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Saving St. James Infirmary 

Wednesday, Feb 10 2016

Walk down Mission Street, and you may not even notice the St. James Infirmary. There's no sign on the door, and the doctors inside won't be wearing white coats — but inside this groundbreaking health clinic, lives are being changed. A peer-based operation (many of the staff come from the community they serve), the St. James Infirmary serves the sex worker and transgender communities, ensuring they have access to services ranging from hormone replacement therapy to somewhere safe to use the internet. It's the namesake of activist Margo St. James, who fought a long crusade against the stigmas surrounding sex work, tirelessly fighting for the rights of society's most marginalized individuals.

The battle continues, as the staff of St. James recently learned they would need to relocate from their South of Market digs or face a potential eviction.

While the St. James Infirmary officially began as a weekly pop-up operating out of City Clinic on Seventh and Market streets in 1999, its existence is predicated on St. James' advocacy. In 1973, she founded Call Off Your Old Tired Ethics, or COYOTE, an offshoot of her previous organization, WHO: Whores, Housewives, and Others. ("Others" references the lesbian community.) COYOTE battled discriminatory policy against sex workers across the U.S., leading to the decriminalization of prostitution in Rhode Island and a focused spotlight on the issues sex workers face.

In the late 1990s, St. James' position as their champion led a female sex worker — who was held at the San Francisco County Jail at 850 Bryant St. — to call her after being subjected to an involuntary blood draw.

Stephany Ashley, the executive director of St. James Infirmary, explains it was then common practice for the city Department of Public Health's STD Prevention and Control Unit to partner with the Sheriff's Department to test known sex workers in custody. St. James reached out to Jeffrey Klausner, then the head of the STD Prevention and Control Unit, who was receptive to her suggestion that a peer-based health care organization was needed in the sex worker community. A partnership between COYOTE, the Exotic Dancers Alliance, and the STD Prevention and Control Center was forged, and the St. James Infirmary was born.

In total, Ashley estimates that it takes 50 people to make St. James run, including 15 paid staff members. In total, more than 3,500 individuals have medical records with the clinic, meaning that time and supplies are always in high demand. Ashley emphasizes the importance of volunteers to the day-to-day success of the health clinic.

"There's this wealth of physicians, including nurse practitioners, medical doctors and so on, that are compelled by the mission and want to volunteer their time," she says.

The St. James Infirmary offers primary medical care, STI and HIV testing, reproductive health care, vaccinations, mental health care, Narcan distribution, a needle exchange, overdose prevention training, and support groups.

However, Medical Director Dr. Pratima Gupta says added resources like a clothing closet, hot meals, and reiki massage are what really set the clinic apart. It's even developing a Bad Date app to alert users about reports of clients who are abusive or renege on payments. Safety and security for their patients is paramount at St. James, as is an emphasis on the judgment-free manner in which care is provided.

"If I see a transgender patient for a cough," Gupta says, "I'm not going to ask if they've had FTM Top surgery, because what does that have to do with their cough?"

St. James offers appointments and weekly drop-in hours, in addition to a phone line where anyone is welcome to call and arrange to be seen. The clinic operates during the evening, which means the medical professionals donating their time are often rushing over from their day practices in order to volunteer their time.

Gupta acknowledges that the St. James environment isn't a fit for everyone, noting that clinicians are required to set up their own exam rooms and clean them between appointments. There is also no electronic medical record to consult, elements that lead Gupta to affectionately deem St. James a "by-your-bootstraps" type of clinic.

The wealth of aid offered by the St. James Infirmary isn't limited to those who visit the clinic's physical location. Outreach is another fundamental platform of their mission, with teams being sent to distribute supplies to those in need on the streets of the Mission, the Tenderloin, SoMa, and Polk Street. As part of their venue-based outreach, St. James representatives regularly visit strip clubs and massage parlors around the city to offer everything from Tiger Balm to condoms. Ashley says that not every strip club is entirely welcoming of these efforts, but they've built many relationships over the years.

