Our Public Health System Created a ‘Viral Underclass’

Journalist Steven Thrasher argues that viruses—like HIV and covid—can teach us how to approach care in a way that isn't "steeped in me getting mine first."

By Rich Juzwiak | August 10, 2022 | 7:44pm

Books Entertainment

Our Public Health System Created a ‘Viral Underclass’

When Steven Thrasher started reporting on Michael Johnson, the Lindenwood University student known to some as “Tiger Mandingo” who had been charged with (and later convicted of) “recklessly infecting another with HIV,” Thrasher’s editor at Buzzfeed, Mark Schoofs, told him, “I think you’re going to work on this for a long time.” In the eight years since Thrasher’s first article about Johnson, “How College Wrestling Star ‘Tiger Mandingo’ Became An HIV Scapegoat,” he’s published several more. And now he’s folded Johnson’s trial into a much larger project about systemic inequity’s devastating effects on public health: his newly released book, The Viral Underclass. Schoofs couldn’t have known how right he was.

Thrasher attributes the coinage of the term “viral underclass” to Sean Strub, the writer-activist who founded the HIV-interest magazine POZ. Strub wrote in 2011 that stigma derived from government discrimination toward people with HIV (such as HIV criminalization, as in the case of Johnson) resulted “in the creation of a viral underclass of persons with rights inferior to others, specially in regard of their sexual expression.” Expanding this idea to encapsulate HIV and other viruses like covid and hepatitis C, Thrasher has assembled a theory of the viral underclass that can, as he writes, “help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death.” In a Zoom interview with Jezebel last week, he said the concept of the viral underclass “can be thought of as a way to see why certain people are affected by viruses repeatedly, and sometimes very different viruses that have different characteristics.”

Most Popular

Thrasher synthesizes recorded data with original reporting in his wide-ranging examination of how our society’s ills exacerbate those of our bodies. He looked at, for example, racial disparity in HIV and covid. Black women face much higher rates of HIV diagnosis than white women. Black people (as well as Latinx people) are more than as likely to be hospitalized with covid than white people, according to Mayo Clinic data. Thrasher additionally connects other types of disparities with public health: Prisoners and jail inmates were nearly three times more likely and more than four times more likely, respectively, to report having at least one disability, according to a statistic he quotes from the Department of Justice.

Long covid testing lines in Everett, Massachusetts, on December 28, 2021. Photo:David L. Ryan/The Boston Globe (Getty Images)

“A viral underclass helps us understand who is in these pathways and then what the effect of being infected by one of those viruses does to people economically,” he said. This underclass is not the basis of a set caste system; Thrasher argues that given the high cost of healthcare in the U.S., a certain downward mobility is a reality for many. “Lots of this stuff could happen to anyone, and suddenly you could be in the viral underclass. If someone gets long covid, that’s going to have a debilitating financial effect on their life and impact their class status,” he said. This is similarly true for monkeypox (too recent of a mass threat to be featured in The Viral Underclass), which requires weeks of quarantine and comes at a steep cost for those without jobs that offer fully paid sick leave.

In his introduction (labeled “An Invitation”), Thrasher lists 12 “major related social vectors” that produce the viral underclass: racism, individualized shame, capitalism, the law, austerity, borders, the liberal carceral state, unequal prophylaxis, ableism, speciesism, the myth of white immunity, and collective punishment. The following 12 chapters assume each of these as their theme. Thrasher then weaves together multiple forms of writing: court reporting, science reporting, cultural criticism (he uses analysis of the 2019 film Parasite to illuminate capitalism’s cancer on public health), and memoir. Some sections function as profiles of various figures, like Zak Kostopoulos, a drag queen activist who was beaten to death in Greece in 2018, and Lorena Borjas, a trans activist who died of covid in 2020.

Lots of this stuff could happen to anyone, and suddenly you could be in the viral underclass. If someone gets long covid, that’s going to have a debilitating financial effect on their life and impact their class status.

There’s even a sense of poetry in Thrasher’s reframing of viruses as connectors of humanity as opposed to dividers. Calling viruses “our greatest teachers,” Thrasher reflects in his writing: “They offer us perhaps the best possibility of a new ethic of care—one not steeped in me getting mine first, but in us taking care of one another and of our very planet.” Trasher demonstrates that covid has not been the “great equalizer” as it was once claimed, but that it nonetheless has united humanity on certain terms. He writes: “There is tremendous power in how, for the first time in human history, all humans on the planet have been going through some version of the same thing, at nearly the same time, with the ability to communicate globally about it.”

At a reading pegged to the release of Thrasher’s book in early August, many of his guests noted that The Viral Underclass is as much about love as it is viruses. That notion has been at least decades in the making.

“I think that gay culture has given the broader society a way to see that viruses do connect us,” said Thrasher, who is gay and Black. “So much of queer culture that I’ve come up in was formed by AIDS. We came into this culture that was formed around negotiating these viruses and trying to find connection, despite how they were trying to keep us apart. It’s almost a sense of survivor’s guilt that I feel, but the culture that came out of that is so beautiful in so many ways.”

Thrasher said he realized at his reading that, “if there was no HIV virus, there’s so many people I wouldn’t have known, people I wouldn’t have loved, experiences I wouldn’t have had. And so in a way, I feel kind of a gratitude that I got to have that experience while not wanting to denigrate how many people it’s hurt.”

AIDS is a good example of a virus uniting a culture, but it’s also a good example of cultural apathy resulting from a virus’ effect on an already marginalized group. That apathy persists—in 2016 the CDC released a projection that if current HIV diagnosis rates persisted, one out of every four Latinx man who has sex with men would be diagnosed within their lifetime. The figure for Black men was one out of two. That projection, by the way, had been discussed among public health experts for years. In the years since the CDC’s announcement, though, barriers to PrEP, which could potentially revise this projection by greatly reducing HIV transmission, remain in place on a systemic level, according to public health experts.

I wondered if Thrasher remains hopeful that his book and message will reach people and prompt awareness and compassion in the face past apathy. He does, though his hope is measured. “I think like the majority of people want to do things that are going to help one another,” he said. “And I think that there’s much more consciousness about how that engages with poor people and Black people and queer people and trans people than there was a few years ago. And that’s something to build on.”

Besides, he saw a radical shift in the understanding of HIV criminalization as he covered the aforementioned Johnson case. Johnson was convicted in 2015 and sentenced to 30 years in jail, only to have that sentence overturned in 2018 over a failure by the case’s prosecuting attorney to disclose evidence in a timely manner. Today, Johnson, who maintained that he had notified his sex partners of his status, is a free man. Thrasher said the salaciousness of the initial reports of Johnson’s 2013 arrest had tempered by 2018.

“By the time he gets out, the Times writes this very sympathetic profile,” said Thrasher. “The headline is extremely calm. It’s much more clinical, and it’s even sympathetic to him. The photograph of him is extremely sympathetic. It’s not what one might expect of the New York Times writing about someone who’s gotten out of prison. So I do think that there was an overall shift in thinking about disease and criminalization and race and homophobia.”

Thrasher, by the way, remains in touch with the subject to whom he has devoted so much thought and ink. He says Johnson is working, feeling good, and his probation is set to end in October. “He actually just sent me a picture with the book, which I was very pleased to see.”