City of Omens, by Dan Werb

Though banal, it’s true that there are a lot of massive, seemingly unsolvable problems in western society. One of these—drugs—was approached as the War on Drugs. The direct approach has been a disaster by all accounts. Shooting the problem, as it were, only makes other problems instead of getting at its root. But where do we put our efforts? Where do we aim? Scientists like Dan Werb, epidemiologist and author of City of Omens, look for that spot by taking several steps back. Instead of looking at the outcomes, they look for the chain of causes that led to the outcomes. In this case, the problem is rampant drug addiction, the unchecked spread of HIV, and the deaths of thousands of women in the city of Tijuana, Mexico. The causes of these outcomes are complicated and surprising…but not as unsolvable as we might have thought.

Werb began his work studying the spread of HIV via intravenous drug use in Vancouver’s infamous Downtown Eastside. For years, the approach to the problem was rounding up users, destroying their needles, and incarcerate sellers and addicts alike. None of it stopped the spread. In fact, researchers found that things were getting worse. When the official approach changed to offering needle exchanges and rehab, HIV started to go down. There wasn’t an explosion of drug use or violence, as sceptics thought. Werb’s work attracted the eye of researchers who did similar work in Tijuana. He leapt at the chance to do something with all the statistical tools in his arsenal. He turns epidemiological methods into an extended metaphor by trying to find the pathogen causing so much death and sickness across the city.

So, starting around 2015, Werb started work with Proyecto Cuete (Project Needle). He conducted years of interviews with addicts and sex workers who operated in Tijuana’s notorious Zona Norte and other drug-use hotspots. The interviews turned into mountains of data points in spreadsheets, fed into statistical models. Werb explains his process over and over; there are several places where I started skimming. The best parts of this book are where Werb lets his subjects speak for themselves. A social scientist will bury a reader in undeniable data but, as an English major, I would’ve told Werb that stories are the best way to get change rolling. We even see this when Proyecto Cuete get the Tijuana police to change their policy of destroying needles by telling them that officers can avoid dangerous needlesticks by not handling users’ kits at all.

Werb’s long view (although I have some editorial comments about how he presents his findings) points out so many places where society is going wrong. He never says it explicitly, but Werb calls for a lot more compassion in how drug users and sex workers are treated by law enforcement and society. Throwing people in jail and/or fining them does nothing except drive everything underground and make it all more dangerous. We all need to take several steps back to find ways to make life safer for people who are often seen as thrown away, dropouts, and losers. People are going to use drugs. People are going to pay for and sell sex. None of this means that they are less worthy of life. And, as Werb points out, none of this is unsolvable.

Traffic in Tijuana, near the Mexico-US border c. 2006 (Image via Wikicommons)

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