Kelly Ray Knight does a tremendous job in this ethnographic study of pregnant addicts working as sex workers in the Mission District of San Francisco. She spends four years working as a volunteer to bring condoms, injection supplies, bandages, and food to the women living in the daily-rent hotels that line Mission Street near 16th. Knight outlines the horror that is their lives, having to scrounge for the exorbitant $50/day fee to rent their rooms along with paying for their drug habit and wondering what to do about their pregnancies. She admits to feeling like a vulture, swooping in to study these sad cases, and examines the impact that the research system has on these women who show up multiple times (in wigs, disguised) to lie about their data in exchange for the research fee ($20-$50).

One compelling fact she exposes is that all these women are living in multiple “time zones” – there’s “addict time” where the main focus is on scoring the drug of choice, “pregnancy time” a ticking time bomb, and “hotel time” necessitating the daily grind of sex work to scrounge up money for the rent. Knight also shows us that these for-profit hotels shy away from accepting government subsidies since they can make a whole lot more money acting as a quasi-brothel, charging an additional $10 fee per visitor to each room.

It’s not a read for the faint of heart or for anyone unwilling to think hard about the serious problem of homeless, economically disadvantaged, poverty-trapped women who have the additional burden of child-bearing to keep them occupied. There’s plenty of open abscesses here, along with emergency room visits, domestic violence, police arrests, and crack smoking.

Knight notices an uptick in people self-diagnosing themselves as bi-polar and investigates. Turns out most psychiatrists blame this on an “all-out campaign by the pharmaceutical manufacturers to overemphasize bipolar disorder.” There’s also the normalization of trauma, described by one physician when detailing the abbreviated language physicians use to communicate, “When we give their history, we usually describe people using these one-liners: ‘forty-seven-year-old, male-to-female transgender, HIV-positive, CD4 count X, viral load X, on antiretrovirals, with a significant history of childhood sexual trauma, recent rape.’ It is all this comma, comma, comma.” Knight goes on to draw the conclusion that the “comma, comma, comma, reflective of cumulative vulnerabilities among the urban poor, is expected.” That’s pretty much where my heart has sunk to its lowest level when reading this.

Meticulously annotated, this is part of an ongoing series called Critical Global Health: Evidence, Efficacy, Ethnography. A fascinating look at a sub-culture that has existed for decades in the Mission and that’s now in danger of being displaced completely by the Google-fication of the neighborhood. Knight notes that gentrification is an ongoing phenomenon deserving of its own ethnographic treatment, and keeps her study firmly focused on these invisible, overlooked women.