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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