friends, yes.

I won’t say that we were a straight-laced crew. Far from it. But, we bought our tickets before showing up to the venues, paid our own way, and most preferred the comforts of the nearest hotel to the wilder times in various campgrounds where the festivities continued well into the wee hours. We enjoyed our time off, and ‘turned on and tuned out’ to the fullest possible extent. But, we did so responsibly (there was always a designated sober person to shepherd the flock).

It was during that incredibly fun-filled and enlightening time in the ’90s when I learned first-hand the absurdity of mandatory minimums, those most insane sentencing ‘guidelines’ which determine the minimum sentence for things such as possession of certain narcotics, or which determine that an individual gets three chances and then they are jailed for life regardless of the offense (three strikes). Sentences under mandatory minimums rarely fit the crime and often remove the uniqueness of an individual defendant and what lead them to appear in court.

A particularly gentle soul, as well as perhaps the unluckiest person I’ve ever known, was facing a mandatory life sentence without the possibility of parole for a third non-violent offence. He had been caught three times with relatively minor quantities of marijuana and LSD (not simultaneously), all under rather unfortunate sets of circumstances. He was 23 or 24 years old at the time, and one of the sweetest, kindest, gentlest people I have known before or since. It was heartbreaking. Prison would break him and eventually kill him, and, just about everyone who knew him understood that simple truth.

In the exceptional documentary, The House I Live In, the absurdity of mandatory minimums and the countless failures of the war on drugs are framed within the context of their effects on otherwise ordinary people, from the incarcerated, to those working within the criminal justice system to individual family members affected by drugs and unfair sentencing laws. The tragic consequences of policies which disproportionately affect the poor and minorities and a ‘war’ which has been waged on the American public are made all-too real. As I watched the Kevin Ott re-tell his own tragic story, I was reminded of my friend’s story from two decades ago:

Story after story after story in this fine, troubling film demonstrate how mandatory minimums are not helping to reduce drug-related crime or drug use itself. Rather, they are forcing judges to sentence those caught to prison terms that are ‘unfair and unjust’ and condemning individuals and families deal with the tragic consequences generation after generation. The cycle of drug-dealing, poverty and hopelessness continue , and specifically impact inner-city African American men disproportionately.

Two decades after an otherwise privileged young man awaited an unfair sentence for a non-violent crime which hurt no one (possession of an ounce of marijuana), the US Attorney General is finally talking sense:

‘While the entire U.S. [prison] population has increased by about a third since 1980, the federal population has grown at an astonishing rate — by almost 800%,’ Holder’s speech says. ‘It’s still growing, despite the fact that federal prisons are operating at nearly 40% above capacity. Even though this country comprises just 5% of the world’s population, we incarcerate almost a quarter of the world’s prisoners.’

It’s two decades too late for my friend. But, it’s never too late to make a sound policy change, particularly one which is based on a fair and just system and which doesn’t mete out punishments far exceeding the crimes, or which, by design, unevenly targets those who are simply attempting to survive the only way that they know how.

‘And I am the Drug Policy Alliance’…

I’m often quite happy to miss the ‘news’ on main stream television, particularly when I read of interviews and exchanges such as the recent ‘debate‘ between Fox News and the Drug Policy Alliance.

The Alliance has just released a rather poignant video highlighting the need for a rational, evidence-based and research-informed approach to drug policy. Rather than focusing our efforts and resources on criminalisation and incarceration, we should re-focus our attention on a human-rights based approach to drug use and policy. I fully embrace this approach, which is not at all surprising given what I do for a living.

A smattering of viciousness and derogatory language from Mr O’Reilly and his co-host Megyn Kelly highlight their inability to understand the issues at stake and how damaging and unhelpful the so-called ‘War on Drugs’ has been and remains.

Thus, the message in the Drug Policy Alliance’s latest video was completely and utterly lost on them. In addition, their segments (three, that I could find) were not based on intelligent debate, but on rhetoric and unsubstantiated claims, many of which are simply false.

Drugs have been legal and regulated in several countries to varying degrees for many years now. I spend about 25% of my time in the Netherlands these days, and there is very little in the way of ‘drug-related crime’. In fact, within the last year or so, I was told by Dutch that the state was forced to close prison facilities because they did not have enough prisoners to fill them. That is, prisons were sitting empty rather than bursting to capacity such as those in the US. Think about that for a moment.

John Stossel, also from Fox News, quite rightly made the point to Mr O’Reilly that prohibition drives the behaviour underground. Indeed. The prohibition of drugs has worked much the same way as the prohibition of alcohol—people will find ways around the law and will go to great lengths to hide it from the authorities.

The real shame in driving behaviours underground is that even if an individual does wish to seek help for dependency or any other medical and/or social issues, they are less likely to do so if they believe they run the risk of incarceration or any sort of reprimand. Thus, any programme designed to reduce drug- or substance-related harm, such as needle-exchange programmes, are less likely to reach them. In an age of HIV, this represents a tremendous shortcoming and travesty.

I support and applaud the Drug Policy Alliance in their efforts to advocate for a human-rights based approach to drug use. And I fully support an end to the War on Drugs.