MHF Podcast Episode 3 Transcript
David
You're listening to the Men’s Health Foundation podcast. I'm David Watson.
Marc
And I'm Marc Esposo.
David
Men’s Health Foundation is a nonprofit healthcare provider for all men, specializing in gay men's health here in Los Angeles.
Marc
Each episode, we welcome members of our care team to discuss trending topics in medicine and wellness to help you take charge of your health.
DAVID
Welcome back to the Men’s Health Foundation podcast. Today we're joined by two of our Community-Embedded Disease Intervention Specialists with our Rapid Results service, which is a rapid STI and HIV testing and treatment service we have in West Hollywood and in South L.A. Today we're joined by Rick Turpin here and Nestor Kamurigi, again, thank you both so much for joining us.
RICK
Thank you. Thank you for having us.
NESTOR
Thank you for having us.
DAVID
So I think the best place to start would be defining what a Community-Embedded Disease Intervention Specialist is. How could you sum that up for us? How would you explain that to folks?
RICK
A mouthful.
[Group laughs]
NESTOR
I personally like the term sex detectives because it kind of like breaks down a lot of what we do in the most simplest boiled down way. You know, we basically, when someone tests positive for rectal gonorrhea, syphilis and HIV, we explain their infections to them for treatment and we try to get them to tell us who who they were hooking up with during the time that they're going to and giving it to other people. And then we're going to track down those people and give them the good news, like, “Hey, are you so-and-so? Well! I got news for you!”
RICK
Anonymously.
MARC
Of course. Anonymous, yes. Keyword.
RICK
It's an interesting role because, like, the...usually the first question we're asked by the person that's infected, they're usually like, well, “Who gave it to me?” And I'm like, “Well, there's not really a test to test that. Here's the window period that it could have been in.” And then the number one question we get when we're notifying people is, “Well, who gave it to me? I need to know.” And it's just one of those awkward like, I can't tell you, but you wouldn't want me to tell, you know, if this was me notifying for you. So, it's just kind of like that balance of making sure that people feel comfortable on both sides.
MARC
Right, exactly. There's definitely…it is kind of a delicate situation at times, right? To figure out how to be respectful to both parties, you know, because at the end of the day, you're just trying to do your job and just inform people and help them be safe.
DAVID
Yeah, just to make sure that I have the right understanding. So as part of our, you know, rapid clinics that do STI and HIV testing and treatment, when folks come in and get tested, if they have a positive result, what's the next step in that process? Have they already....do you then ask them for contact information of people that they may have either contracted this from or may have given this to? How does it come up in the process of getting tested?
RICK
So usually after they...their results come in, depending on if the nursing gets the information or we get the information first, we’ll contact folks and just kind of give them their results, connect them to treatment. That's number one, right? Getting the...stop the spread right there and then definitely exploring some STI infection, because a lot of...there's a lot of misconception when it comes to STIs. You see these big billboards by other nonprofits. That, you know, “Gonorrhea is deadly!” and it's not, you know. It's treatable, but they like to make these dramatic billboards so that you go get tested. So, making sure that you explain how it's actually spread, because a lot of people don't know. You take one sex ed class in high school and it's not having to be covered like everything doesn't need to be covered.
It actually differs by the state on what they actually cover in sex ed. So, after that, you never take another sex ed class, so you can't really expect them to know these things. But we should as a society practice, you know, education in that way because this is a natural thing that everybody does. So informing them about like how it's spread. And then we kind of like, linger. We’ll either like meet them in person. I tend to have more success getting partner information when I talk to them in person, but we'll definitely put it out there over the phone and like connect with them in person when they come in.
DAVID
Is that up to the person to decide if they're going to provide information as far as other folks?
RICK
Yeah, they don't have to. It's just one of those things that…we also partner with tellyourpartner.org as a foundation. And so I do...if they're hesitant or like they just kind of give me no response, I usually will just put that out there because at least you now have that knowledge that that is out there, that you can do that, because the only people that can make things weird are us and the person.
So as long as they feel comfortable being able to have that conversation even anonymously, whether it's with us or a third-party service, it's just at least it's out there.
NESTOR
Yeah, I'd like to expand on that too, because it can also just be down to the schools you go to here in Los Angeles about what your sex and education's going to look like. I often have to start from square one with just about every patient I see over in the South Central location, because, you know, people really don't want to get tested or don't even know what's going on with their bodies.
DAVID
One of the things I wanted to be sure to ask about, we're seeing headlines recently talking about a spike in syphilis cases, seeing an 80% spike in syphilis cases since 2018. The most new infections recorded in the U.S. since 1950. Can you tell us about that? How if you've seen that same impact and that same surge locally here in Los Angeles and just what you've observed.
