That you can watch all of our congressional coverage without free video app cspan now or online at cspan. Org. A healthy democracy doesnt just look like this, it looks like this. Americans can see democracy at work. The citizens are truly our republic thrives. Get informed straight from the source on cspan unfiltered, unbiased, word for word from the Nations Capital to wherever you are. Get the opinion that matters most. This is what democracy looks like. Cspan, powered by cable. Thank you for coming to this panel about a very important subject, Health Inequality and health justice. We have here two fantastic authors with books i think every american needs to raid. First off we have bat may see shes a virginiabased journalist her previous book was, duke sick dealers, the drug, doctors on the drug computing that addicted america. She was an executive producer on hulus pew body before that she spent many years reporting for the Roanoke Times in virginia and occasionally contribute essays to the new york times. Shes here with her book, raising lazarus, hope, justice in the future of americas overdose crisis. And next to her we have stephen fracture, he holds the inaugural run burchard northwestern school, i jeweler professorship in the world. To focus on lgbtq research in the world to focus on lgbtq research. He is also on the faculty of northwesterns institute of sexual and gender Minority Health and wellbeing. He has written about the aids hiv, covid, and monkeypox academics for the new york times, buzzfeed news, and numerous scholarly journals. He is here with his book the viral underclass, the human toll when inequality and disease collide. I think we are going to have a great discussion. I want to start this off sort of framing with this quote that appears in raising lazarus for Martin Luther king junior. Of all the forms of inequality injustice in health, its the most shocking the most inhuman because it often result in physical death. I think that is so important to keep in mind as we continue with this discussion. I want to start with you live the viral underclass. This is in many ways the followup to dope sick. I can imagine that was a difficult book to report on. I can imagine the sorrow and the pain that you would have to share with people in that. Can you just explain why you reported on the Opioid Crisis . I would love you to share the story of that title. It is such a vital part of the book. Thank you. Thanks, everybody, for coming. I already cant stop talking to stephen. This is a great pick, whoever picked this. Why write a second book about the Opioid Crisis . I was so bereft by the time i finished dope sick. My main person i had been following, a young woman who struggled with addiction for five plus years, had been murdered after being abandoned by every system that was meant to help her. The last image in that book, for those of you who have read it, is a mother saying goodbye to her body at a funeral home. Shes bereft because of the loss and bereft because of the four responses of our nation to the Opioid Crisis. I really was not ever going to write about it again. My husband said that i should write a cookbook. But laughter i started talking to people in a learning about really innovative things that surprised me, particularly when you have people doing cutting edge Harm Reduction and low barrier care in rural space, in Rural Communities which havent even passed medicaid expansion. I am like, holy cow, if they can do it, why arent they the model for our nation Going Forward . We still have an 87 treatment gap in america for owe you the, opioid use disorder, and that means only we still have an 80 percent treatment gap and america for all you due to, opioid use disorder. Only 13 of folks were able to access treatment and its largely because of stigma and inaction. I thought with this opioid money about to be coming down the Litigation Settlement money, why dont i write this book which is more hopeful . The bits of hope are not to the scale that we wish it were. This will help teach communities how to best spend that money which is in the way that the evidence supports and also just in the ways that humanity supports. That leads to the title. A lot of people think the title raising lazarus is a reference to narcan, the overdose reversal drug. Narcan is part of it, but i started reporting on these two women who were married and they started what they called the nations only, biracial, faithbased Harm Reduction group. They started passing out needles on the slide before it was in the back of their pick up truck. They were poised when it Needle Exchange was legalized in North Carolina to become a fullfledged organization. They now do amazing work. They do cutting edge work. People call upon michelle, the minister, when she is trying to get christian groups to check blind spots about harvard auction which is this idea of going to meet people where they are, shooting them with nonjudgmental care, love, and saying its okay if they are still using. You are still a person if you are still using. We know that people are more likely to enter treatment. I am sorry about the long answer. For the first time i meet michelle, shes in this Community Meeting where the it is hijacked by someone says, well, i think we should let them die and keep their organs. Really . She tells a story of lazarus. Jesus was four days late getting to lazarus. He was dead when he got there. Okay, jesus performance was a miracle of bringing lazarus back from the dead. Its up to the disciples to roll the stone, to remove the barrier. I have a chapter called stone rollers. Its up to the disciples to do the messy work of an binding lazarus but only by getting close to these folks on the ground. Can you experience the miracle of raising lazarus . Thats where the title came from. I love the praise, the sticky messy work involved in that. Steven, lets talk about the viral, underclass its not a phrase that you coined yourself. But you used to great effect within the book. I love this framing that you put on the book, when we follow the virus, any virus, we follow the culture, which is a line of what you are exploring in the book. The interrelationship between the spread of disease and marginalized people. What is the genesis of this book . Well, thank you so much for having me. Im happy to be here. inaudible hes using it to describe how and why people are criminalized for transmitting hiv, or exposing other people to hiv. There are many points in our books, one of the misunderstanding the ways that stigma is the stone that keeps people from getting the help they need. And for people who dont know, in the, audience it is illegal to expose someone else to hiv or transmit hiv to somebody else under circumstances in half of u. S. States. 