For Gupta, one of the main draws of working with St. James is the chance to help educate the community at large that sex work can be a choice. While condemning forced labor of any kind, she feels many people assume that sex work is always something people are forced into. It's a misconception she is eager to change.

"St. James [provides] services to participants in a setting where they feel safe," she says. "They don't have to risk being judged about what they're doing, or worry that we'll try to convince them to do something else."

Precious Lovely first discovered the clinic after moving up the coast from Santa Barbara in 2014. It was a colleague at the Haight Ashbury Walden House who first told her about the infirmary.

"When I arrived, they [helped me to get] all of the resources I needed," she says. "They went over and beyond to make sure my person was OK."

Lovely says that St. James assisted her with estriol and hormone treatment therapy, in addition to counseling and case management. She says that without St. James, she isn't sure where she'd be right now.

Unfortunately, the St. James Infirmary was also recently unsure of where it might be in the future. In July 2015, Ashley learned that Mercy Housing California had sold the building at 1372 Mission Street that houses the clinic to a "high-net worth real estate owner" (in the words of the Registry SF, a real estate news publication). Michael Taquino, a listing agent who brokered the sale, told The Registry that the buildings would be rehabilitated into "desirable creative space[s]" at short-term leases, a prospect unlikely to help the thousands of clients who rely on St. James. In addition to the St. James Infirmary, the sale has also displaced the Transgender Gender Variant Intersex Justice Project, which operated out of the same space.

Aware that the building's new owners wanted St. James out, and could enforce a 30-day eviction once they took ownership, Ashley immediately began searching for a new home.

"Moving a medical clinic in a month is not a task you want to take on," she says.

With the exorbitant price of real estate in San Francisco, Ashley knew that it would take the generosity of the community to help St. James pull off its move. Inspired by an anonymous benefactor's offer to match up to $25,000 in donations, the St. James Infirmary launched a GoFundMe campaign in October in hopes of pulling it together — a goal that took just three days to reach.

"We were completely blown away by the amount of support we received," Ashley says. "It was just not what we were expecting at all, and it was really heartening."

Additional donations, bolstered by further offers of matching contributions, helped St. James Infirmary raise over $75,000 to subsidize the move. Ashley says support came in other forms, such as people calling in with tips on potential new locations. Through a bit of what Ashley calls "incredible serendipity," she found a Tenderloin health care clinic that had fallen into disuse. While citing the benefits of having a laboratory and exam rooms already built out, she's also happy to have found a location with sinks in the right places. And relocating to the T.L. means St. James' target community can still access its services with ease.

While the ink isn't dry and lease negotiations remain ongoing, work has already begun to modify the space at 234 Eddy St. With many of the necessary fixtures already in place, most of the labor revolves around giving the clinic's new facility the same personal touches that make its current home such a welcoming space. Posters from Margo St. James' campaign to run for Board of Supervisors and posters from the Exotic Dancer's Alliance's efforts in the 1990s to unionize strip clubs will adorn the waiting room, and there are hopes of commissioning a community mural as well.

Ashley hopes to make the move at some point in February. The staff has already begun the tasks of painting the walls and moving supplies to their future home. For the time being, things continue at the current location on Mission, making for busy days and long nights for the dedicated personnel that have made the St. James Infirmary their labor of love.

Gratitude for the immense support St. James has received extends beyond just the staff. Lovely says it's "truly amazing" how the community responded, and hopes to see Mayor Ed Lee take a more active interest in the clinic's work.

She believes a second St. James location is needed, and hopes the resources she's so grateful to have received can be extended to help even more members of the sex worker and transgender community.

"Being a client of St. James really helps you to continue on your path of life," she says. "They give you all the solutions to the problems that are occurring in your life."


About The Author

Zack Ruskin

Zack Ruskin

Zack was born in San Francisco and never found a reason to leave. He has written for Consequence of Sound, The Believer, The Millions, and The Rumpus. He is still in search of a Bort license plate.


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