NESTOR
I've definitely seen an increase in cases since I started like in this steady rise. I think the hardest part is because, you know, like they…even in the medical field, they call syphilis a great imitator because some of these things can show symptoms and then go away on their own. And then people often don't go to the doctor. And it clears up on its own and they’re like “Oh, okay, it's gone. It's just…it was a passing thing.”
DAVID
What are you all talking about, you know, when you're talking to your teams and you're talking to other partners in L.A. County, what are you thinking are some of the causes behind this spike? Why are we seeing more syphilis cases recorded?
RICK
I think with the introduction of PrEP in the last 15 years and, you know, Truvada and now Descovy and Truvada being FDA approved, meaning the FDA approval allows women and trans folks to be able to take Truvada as well. And with taking Truvada and Descovy and PrEP, you have to get tested every three months.
And prior to that, you wouldn't go to the doctor like Nestor said. You don't…it's kind of a fearful place. The health industry is kind of... especially with insurances and no insurance and it can be...especially in different areas there's a lot of fear and stigma behind it because of how, you know, different people are treated and the biases against them.
So I think the introduction of PrEP and people getting regularly tested showed that maybe all of this was still there prior, we just weren't testing and we didn't have that knowledge that we do now. And so now that we have that knowledge, that's how this position was born for us at our foundation so that we could help stop the spread.
DAVID
You know, it's interesting talking about cases since 2018, I'm curious to hear your perception of what else has changed recently for folks as far as, their awareness of STIs and their attitudes towards sexual health. Do you feel like in the past couple of years that people are kind of going in a different direction as far as trends, as far as how people come across sexual partners or their attitudes toward that? What have you observed?
NESTOR
I want to say a lot has changed. I mean, in the last ten years we didn't have an app, that you could just pick up the phone and have sex just right away on demand. People are having sex more often. It's more convenient for people to do so. And you know, in the dark, people kind of just tend to ignore symptoms, especially the rashes.
And I think that, people are having more sex. And because we've never had a good foundation when it comes to sexual education to begin with, it's just kind of created a convenient cocktail of transmission.
DAVID
Anything you would add to that, Rick?
RICK
I think that Gen Z is just very fluid. And I love that. I love that they're just so comfortable with this natural part of our body but the thing that's missing from that is health education, and it's how you give the information and it's how you provide that because again, school or the Internet. And if you Google anything, you know, “Oh, I have a tickle in my throat”. “Well you have throat cancer and you're going to die.”
Like if you Google the wrong thing in the wrong way, you're going to get so much information. A lot of it isn’t accurate. They're also getting a lot of their information from Tik Tok, which is I don't even use Tik Tok, but I know it's like less than 30 seconds of information and you just can't compile all of this in 30 seconds because it's going to come across like that scene in Mean Girls. “You will get chlamydia and you will die”. That’s just how it's going to come across right?
And so, I think this fluidity and like the sex aspect and I think it's just such a cool thing that people are being so free and more accepting and less shameful about these practices. There's just the educational aspect of like how to protect themselves and have safer sex because it's not about abstinence like it was when I was growing up.
I went to a Catholic school and that's how we were told, like, “Don't have sex until you're married. It's only for procreating.” And that's what it was. And that was like the view that I had to unlearn as I grew up. And, you know, condoms have become one of those things that are in the back of our mind. We can talk about how to, like, make it more in front of our mind, but that's not the way people have sex anymore.
Or, you know, a lot of people because of the introduction of PrEP and like not needing...not having that as a forefront of fear in their mind because an STI is treatable. But we want to make sure that people know that, you know. And so we want to meet them where they're at. How can we help them have safer sex for the type of sex that they're having?
MARC
Right. When you guys are making your calls to people and contacting people and letting them know about their diagnosis or things like that, is there room for education during the actual initial call? How do you guys approach that?
NESTOR
Well, after the initial “Who gave you this number? How do you know me?” It comes…for me, it's easier to transition to it when it comes to trying to find them care. So, it's like, hey, you know, “Where are you going to get your care, like you could schedule it with us or, you know, I could help you with your health providers like, do you have any questions?”
I try to open it up to them and you know, after I kind of just reassure them that there's no way I'm going to give them their partner’s information. They want to know more specific details about, you know, like, “How did I get it is the second question usually. And then, you know, from there, it's a great way to segue into the explanations of just every possible way you can get…especially syphilis, like there is just different stages and different ways to go about it.
So it's kind of finding that kind of “in” during their initial outbreaks because, you know, people get scared.
