The online diary of a gay courtesan.

Interview: Stacey Swimme of St. James Infirmary

Devon Hunter: Please tell me: a) the contact info you would want used in the interview, b) a brief description of the organization’s history,  c) and how the organization fills a gap in standard attitudes towards sex workers.

Stacey Swimme: I am the Development Director of St. James Infirmary.

St. James Infirmary provides compassionate and non-judgmental health care and social services for all sex workers, while preventing occupational illnesses and injuries through a comprehensive continuum of services. We offer free, confidential medical and social services for female, male, and transgender, sex workers.

We are the first peer run occupational health and safety clinic for sex workers in the United States. In our case, peer run means that the majority of our staff, current or former sex workers and are active clients of the clinic-that is they also receive our services. The nature of peer-to-peer services creates a safe space where sex workers can feel safe in discussing their sexual health, seek out services that are appropriate to meet their needs, and receive culturally competent care. Sex workers tend to be pathologized in medical environments, resulting in fractured relationships with medical providers and inadequate care. At the St. James Infirmary participants have no fear of their occupation interfering with their right to receive quality medical care.

What services do you offer at the Infirmary, and how are these services funded?

About one third of our funding comes from the City of San Francisco and state of California through their respective AIDS prevention funds. This support has been slashed in 2009 as the city and state are both facing severe budget cuts. We also receive in-kind support from other clinics and HIV/AIDS prevention organizations.

We’ve recently become qualified for some third-party billing programs such as Medi-Cal and FamPACT (a family planning fund). Through these programs we’re able to receive reimbursements for some of the clinical services provided, such as gynecological care. These reimbursements are helping to off-set costs, but often still do not cover the full expense that we put out for these services.

The rest of our funding comes through private foundation grants and private contributors. Individual private donors who contribute small amounts, anywhere from $20 to $200, are really helping us keep our program going.

Our services include Primary Care, Transgender Hormone Therapy, HIV/STD/HCV Counseling and Testing, Hepatitis A/B Immunizations, Acupuncture, Massage and Reiki, Peer and Mental Health Counseling, Support Groups, Health Education Workshops, On-site and Street-based Syringe Access & Disposal (NEX), Street and Venue-based Outreach, Wound/Abscess Care, Food and Clothing, Harm Reduction Supplies, Apprenticeships and Internships, Community Research, and Education. We are open 3 days a week: Tuesdays 1-6pm (NEX) and Tuesdays 3-6pm (wound and holistic care); Wednesday 6-9pm (drop-in and appointment-based Medical services); and Thursdays 1-4pm (appointment-based transgender healthcare) and Thursdays 6-9pm (drop-in primary medical care).

A full list of the support groups, meetings, and other opportunities to participate or receive services is available at our website at www.StJamesInfirmary.org.

What type of political/social/cultural climate is required for a city to have an organization like St. James? What kind of cooperation is needed from local authorities?

This project was made possible because of the unique vision of Sex Worker rights activists from COYOTE and the Exotic Dancers Alliance (EDA). In 1999, via collaboration with the Department of Public Health STD Control and Prevention Section (known as “City Clinic”), the University of California San Francisco, COYOTE, and EDA the St. James Infirmary started as a private non-profit 501(c)(3)

Having a rich history of sex worker rights organizing in San Francisco (first with COYOTE, then BaySWAN, and later the Exotic Dancers Alliance) was central to ensuring that this would be a strong peer-led effort that would honor the true needs of sex workers. Several things happened that made this possible. In 1996 the San Francisco task force on prostitution made recommendations that the City should fund occupational health services for sex workers. In 1998, sex workers rights activist from COYOTE and EDA called the Director of STD Control and Prevention of the San Francisco Department of Public Health, Dr. Jeffrey Klausner and proposed a clinic model for sex workers that went beyond HIV and STI testing. This was the beginning of conversations and alliances to be made that provided the framework for a peer led occupational health and safety clinic for sex workers.

First we were just open one night a week at City Clinic. For five years, every Wednesday night 6-9pm, City Clinic was open to sex workers and their current partners for services ranging from primary care, STD screening and prevention, and free sexual health resources to items such as condoms. In 2003 we got our own clinic! Our hours were expanded, and a wealth of services were added.

How do you protect the privacy of the people who seek your help?

