Steven Thrasher on 'The Viral Underclass' and why viruses connect us all : It's Been a Minute After years of covering HIV and AIDS, journalist Steven Thrasher knew that the hardest hit communities were almost always the poorest and most marginalized ones. Then COVID-19 struck, and he saw that the same groups of people were suffering the most.

In his new book The Viral Underclass: The Human Toll When Inequality and Disease Collide, Thrasher explores how this pattern plays out in communities around the world. Guest host Tracie Hunte talks to him about the ways that systemic oppression puts marginalized people at greater risk of infection for all diseases – and also blames them for transmission.

You can follow us on Twitter @NPRItsBeenAMin and email us at ibam@npr.org.

Why protecting the 'viral underclass' can keep us all healthy

  • Download
  • <iframe src="https://www.npr.org/player/embed/1115011915/1115084476" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

(SOUNDBITE OF MUSIC)

TRACIE HUNTE, HOST:

Hey, y'all. You're listening to IT'S BEEN A MINUTE from NPR. I'm Tracie Hunte. You may know me as a correspondent for WNYC Studios, the public radio station in New York City. But for the next two weeks, I'll be guest-hosting the show. And today, I want to introduce you to a term you may not have heard before - the viral underclass. The phrase is new to me, too, but it essentially refers to a group of people who are the most dramatically affected when a virus or a disease surfaces.

STEVEN THRASHER: They're more likely to get sick. Their kin and the people around them are more likely to get sick. And even if they do get the care, they could leave a hospital with a $100,000 bill that's going to financially ruin them for the rest of their lives.

(SOUNDBITE OF MUSIC)

HUNTE: That's Dr. Steven Thrasher, a journalist who has spent years covering HIV and AIDS. He's the author of a new book called "The Viral Underclass: The Human Toll When Inequality And Disease Collide." And his argument is that, no matter the virus or how it's transmitted, it's almost always the most marginalized people who are harmed the most.

THRASHER: I came up with this analytic because I was seeing - the same maps that I'd seen where HIV and AIDS were most concentrated were initially the same maps that were where the most COVID transmissions were happening. They overlap a lot right now with where the monkeypox infections are happening. And so I was realizing it wasn't the characteristics of the individual viruses, which move between bodies in quite different ways. It was more that they're - the same social drivers are why people get into the path of viruses and then why they're more likely or less likely to survive them financially and biologically.

HUNTE: Dr. Thrasher saw this pattern play out in communities all over the United States and then all over the world, and he says understanding what it means could help us face disease in ways that are more equitable and more effective.

(SOUNDBITE OF MUSIC)

HUNTE: You're making all of these connections between, like, AIDS and COVID-19 and - you know, in marginalized communities all over the world. Why do you think it's so important to make those connections clearer for people?

THRASHER: Because the sort of magical thing about viruses is that they prove to us, in a way that we can't ignore, that we are not - you know, that we're not alone. We are not discrete...

HUNTE: Right.

THRASHER: ...Individuals. We are always connected to one another at the level of our breathing. And so I would hope that a viral underclass framework helps people see that we're all connected to each other in this, and our fates are connected.

HUNTE: And to illustrate this point, Thrasher writes about Michael Johnson, a young Black man who was convicted in 2015 for allegedly failing to disclose his HIV status to sexual partners.

THRASHER: This young man got arrested for a very salacious charge. The claims were he had knowingly and purposely tried to infect people with HIV, which was not actually the case.

HUNTE: Michael Johnson was a college athlete - a wrestler. And he was good at it. He got a scholarship to wrestle for Lindenwood University in St. Charles, Mo. In 2013, he was diagnosed with HIV when he was still a student. Johnson was openly gay, and he continued to date men and use online dating and hookup apps. He says he disclosed his HIV status to his partners, but one of them went to the police, saying Johnson had not told him he was HIV-positive. It didn't take long before Johnson found himself in court. The prosecution called several witnesses, who alleged that Johnson had knowingly exposed them to HIV.

THRASHER: I sat through every second of the trial. It was, you know, openly, openly homophobic and bigoted and unscientific. The quote-unquote, "news stories" about it in the local press were just regurgitations of the prosecutor's press release, and then it had, like, three or four days of being an Internet story in the fall of 2013 in multiple countries across the planet, giving the sense that, like, this one kid was a global menace, giving people HIV, when tens of millions of people currently live with HIV.

HUNTE: To Johnson, it felt like the jury came in with preconceived ideas about him. He told KSDK News in Saint Louis...

(SOUNDBITE OF ARCHIVED RECORDING)

THRASHER: They saw the - what the media initially wanted to put out was that it was a scary, big, Black, gay man wrestler that was out to cause harm.