MARC
Yeah, for sure. I mean, I can imagine, the average person who receives this type of call, who doesn't know a lot about STIs can have a lot of questions, and then maybe with those questions comes a built in sense of like denial in a way, you know, like “I didn't...I was safe!” You know, like, “How can I get this?”
Do you feel the same way about, like educating during calls Rick?
RICK
Yeah, I think it's really important because while people might have a lot of questions, the trick is the questions that they're not asking or the questions that they're ashamed to ask, or because they have their own stigma and biases that they placed upon themselves. Growing up in a Catholic school and receiving that kind of education, I had to unlearn that as I became an adult.
And all of these folks are kind of like on their own path of learning what was right for them. But we don't know what conversations they've had their entire lives about sex. That: “What got them to that place of fear of asking the questions?” So, there's a pretty standard thing that Nestor and I will do when we're saying…we'll just kind of talk about it naturally, like, “Oh you know, it's spread through bodily fluid.”
Usually that embarks an eye-opening experience for them. Like, “What does that mean or what do you mean I can have it?” Because a lot of the times they'll test positive in an area where they're not having penetrative sex and they'll usually be, “Well, I don't...I don't bottom or I don't have sex there or…I don't go there” or whatever.
And there's like an own bias against that themselves. And so that way it's more of a calming of like, you actually don't have to have penetrative sex there. It's actually spread through bodily fluids. So that's why we encourage the rectal swab everywhere that you go. It's not about just the types of sex you're having. It's about making sure that all of your areas are protected.
DAVID
I remember I think an interesting point about that. And we were talking before we started recording and Rick, I remember you mentioning that it doesn't take much to come into contact, you know, with, I guess, an orifice or just to get into the body somehow. It doesn't have to go very deep in order to end up testing positive.
RICK
No, not at all. All it has to do is crack that surface, you know?
NESTOR
Right.
DAVID
Yeah. One of the things I wanted to, I think, might be worthwhile to get out of the way is just just some general information about STIs to folks listening who might have some questions, who might not be as familiar as some of our listeners. First thing I want to get out of the way is, is there any STI that would go away on its own?
RICK
All their symptoms will go away on their own, but you'll still have an active infection unless you've been treated.
DAVID
Sure. So if anybody's experiencing symptoms, or think they may be at risk, it seems like there's no reason not to go in and get tested. It's always going to be in their best interest.
RICK
Yeah. Usually if you're showing symptoms, mentally, you would go to the doctor, but there's a lot of people that see that but then it's gone the next day and they think, “Oh maybe I just had an allergic reaction or a UTI” or like all these other things that it could be. But then they're living with an active infection of an STI. So it's just always good to go get tested.
DAVID
And then I think it's interesting to just bring up for folks the difference between some of these main STIs that come up most often, just so they're aware as far as how symptoms might look, different health risks might look different between them. Can we just quickly go over that?
NESTOR
So things like syphilis, right? Yeah, the primary stages where it looks like a cut in the penis, vagina, anus, mouth. Doesn't hurt, doesn't itch, and most people think that they've cut the inside of the mouth eating something somehow and then, you know, without treatment that symptom can go away on its own. From there it can move on to secondary, which is the rashes which can be transmitted from skin-to-skin contact.
So it doesn't always get protected by condoms, which is I feel like…even though primary is the more transmissible one, I think that it gets around more through the rash because that's the thing that people just don't think about at all. But that, again, doesn't hurt, doesn't itch and that’s something that can go away on it's own. From there, it can lead to further complications like neurosyphilis, you know, getting to the brain, affecting your ability to think and sense of self as well as, like, ocular syphilis, the ability to see as well as alopecia.
The good thing is syphilis is completely curable. So you can get all these things treated. The thing about it is, from the last update we got from ocular syphilis, whatever you lost when you got ocular syphilis, you lost, you ain’t getting it back, like that's just something that…that’s just what's going to happen during that stage of syphilis.
DAVID
Sure. All the more reason to get tested.
RICK
Neuro and ocular take years of not being treated to get there which is important. So not to like, fear...to make it scary, but it is scary because syphilis, you know, a long time ago was deadly. If you look up like a lot of random old people, you can see that they just died of, you know, this area or syphilis or all these random things that we don't really think about now.
And now syphilis is a treatable STI which is great, right? And then you have gonorrhea and chlamydia, which can affect, you know, the urine, the penis, the vagina, the anus, and then orally. You can get it in other places we just don't test for that at our facilities. But, yeah, you know, burning discharge. What else?
NESTOR
Oh, there's one other fun fact that Al Capone, Scarface, died of syphilis.
RICK
Oh! There you go.
MARC
Wow. Fun fact.