70 countries around the world. And its a really bad law because when people are positive with hiv, or covid, or monkeypox, or anything, what we want is for them to be able to come forward and get the care that they need and to know that theyre not gonna be judged, and that they are certainly not going to be thrown in prison. So i started writing about a case of a young man in st. Louis, into thousand 13, who was arrested for criminal exposure to hiv and transmitting hiv to people. He was facing life in prison. He eventually got sentenced to 30 years in prison. Because of our reporting, at, buzzfeed and a lot of activists, work we got him out about 25 years early. He spent most of his twenties and prison. It was a real wake up call to me to understand that even if people think that doing things that might lead to exposure to someone, else nobody is trying to give anyone else covid. Nobody is trying to get anyone else hiv or aids. But when you tell people that, if you find out your positive, and for the rest of your life you can be prosecuted, they see somebody go to prison for 30 years, that becomes a stone that keeps people from getting tested in the first place. The work of hiv prevention people but i work with got much harder after the beginning of that case. So a viral underclass, i started seeing sean used to talk about People Living under hiv, living under. Flaws i heard activists using it in slightly different ways. I was trying to this became a serious for a long time. It became the basis of my phd dissertation. I understood it as a way to understand systemic racism because overwhelmingly. The people who are prosecuted are black. Anywhere around the world of this happens. And i started to use this as a way to think of a viral underclass as an analytic to understand how and why similar groups of people become exposed to the different social conditions and different kinds of viruses. Hiv, when you look at where people get hiv, and where it progresses to, a. I. D. S. You also find people who are dying in criminalized over policing, police, killings you just see it on maps. When the covid19 death started happening in 2020, i saw the same maps filling in. So my move in the book, the viral, underclass i build off the work around, race but one of the ways my book intersects is that this is not only a matter of, race race is a big part, of it but this is affecting poor white people, poor people who are lgbtq. Disabled, and in another way, people who have been incarcerated. I want to add one point of hope. Activist, since the time i sort of work in, this have done really really good work raising awareness about the criminalization of hiv. Only two states have gotten rid of the laws entirely. When people are cynical about the two party system, i tell them the two states that have gotten rid of hiv laws are illinois, where i live, blue top to bottom, in texas. So thank you for all of, you this happened under your government. With lots of bipartisan support. Thats great. Great. The first area i would like to drill into, you both alluded to in your discussions of your books just then, it is stigma. Because it is such a big part of what you both are reporting about in this book. To me, stigma is about creating a sense of a, where these problems, these issues, therefore other people and other groups that we can shunt away. In this country, most of us have a good awareness of how we treat people as others when it comes to racial divisions, or sexual orientation, or gender identity. When you all what you both explored is this treatment of other when it comes to drug use or homelessness, or incarceration, or sex, work or even just people having some of these diseases that come with stigma. Hepatitis, hiv. You know, when its put so well treating human beings as objects, rather than i would love both of you to drill in just a little bit more how stigma prevents us from reaching solutions in these Public Health crises. Thats a great question. Someone domenico . First so much of the stigmatization comes from this place where people fall through the gaps and die. That is this tension between treating people like a criminal, a moral failure, and treating them like the human beings that they are with a treatable medical condition. They really are people with a treatable medical condition. Just like you would take insulin if you had diabetes, which i have. So if you look at that, it goes back to the narcotics act of 1914. It goes back to nixons war on drugs. I take a brief digression to talk about nixon in his early years, when he actually had treatment funded as well as he had incarceration for drug use funded. He appointed the nations first drug czar, this super crusty psychiatrist name jerome javid hooper reported directly to him. Designed a program of on demand methadone clinics. But then, you know, you see a start to become a way to place people in order to get votes. And the southern strategy that he employs, which is well documented, that is harsher against poor people and people of color. When i think of stigma, i think of the story in my book that got me the most. I was falling around in hiv worker whose job was to tell test and treat people for hiv in charleston, west virginia, the state that has the most concerning hiv