Advancing Access Through Place Based Care

Repeatedly over the years, I’ve asked funders to consider investing in (sponsoring) various sexual-social events. Often these events are already tapped into local clinic networks or community service organizations and, historically, these organizations are not “large” by any stretch of the imagination. If we look at one of the most influential (and sometimes notorious) examples, The Sisters of Perpetual Indulgence, the raucous, often raunchy members of the organization’s chapters are deeply, deeply tied into any given community’s needs. From providing street “ministry” by giving food to houseless persons to giving out condoms, education, and, in the case of the Las Vegas chapter, providing a community-based AIDS drug assistance program for people needing more assistance than the state program offers, the Sisters aren’t known for being…conservative. And they’re not alone.

Indeed, in nearly every large city (and often even smaller cities) across the country, there is some kind of sexual fraternity which gathers at leather bars, bathhouses, and large events, like International Mr. Leather or International Ms. Leather. These events are explicitly sexual in nature. But they’re also where these communities we seek to serve gather and often with intentional efforts are welcoming and involving people who live at layered intersections of marginalization; Onyx, for example, aims to meet the social needs of queer men of color. And all of these organizations and events and the clinics that find ways to serve these events could well stand to use additional financial support.

Every time that ask has come up, I’ve been told it might be “too edgy” to place a well-known brand in sponsorship. The Ryan White CARE Act explicitly forbids federal grant dollars from “promoting homosexual behavior” – necessarily prohibiting any financial support of these spaces which operate as centralized gathering of an audience and only allowing service providers to show up. But those sponsor dollars are what makes it possible for service organizations – be they clinics or these fraternal organizations – to show up and engage in the most effective place-based outreach and care. In November, Time published the opinion piece, We Need to Bring Sexual Health Care to Places Where People Have Sex. The piece highlights the effectiveness of place-based, going to the source, outreach, education, and vaccination in response to the mpox outbreak that’s wrapped its fingers around the globe. Across the country, health departments and federally funded clinics have quietly been working in these spaces for decades. Dr. Demetre Daskalakis, the director of the Center for Disease Control and Prevention’s (CDC’s) HIV Prevention Program, is reasonably well credited for ending a meningitis outbreak in New York City by providing vaccines on location at bath houses – where people have sex.

HIV and Hepatitis C do not thrive in “neat” and “clean” and “conservative” environments. Rather these viruses thrive where people are getting their own needs met and that includes where people are getting their sexual needs met and their coping needs met (drug use is, at its core, a coping mechanism). And interventions to curb the transmission and detrimental effects of these viruses thrive when communities come together.

Just as we need to extend funding supports that incentivize churches to host testing and education events in order to address stigma, we also need to fund the entities, communities, formal and informal, and places where communities gather. Leaning into culture, as opposed to avoiding it, ensuring existing communities thrive, meeting people where they’re at, and funding where advocacy goes to celebrate is something we need more of. Advocacy needs our funders, of all stripes, to not be afraid of being labeled “sex-positive” and to show up for us and our communities in the places we already exist.