RICK
Yeah. And now there's cool...DoxyPEP has been kind of a big, big introduction into this. And I get a lot of questions about like, well, am I going to become resistant to it if I'm taking DoxyPEP or whatnot? And the county provided us a kind of training, just like on doxycycline as a thing. And I you know, I just learned that it had been around for so long.
RICK
And in our history of having doxycycline, there's only been one shortage and it was due to a mining accident that prevented us from getting doxy. And I thought that was just a really interesting, fun fact, just because it has been around for so long and then with penicillin being something that was introduced later. But as you know, we've seen over the last few years that it's been quite a few shortages of penicillin where they revert back to doxycycline as the treatment for syphilis.
RICK
Doxy also treats chlamydia, but DoxyPEP is really cool. You take two pills within 24 hours to 72 hours of exposure. So sexual contact, all types of sexual contact, because that looks different for everybody. And you know it helps prevent contracting chlamydia and syphilis primarily. And there have been some studies where it has been effective with gonorrhea as well.
But doxy hasn't been a treatment of gonorrhea in a long time. So it's not necessarily the primary focus. It's more the chlamydia and syphilis, which are very, very prevalent in all communities. Chlamydia is still, I think the number one STI that is going around in that sense so it's a really good preventative…just to have on file. And, you know, like honestly, sometimes in my encounters I'll give it to my partner as well when I've had it, so that way it's just a fun little thing that we're doing together, even if it's an anonymous hookup or whatnot. But that way it prevents everything, in that sense, or at least are just a little safer.
MARC
Yeah, I love that. I love that you mentioned, just sharing showing care for the person that you're sharing the encounter with and it's not just like, “All right, you're there to please me and then we're never going to see each other again until someone else calls you and says, ‘Hey, you might have had contact with this person, so you might have this STI.’”
RICK
Yeah, it should just be an open door of communication and like, why make it weird? Like, this is out there. We know if I'm doing this with you, you're probably doing it with someone else, and that's fine, as it should be, but let's just prevent the spread.
MARC
Exactly. I think going back to the education point, like just being open and being vulnerable with people and being honest, I think is a very...a really good thing to do, in helping to stop the spread.
DAVID
I think all of this hopefully is nice to hear for folks who might be in a position that they feel…that they're in a situation that maybe they have some news to share with folks that are concerned about how they're going to bring this up. Do you have any advice for folks that might be looking to do that themselves who don't have someone like a CEDIS to turn to if they feel like they need to talk to their partner or partners about maybe having come into contact with an STI?
RICK
Yeah, I mean, I think going to get tested and being able, you know, also like talking to their partner about going, getting tested together I think is always a really big thing just because that way you're both…if you do have it, you're all in the same time frame of refraining from sexual activity because of treatment.
But also like there should be a shared space of safety to be able to talk to your partner. And that's another thing that like I've done, like with patients who are diagnosed and, you know, I'll ask like if they have support or somebody to talk to or if they want me to help them or give them words or phrases that they could say to their partner so that it is a safe space for both of them to be able to talk to each other.
DAVID
Any examples you could give us, some of those like phrases that? I’m curious.
MARC
Yeah, I'm curious too.
RICK
“It's treatable.” You know, there's medication for it. It just depends on what they were diagnosed with in that sense. But it's more about just making them feel comfortable. Like I usually pass my card along if they want to. Maybe they miss something, they can contact me and I'll talk to the partner with their consent, not necessarily about the other person, but about the infection.
I do STI...people call for nursing line to get STI information on our line all day long and they'll just patch it to us and we provide natural STI information just for people that even aren't our patients. But maybe they'll become them, so…
DAVID
That’s great!
MARC
Yeah, that's good to know.
DAVID
What advice do you tend to share for folks, Nestor?
NESTOR
One of the things I get, there's, you know, the people like, “Why me?”, or “How did this happen?” or X, Y and Z, right? So I try to ensure people like the reality is that often people who are transmitting STIs don't even know they have it themselves. And so it's not always like just this malicious intent of someone going, “Oh, I'm about to go give someone gonorrhea or HIV.”
NESTOR
Like often they themselves haven't ever been tested and are like going out there and having fun and that's great. But, you know, if you don't know, they don't know. And it's getting passed around which is why it also helps informing the partner too. It's like they may not know and it might not just be you. It could be a bunch of other people because they may not know.
DAVID
Good point. I guess in that sense they're not alone. That's for sure. That's a given. I'm curious, how did you all both get into this career, to this sort of position that you're in right now. It seems like such a unique thing to be in a position to do. And what drew you to this sort of experience?