HUNTE: The jury gave Johnson two 30-year sentences. That's worse than what you would get for second-degree murder. Dr. Thrasher would spend the next eight years covering Johnson's story. The case showed him the connections between homophobia, racism and disease, and how the people at the intersection of those spaces - people like Michael Johnson - became scapegoats, blamed for diseases they don't want and can't control.

THRASHER: When I was writing at the time, I thought, a lot of Americans only know about gay life kind of like - "Will And Grace" is their first reference point. There's this misperception that gay people are wealthy elites living in a handful of cities. And in reality, most LGBTQ people are poor. We earn less than the national average because of the many ways that homophobia has a bad impact on our health, professional earnings, education - all these things. And so I thought that his story really helped show that in a pretty direct way.

HUNTE: We're going to take a quick break. And when we get back, Dr. Thrasher traces the way that blame perpetuates the spread of a virus.

(SOUNDBITE OF MUSIC)

HUNTE: So I want you to think about Michael Johnson's story for a second. He was scapegoated for the spread of HIV. The system was looking for someone to blame, as if their behavior is the main reason a virus spreads. Our individual actions do affect what happens in our communities, but Dr. Thrasher says that doesn't excuse the fact that our public health systems are just not set up to help vulnerable communities confront viruses. And he says that reality is obscured when we're constantly looking for someone to point to - a patient zero, if you will - someone to pin all our fears on - whether it's HIV or COVID or the novel monkeypox virus currently making headlines.

THRASHER: We, in the United States in particular, focus so much on the individual and try to make it...

HUNTE: Yeah.

THRASHER: ...Their responsibility alone.

HUNTE: Right.

THRASHER: And so when a fat person or a queer person or a disabled person is at increased risk, it's not because they're bad people or they're irresponsible. It's because they're not getting, you know, the support that they need to lead the healthiest life that they can.

HUNTE: So one thing that you wrote that really stuck with me was this - (reading) the teenager, working in McDonald's, who's sick with COVID-19; the Black gay man in Mississippi who's infected with HIV; the Jewish girl, forced into a Warsaw ghetto by the Nazis, who's plagued with typhus; the Palestinian boy who was stuffed into cramped quarters in Gaza and whose diarrhea is filled with norovirus - all of these people deserve compassion for how viruses affect them - not blame. What is it about assigning blame that prevents us from dealing with viruses?

THRASHER: Well, blame is a really good technique of social control to make an individual feel like what they're going through is their fault...

HUNTE: Yeah.

THRASHER: ...And therefore they deserve all the bad things that are happening to them, and they're pointing out those ways we can see where people are forced to live in squalor. And the dominant powers are trying to convince them it's your fault because you're a bad and quote-unquote "dirty" people, and that's why...

HUNTE: Right.

THRASHER: ...You're stuck with this. So right now, you know, we have a monkeypox epidemic, which I've been doing field research on, and I've been able to get one shot myself. And a lot of my friends are struggling to be able to get shots. And I felt like I understood, you know, some of the dynamics around it - that there just wasn't enough vaccine to get out to people. But, yesterday, The New York Times reported that the U.S. government actually had access to 300,000 more doses that they just didn't want to pay for until they saw how it all played out.

HUNTE: Ugh.

THRASHER: And so that made me incredibly, incredibly angry because this is not a virus where even, you know, using a condom or things you might do for HIV or other...

HUNTE: Yeah.

THRASHER: ...STIs don't seem to work. You really just need to be vaccinated 'cause it's a - can be skin-to-skin and breath transmission. And so a lot of the messaging was like, you need to solve this. But all the gay men I know are ready - very willing and ready to get vaccinated, but the U.S. government didn't want to pay for those vaccines, nor did they look at what we could have learned from the COVID-19 pandemic...

HUNTE: Yeah.

THRASHER: ...And built out an infrastructure for delivering vaccines in a way that could've been permanent.

HUNTE: So at the start of the COVID pandemic, I had been working on a story about the ACT UP movement. And in one of their - in a couple of the different protests that they had done - particularly one, where they - where a few dozen of them took ashes of their loved ones who had died of AIDS and put them on the White House lawn.

(SOUNDBITE OF PROTEST)

UNIDENTIFIED PEOPLE: (Chanting) Bringing the dead to your door. We won't take it anymore. Bringing the dead to your door. We won't take it anymore.

HUNTE: Now, with monkeypox - you know, like, it's sort of being talked about as, like, a gay disease, for example, the same way that AIDS was. It's harder to feel hopeful when we keep repeating the same mistakes over and over and over again. And I don't know - like, how do you find hope in a situation where it seems like we never learn the lesson - or the lesson that we do learn is never carried into the future?