Participants are never required to provide identification. Whatever name, gender and other identities an individual wishes to be known by at our clinic are what goes into their medical records. The records are only accessible by staff who need them. Since we are mostly peers and share a desire for privacy, participants have no reason to fear that we will be insensitive about this. Medical records are protected under privacy laws and can only be shared with outside sources at the request of the participant (patient) or through a court ordered subpoena. However, we are not an anonymous test site, we are a confidential test site. Under the law, positive HIV and STI test results are disclosed to the Health Department. But if a person is using an alias, than that is the name that is reported with the test result.

What measures would you suggest if someone wanted to pursue founding a similar organization for their own area?

Collaborate! Start by building a relationship with a local clinic that sex workers in your community trust. Sometime Planned Parenthood is a good place for sex workers, sometimes they’re not. Clinics that serve LGBTQ communities also tend to be kinder to sex workers, but again, it’s hit or miss in some towns.

You also need a strong sex worker community to advocate for a rights-based approach to healthcare. Team up with your nearest Sex Workers Outreach Project (SWOP) chapter or other regional sex worker rights group. Talk with other sex workers in your community about what their actual needs and interests are. Remember, sex workers had been building community in San Francisco for over 25 years before SJI was created. That foundation and well-connected members of our community are how this was possible.

In 2006 you offered a scholarship. Can you tell me how that happened and whether or not it is an on-going program?

The scholarship program we offered was a one-time program that was the result of unclaimed settlement money in a class action lawsuit. In 2003, a group of exotic dancers filed suit against some strip clubs in San Francisco and then settled the case (Siefred v. Centerfolds, et.al. Case No. 305470). After the court exhausted attempts to reach all the original plaintiffs in the case, the Court ordered that unclaimed money from the settlement be used for a grant program focused on education, job training assistance, and alcohol/drug treatment counseling for members of the dancer community. The St. James Infirmary was one of several agencies that received grants from this program. We decided to use our grant money for scholarships to any dancer who could verify that they were currently enrolled in school or a job training program and had danced in San Francisco since 1998. The money was then paid directly to the educational institutions. It was a really amazing opportunity for us to redistribute that money to the community. All together we awarded over $60,000 in scholarship money to about 30 exotic dancers.

Which organizations do you collaborate with and how/why?

In San Francisco:
SF DPH, San Francisco AIDS Foundation, SRO Collaborative, Coalition on Homelessness, Coalition to Save Public Health, the DOPE Project (Harm Reduction Coalition), City Clinic, TransTHRIVE, Positive Directions, Harvey Milk Democratic Club, BaySWAN, and others.

Sex workers rights: We are a community organization member of the Desiree Alliance, we work with other sex worker rights groups as well including SWOP.

What benefits do you see your community enjoying because of the work done at St. James?

Most importantly we are a safe haven with understanding supportive peers. From personal experience and from speaking with others, I know that having a sense of community and a place where you feel welcome contributes to a sense of self-value that motivates us to be healthy and informed. In addition to all of the free services we offer, such as massage or accupuncture, we make friends here. We meet other participants here who will be a safe call when we do outcalls, or who can tell us about a new website to market whatever our unique service is. We circulate a bad date list to help people avoid dangerous clients. People can not only pick up condoms here, but also get info on how to use them or how to be assertive with a client who doesn’t want to use protection. These little details that we understand make huge differences in the lives of sex workers, and these details are often not available at other health clinics.

Are there any obstacles or challenges that hamper your efforts?

Lots! We’re running out of money. That’s the biggest thing. We’ve been holding on for as long as we can to avoid service cuts and cutting back staff hours. But with the reduction in support from city and state, plus the huge cuts that private foundatiuons are experiencing due to the economy, we are in a very tight place right now.

Other challenges: People’s attitudes toward sex workers; the fact that we see sick people arrested and cycled through the jail system; and them then coming out at the other end with their health in even worse a state… all of these things are hard for our staff to see and experience. The criminal status of some of our participants is a driving force in blocking their access to healthcare and safety resources. While we are running low on funds we continue to see money wasted on prohibiting prostitution, which is directly working against our mission to help sex workers stay healthy.

What is the over-arching goal of the organization, and how do you measure effectiveness?

The main goal is to give sex workers access to the tools they need to be safe and healthy. More than 70 per cent of participants say that they heard of us through a friend who has been here. This is a major sign of how effective we are being at providing culturally competent care to a very marginalized group of people.

This year is our 10 year anniversary! We’re having a huge anniversary party on June 5th, 2009 in San Francisco. Info will be at our site at http://www.StJamesInfirmary.org.

I was wondering if you might be willing to link to http://www.BoundNotGagged.com, a blog for sex workers?

I would be happy to list your links. And thank you for sharing this incredibly helpful information with me and my readers.

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