NESTOR
For me, I was born HIV positive. And so [I’m] a lifetime survivor. And I grew up in the neighborhood in South Central, where the clinic is located. And so there it's a predominant neighborhood full of sex work. And it's very...I grew up in the hood, in the ghetto and I grew up understanding firsthand the lack of information and resources for people with HIV and not to mention, like the greater realm of STIs. I mean, you really only have Planned Parenthood and that's “end of list” and they're not a primary provider.
And then from there, you know after years of therapy for having to deal with the whole, you know, being positive and all that, I got into testing people for HIV and then case management and advocacy and activism and all that.
And I've always wanted to be that person I didn't have when I found out when I was positive or when I was going getting sick or like just didn't have that understanding. And like, especially dealing with Men’s Health Foundation because often I’ll run into people who I went to high school with and so it's really special to me.
It's really close to my heart to be able to like, try to help prevent new transmissions, especially with congenital transmissions of HIV or syphilis. It’s a fight that's really close to my heart.
DAVID
Oh that's beautiful.
MARC
I love that.
DAVID
Yeah, thank you. Thanks for what you're doing. For both of you. It seems like it's a tough job. Does it feel like a hard job to do or do you feel like you sort of adjust and get used to it? Is it gratifying?
RICK
I think there's times when it can be a little challenging. I really feel like it's more fulfilling because you get a lot of light bulb moments with, you know, folks when you're educating them on this stuff and they...when you see it kind of click or you realize that they realize that they're not alone or that they're not weird or they're not doing things that are wrong or like Nestor had said, the “Why me?”
You’re able to help them. I think that's a really fulfilling thing. And I think that's what the community part of our position is really being, [it’s] the connecting to the communities that we serve, you know, and I think that that's just really important to be able to connect to somebody and just help them not feel judged. It's a safe environment to talk and learn about this stuff because you might have only learned about it once in your life.
MARC
Right. I can totally relate to what you both said about feeling judged. If someone feels judged, you know, I think it helps reassure patients if they know or they can tell that the person speaking to them has been there, and has their back and is from their community.
I think that helps people feel more at ease and less like they're being lectured to, you know, because speaking from personal experience, I have felt that in the past, too, when I've gotten tested and things like that. So I think it's great that you guys have...you both have like a communal approach to it.
NESTOR
I wanted to add, like there is some parts. Well, I agree. In my own personal experience, it can be a little bit emotionally draining in the sense that when you have to tell people when they're newly diagnosed with HIV, especially if they don't have the information, it’s just all tears and just like “I am going to die because I don't know anything about HIV” and outside of like, especially older people, like “Outside of my experiences in the nineties, I know nothing of this and now I’m here.”
And so, you know, you have to bring them from tears to understanding that, okay, this is treatable and I'm going to be okay. And then sometimes it's hard also to just...It’s happened many times where you call someone, you told them they were exposed HIV, and then like, “Well, I've only ever been with my partner and then you're just like, well, I don't know what to tell you about that, man.”
“Like, I just…I just need you to get tested. I can't, like, be your therapist in that one. I’m sorry.” And people get mad and want to shoot the messenger, but you know, what can we do about that?
RICK
Sometimes taking that brunt allows them because that's just where they're at in that moment. And I think at the end of the day for us, like we get that, but we take a deep breath and we just kind of get them what they need in that moment for the now, because that's kind of all we can do within our position is just make sure that they have the knowledge, have the information, and that we get them tested or treated.
And sometimes it does come with kind of a smack of defensive or that awkwardness. But it's not the norm, which is nice. But it can be…it can be draining when somebody does that. But at the same time, I picture myself in their shoes in the sense, “Okay, like they just got diagnosed. They're feeling a certain type of way and they're reacting the only way that they know how.”
And that's how I kind of not take it personally or let myself, react in that moment back. I just kind of take it and just let it kind of roll off and it doesn't prevent me from helping them afterwards. And Nestor as well.
MARC
That's great. I mean, yeah, it's really tough, to think about how to be a good messenger and just focus on doing your job and dealing with the emotional load that comes with that. So I just commend you both.
DAVID
Yeah, I mean, it seems like it's absolutely, in so many ways, I feel like you all are so much at the frontline of people's experience to becoming more empowered with sexual health and with, you know, a relationship to their own health in general.
I'd be curious, is there anything you can share as far as any experiences you've had, without mentioning anything too specific about the person, where you've seen that this kind of experience has really made a big difference in someone's life?
RICK
I mean, in general, I've seen folks who've been diagnosed with syphilis and like they'll come back and they'll pull up their little note tab that I've told them to kind of keep so that they can keep track of their titers, which is how we monitor the syphilis infection. And they have this like sense of pride that they're taking it down and taking ownership of their infection and monitoring.