outbreak in the nation. And the criminalized needs based syringe exchange. The one thing we know works to prevent the spread of these infectious diseases. So im following around this ryan white work named brooke parker. Shes looking for three people, but theyre mostly unhoused. She cant find them. And that needs are to streaming on her like, coming at her right and left. And at one point were looking for a person, write a homeless encampment. We run into this man in a wheelchair. Hes dope sick, hes crying, hes got maggots coming out of the abscess in his feed later in the day. He will go to the hospital, even though hes gonna die of this bacterial infection. Because he went there last week and he was treated like bleep for 18 hours. Shes begging him to go. It was like watching jesus, she sits on the dirty ground, she opens her first day, catchy puts gloves on, she puts packet after packet of antibiotic ointment on him. Hes wincing, hes crying, hes dope sick, he needs to get drugs to get well. And at that moment, a Police Officer comes up, and puts an eviction notice on the homeless encampment. I thought, all of the stories just came together in that moment. A sex worker who also lives in the homeless encampment comes up and says, to brooke, honey, that antibiotic ointment aint going to cut. It i was a nurse for 17 years. An lp end, and then i got married. And then it was like it she went like this, it was incredible. And she walked away, and brooks said, she should be the person treating him. If something had gone wrong for her, this is what we have to remember, this is the base of stigma. If we have to remember that this guy and well share had a family. He had kids. He could be just like us, and so i think stigma is really at the base of all those many things, all the layers of discrimination in that one moment, and just how poorly people in our own Health Care System, which by the, way participated in starting the Opioid Crisis, and they need to participate in putting an end to it. Stephen . So, the statistic that i think about the most that i read about in the book, and have for years, is one and every two black men are projected to become hiv positive in our lifetime. Theres no reason for that to happen. Certainly theres no reason for anyone to die of aids. Hiv is extremely slow acting virus. It can take five, seven, ten years for people to start having bad health effects. 10 to 15 years until they die. 10,000 people still died of it in the United States are. Youre the better part of 1 million diet around the globe. And a big part of it is economics. But a lot of that is the stigma. People are made to feel so bad, it is so shameful through hiv criminalization, laws, jokes through the ways people are treated in health care settings. That they dont get the help that they need. And i was thinking what you were talking, beth, if people dont have a safe place to sleep, it doesnt matter whether or not you get them these drugs. Hiv is relatively easy to deal with when you catch it in its early stages. People take one pill a day, they go on with her life pretty much normally thereafter. But stigma is a huge barrier in getting the care that they need. I was saying something nice about your state earlier with hiv criminalization, laws but what theyre doing with trans children and the ways that lgbtq people are getting formalized in this state, in florida, arkansas, its creating these pathways of the state to let viruses into bodies. Trans people, if principle can get the medically supervised care that they need for hormones in a safe setting. If people are dealing with addiction as a Health Matter cannot get syringes, then the state opens up their fans and their bodies to hiv and hepatitis another pathogens. Because theyre going to get the care they need somewhere whether or not it is sterile. And stigma, not only is that a physical matter, but stigma becomes this barrier that makes people feel ashamed to get the help that they need. So one of the stories that touch me the, most in the first person in my outer Social Circle to die of covid was a really amazing activist named who was known as the trans latinx mother of the mother of the trans Latinx Community in jackson heights, new york, in queens. She had been living with hiv for decades. She had been a sex worker, she did amazing volunteer work, she would go out on the street and get people sit there ulcer. Inches she would give them food and condoms, and anything they needed. And met people where they were. And she was the first person i knew who contracted covid and died. When she had covid, those very early days in march 2020, she did not want to go to the hospitalriencd because of all the bad experiences that she had had in the hospital herself. I wont go into any depth here. I wrote about an experience that i had when i needed a testicular sonogram when i was doing my ph. D. Work. I was a bit older frustrated, but not that old. I was made to feel very unwelcome because of my age. The receptionist made a joke about not thinking i could be a referral from a Student Health center. That really made me understand the ways that, if a trans persons going for health care, particularly around something sensitive like Sexual Reproductive Health or cancer or something, if theyre met with that response, you dont look like what i was expecting, thats a big reason why they might not want to go in and get care. Thats one of the reasons they are so much more likely to get sick. Unnecessarily. I want to ask about intention here. So we have this Health Care System in our country that is capitalistic, and profit driven. So what interests me to explore a little bit is to what extent you think that the people making the decisions in our Public Health system and our Health Care Companies and hospitals, have some sense of malignant intention to intentionally marginalize these groups. To what extent is this just a byproduct of the structure of our system . Because it is profit driven . Go ahead. Well, before dopesick came out. I was ask