THRASHER: Well, I actually think that - I think that monkeypox should be talked explicitly about as a sexually transmitted infection - that it's primarily affecting gay men. And that, I think - that has been informed, I think, a lot from my reporting on Michael - to not shrink and be embarrassed about, you know, what's happening in reality. He refused to be embarrassed by all these things people were saying about his sex life. The homophobia is deplorable, but it doesn't go away by not talking about things. And I am quite concerned right now that between 95% and 99% of the cases around the world have been among men who have sex with men. And so I feel hopeful with people who are saying, like, yes, we have sex, and we demand to get the health care that we need.

Where I feel extremely worried is that people need to quarantine for at least 21 days. It could be longer, but 21 days is the minimum that you need to quarantine once you're diagnosed. And yet, we still don't have paid sick leave, even after this pandemic that took out so many people. We need an economic apparatus where, if someone's sick, that they can stay home. Students are almost always amazed by this when I tell them this - that, you know, prior to AIDS, like, doctors didn't wear gloves, you know? Your dentist didn't use gloves.

HUNTE: Oh, my God (laughter).

THRASHER: You know, your dentist - yeah.

HUNTE: No, I'm sorry.

THRASHER: Yeah.

HUNTE: I did not know that (laughter).

THRASHER: Yeah. It's all right. A lot of people don't know that. So, you know, before HIV, like, you know, your dentist would be, you know, moving around in your mouth without any gloves. That...

HUNTE: Oh, my God (laughter).

THRASHER: But that triggered these universal precautions. And lo and behold, using gloves does all kinds of good things, you know, for...

HUNTE: Right.

THRASHER: ...Your mental health, your dental health, your physical health. When medical practitioners use them, it protects them. It protects the person they're seeing after them. It protects you.

HUNTE: Yeah. Mmm hmm.

THRASHER: But there are these processes that came along, you know, that we've learned from these pandemics - that we can learn from these pandemics that can have really good applications for everyday life.

HUNTE: All right. We're going to take another quick break. And when we get back, Dr. Thrasher talks about how vulnerability is both humbling and empowering.

(SOUNDBITE OF MUSIC)

HUNTE: Over the years that Dr. Thrasher covered Michael Johnson's story, he tried to keep a professional distance, but he found himself rooting for Johnson. So when activists and lawyers got the court to rule that Johnson had had an unfair trial and to reduce his sentence from 60 years to six, Dr. Thrasher couldn't help but feel personally involved.

THRASHER: I mean, I was certainly angry at the time. Around his story in particular, I mostly feel gratitude now because it just feels so stupendous to me that he's out and living his life. I didn't know if I'd still be alive when he got out of prison. He would - I would have been - I think I would have been, like, almost 70 if he had served his whole sentence. My primary emotion is gratitude that he's out, while realizing that that's an extremely anomalous situation.

HUNTE: He was there the day Johnson was released from prison and met with hugs from his friends.

(SOUNDBITE OF ARCHIVED RECORDING)

MICHAEL JOHNSON: Oh, thank you so much.

MEREDITH ROWAN: (Crying) I don't want to let go. You're out.

JOHNSON: (Laughter).

ROWAN: (Crying) I got him.

THRASHER: And I think that viruses - like, that's one of the things they teach us - is that we are vulnerable, and we can learn how to be vulnerable with more humility and in ways that engender connection and friendship and mutual support and interest. Vulnerability doesn't have to be something that we fight against or, you know, try to hide from. It's something that we can do that allows for us to make a better world together. We do share connections, and the viruses are telling us again and again that we share these connections. And so if they can help us do so with less defensiveness and more mutual aid, then that's a good thing.

HUNTE: You kind of - you end the book on this optimistic, more hopeful note. And are you really that optimistic that we can change society?

THRASHER: Yeah. I'm not sure if I'm optimistic. I am...

HUNTE: Optimistic in general, or optimistic about changing society?

THRASHER: I don't like to think of optimism as a point of predetermined destiny, right? Like, I'm not optimistic that things will get better. I am optimistic that there are possibilities to make it better and that viruses give us all these frameworks and tools for moving towards that possibility. Viruses adapt continuously, and we have to adapt as well.

HUNTE: Well, Steven, thank you so much for taking the time to talk to us. This was really, really great.

THRASHER: Thank you so much. It's been a pleasure, Tracie, and I really appreciate your interest and your questions.

(SOUNDBITE OF MUSIC)

HUNTE: Thank you again to Dr. Steven Thrasher. His new book is "The Viral Underclass."

This episode was produced by Barton Girdwood and edited by Jessica Mendoza and Jessica Placzek. Until Friday, I'm Tracie Hunte. Talk soon, y'all.

(SOUNDBITE OF MUSIC)

Copyright © 2022 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.