And I just love those kind of moments and you can feel it or when they come back and they're like, “Hey, I don't need to talk to you today!” Because, you know, like going out in the community as well, I often get, either they'll look at me and then look away or they'll like come up and say, “Oh my gosh, thank you so much. I really appreciate what you do.”
And, you know, to protect anonymity, I kind of let them recognize me before I can recognize them. It's just…I love the sense of community that comes from it. It's not necessarily like, you know, we're changing their lives in that sense, but we're allowing them to go back out into the world a little less judged than they were before.
DAVID
Ooh that's powerful.
MARC
Yeah. You're empowering them, literally, you know, to go out and spread their knowledge that they've learned from you.
RICK
But not STIs.
MARC
Yes spread knowledge, but not STIs, people out there!
DAVID
What are you thinking, Nestor?
NESTOR
I was gonna say that we’ve had a lot of cases as of last year and even this month. But if I want to say one that was really empowering for me or just special to me, it was kind of one I was working with a patient who was diagnosed with multiple STIs, they had told me they engaged in sex work but they were just so sad and upset about like...they just really felt ashamed about telling me that.
And, you know, I just told them like, you know, relax. Work is work. Everybody sells a different part of their body. And like, we just really had like a good conversation about, sexuality and being free and do what you want with your time, money, and body. And, you know, we came from...we moved from this whole like, “Oh I'm a sex worker” to “Yes, I'm getting it and getting a lot for it.”
RICK
Rent is expensive in LA.
NESTOR
I'm gonna go on Feet Finder soon enough if these rents keep going higher.
RICK
I keep telling my cats that they're going to go on OnlyPaws one of these days
MARC
OnlyPaws? Is that a thing?
RICK
I don't know but I don’t copyright it. Please somebody do it.
DAVID
I hadn't asked you yet, Rick. What got you into this experience yourself? What's your backstory?
RICK
You know, throughout my career and life, I've been...I taught kindergarten and then I wanted to do more. And then I was a crisis counselor for another nonprofit that served the LGBT youth in kind of traumatic scenarios. And they would call in and you'd kind of counsel them and help them and just kind of be that friend.
And that was during COVID. So that was a little taxing mentally for a little while, and it led me to want to go back to work in person and kind of be hands on with the community. And I just remember scrolling, I think it was Indeed. And I saw this job description and I kind of felt like I had never heard of anything that was quite like this before, because it certainly didn't exist when I was in my twenties and like going through my own exploration of life.
And I wish that I had somebody that I could ask about STIs or actually having education for. And so I was really interested and I applied and I started and here I am. It's almost been three years of doing this. And I…I really love it. It's inspired kind of my own growth and journey of like where I want to see it grow and go.
And, you know...it started out as just like two of us in South L.A. and now we're about to grow to grab more and help more people. And, you know, “nobody gets left behind” kind of thing. It's really cool to see and watch it kind of just get bigger and bigger as we go and it's in relation to the work that we've done ourselves.
Our manager is just such a supportive person and he did this work prior for another organization and that was how it kind of came to be here. And so we've kind of taken this little, like, baby that he had and it’s just kind of grown into a bigger thing. And it's just…it's just really cool. It's a supportive environment. And I think that that's an attest to what we have to do. So it's really nice that we get that on the back end as well.
MARC
That's great to hear. I mean, it sounds like more to come from Men's Health Foundation in the public health front.
DAVID
Yeah! I think that's what we're all planning for. So I'm curious when it comes to the past couple of years, you know, I wanted to bring up mpox and the mpox outbreak just to check in on that. Is that something that you're still...is that still coming up in your work and is that still something that people are experiencing?
RICK
I haven't seen as many cases, especially not from when there was like the big outbreak, but we still are providing the vaccine and we still are ordering it. It's not coming back as influx because I think the difference between like how we rallied around COVID versus we rallied around mpox was, it was pretty aggressive in like, “Let's fight this, let's get this, let's get you vaccinated.”
And I know we at MHF were very, very, very prevalent in getting people vaccinated. And it was really cool to see, just like the amount of people that were in and we were getting them vaccinated and preventing this. So it was just really cool to see what the front lines really looked like in that sense.
And so I haven't seen it as much, but we still are offering it and every now and then we'll get, you know, the vaccine for somebody or somebody who needs their second dose or stuff like that.
NESTOR
I would say it was a little bit of a beautiful moment to see everyone in public health all go, “Oh no you don’t!”
MARC
Right!
DAVID
One of the things I wanted to ask about, I think it's so interesting, you know, Rick, you working in West Hollywood and Nestor, you working in South L.A. just to hear about those neighborhoods which I think have so many unique qualities to them compared to just about anywhere else in the country as far as it relates to just the specific challenges in those communities and maybe some of the things that…I think about with West Hollywood, I think of it as like a very...I would I perceive it to be a very sex positive community, but I'm not sure if that's the full story.
I would love to hear your insights on what it's like to be serving these communities and just what you’ve noticed as far as some of the specific challenges there.
RICK
You know, one of the things that I love about working in WeHo, WeHo as a community, yes, it's very sex positive, but there's a lot of people that still don't have sex education and when I do provide them how an STI is spread, that is a light bulb moment for people who have a lot of sex and they're open about it, but they might not know the other things, which is part of the safer sex, you know, just that knowledge of how it’s spread.
But I think to be honest, like I love that aspect, but one of the things that I love more about it is we are open on Saturdays and I personally work on Saturdays and I work the front desk a lot of the time, and it's because I want to connect with the people that come in. And a lot of the times on Saturdays, clinics all over L.A. are not open.
Even our South L.A. branch is not open. So WeHo, we’ll get people from South L.A., we'll get people from the [San Fernando] Valley. We get people to drive from Riverside because we're...they're going to a quote unquote “gayborhood” because it's a place where it is a little more sex positive or perceived that way. And they'll come and get tested.
We get a lot of people that identify as straight that will come in because same thing. They know they're not going to be judged for what they were doing, you know? And so, on Saturdays in particular, we get a lot of people that aren't from our community, but they feel safe coming here because they know we are more sex positive than their areas.
And they'll...it's such a big market that we get on Saturdays in particular, where they will drive 2 hours to get tested or treated from us, which I just-it's really cool to be able to talk to those people or even younger folks like...some high school students came in to get tested and it's great.
It's great that they felt safe enough to come from where they were coming from to get tested here, taking the bus for 2 hours to get there was...it was just a cool moment to connect with all types of people. And like, I think that that's one of the reasons I also really love working in WeHo is just it's perceived this way. So people flock to it.
DAVID
Oh yeah! That's a beautiful thing. Yeah, that's great to hear, too. I didn't know that.
MARC
I didn't know that either. All the way from Riverside, you know.
RICK
And I'm sure there's clinics but judgy, you know, like there's stigma everywhere. You drive 5 minutes out of L.A. and it's a whole different world, you know? So it's just...you can provide that space, but you just have to be able to provide it. And so that's why I think people come which just fosters that in me to want to continue and spread that.
MARC
Love it.
RICK
Knowledge, not STIs.
[group laughs]
NESTOR
On my end. I love the location. I mean, outside of it being we're in the...I mean South Central has its own sex positivity in its own way because, you know, Figueroa has nothing but like the women sex workers and Broadway has all the boys that [are] a little more down low on that appearance as far as like sex work goes there.
And we also have like three or four homeless shelters that are like within walking distance. So there's a challenge all around because you know, people who are hiring sex workers aren’t always those that keep track of their Johns but they're pretty good at wearing condoms. So it kind of balances out. And the harder challenge, I would say, is the homeless population, because homeless people, they don't [always] keep track of each others names or actual government names.
The most I can get out of them is like, what tent or what corner are they? Or sometimes they're at the shelter nearby, but they mostly just come for gift cards and testing and then we might not see them again. So it's like a really…if I don't get a hold of them or we can't get them treated right away, it's much harder to try to get them to come back later on.
Or I usually have to put like alerts on them because if they don't show up, they'll likely come back in three months for another gift card. So I can like try to catch them then. But it's...I think that's really the biggest challenge is that people…we deal with a higher homeless population there. So it's you know, a bit of a touch and go when it comes to getting people or tracking them down.
DAVID
Wow. Yeah that's really impressive that you're doing that, regardless. I'm curious when folks come in, when they get tested, can they get treated on the same day? For the most part?
Yeah, usually, especially if they have symptoms or they’re symptomatic, I just try to test them right away. Just in case, especially if they're homeless. Sometimes I'll just treat them just because we know that we're probably not going to see them again.
RICK
If they show symptoms or they have an exposure or, you know, it's at the end of the day, it's up to the provider on what they're going to do. But we treat prophylactically quite often.
MARC
When you said “alert”, Nestor, could you explain a little bit more about what that might mean?
NESTOR
So usually when I have…when someone's homeless or like they're just not clear and I’m not able to track them down, on their chart when someone will try to open it up, it would say an alert: “This person needs syphilis treatment” and then you can go into their chart that way. Because that way... whoever is putting the intake for them can let the provider know, the provider can see that in their chart and say, “Okay, well this person hasn't been treated and needs to be treated.”
MARC
Gotcha, okay. So it's sort of like tagging it so that the information is easily accessed for the next person and passing the information along.
NESTOR
Yes, and once they’re treated, I can, since I’m keeping track of their case, I can take [the alert] off and, you know, follow up from there to make sure that they're treated.
DAVID
Sure. One thing I haven't asked is if this is a process you follow for folks recently diagnosed with HIV as well, is that something that you all also have a role in as far as like letting other folks know? Or is that process different?
RICK
In the sense of their partners?
DAVID
Right.
RICK
Yeah, that's something that we do with like a newly diagnosed person. If they provide us their partner information, we’ll contact and try to get them in for testing and kind of go over what a window period looks like with that so that they can close that window from that sexual encounter so that they can have that sigh and breath of relief if they’re negative or connect them to care if they are positive so that they can remain in care.
DAVID
Sure. Is there ever an opportunity that you've experienced where there's-where PEP might be an option? Is that something that comes up?
RICK
We do PEP in both of our locations. It's, you know, post-exposure medication that you can take within 72 hours of that sexual encounter where it's believed that HIV could have been contracted. You know, again, it's up to what the provider sees as like an active need for it. But yeah, it is something that we provide for our patients that need it.
DAVID
Great.
MARC
That's great! Yeah.
DAVID
And do you have any advice for folks that are also, you know, working in public health and are working maybe, in general, in the medical field who are working with people with STIs, or at risk for STIs? If you could give advice that you think is something that is an overarching top line issue most of the time, what would you recommend to folks as something to look out for?
Just a way to talk to people, a way to perceive, you know, addressing folks when it comes to STIs and sexual health.
NESTOR
There's something I heard and I found out that it was a psychology thing, apparently. But, I always think about it when I approach patients. It's, “I don't care what you know until I know that you care.” And so it's like the most important thing I try to get a part through to people. Like, you know, a patient doesn't care about anything if you don't care about them. And they're not going to be there to hear it either.
DAVID
Wow.
RICK
Something that I've learned along the way is, you know, an expert's mind only has one outcome because they are tried and true that that works. A beginner's mind tends to have a toolbox and they're open-minded to everything. And sometimes when we've been doing things for a long time, we need to kind of check our ego and go back to that beginner's mind set so that we can remember that our first mission is to help the person in front of us.
MARC
Wow.
NESTOR
That's real.
MARC
Yeah, that is real. And thank you. I mean, just to respond to that, I think it's just amazing that you guys continue to do this work. And I think, the listeners out there and people who are scared or might have internalized shame or stigma, I think it's really good for them to hear this, you know, and really talk to two actual providers and let them know “Hey, we're actual people and we’ll treat you like a person too.”
DAVID
Yeah. So guys, I wanted to just check in. Is there anything that we haven't covered in this conversation yet as far as it relates to, you know, the work that you do? Talking about, you know, the sort of latest situation right now with STIs that you wanted to make sure that we address before we wrap up.
RICK
No?
NESTOR
It's important to go get tested. You know, there is, like I said, noted increase in syphilis and in cases of congenital syphilis. You know what does it say? How do they say? Monogamy means different things to different people.
RICK
Relationships are very different. there's a great book out there that helped me kind of grow with my own mindset because we're kind of...you're brought up with monogamy, monogamy, monogamy is the way to go and like, that's all. But as you grow and you learn that that might not be what's for you. Like when I read The Ethical Slut, it really helped me just at least put myself in other shoes to kind of understand the type of relationship I might want to have and what others have and how not to kind of judge that relationship.
RICK
And that's taken like a long journey to unlearn, but like everybody has a different type of relationship and monogamy doesn't mean the same thing that it meant to our grandparents.
DAVID
Thank you both so much for joining us today. We'd love to talk again sometime soon. I think there's so much to unpack with the work that you do and we really appreciate it.
MARC
Yeah. Did we want to shout out one more time, like where people can get tested or how to reach us and things like that?
DAVID
Sure, yeah.
NESTOR
Well, if you want to find me, I'm at 8601 South Broadway in South Central. Your Nestor from the neighborhood.
RICK
And I'm Rick. We're at 8280 Santa Monica Boulevard right next to Hamburger Mary's. Can't miss us. You can also make appointments on our website: menshealthfound.org/rapidresults. It's a really seamless, easy process. You can do same day appointments. We do PrEP follow ups with insurance, and we do a lot of those things. We can connect you to care.
Our primary care office has so many other services. We can do referrals, all that fun stuff. We have a behavioral health department now. So that's even great. All sorts of things coming out of here. So get tested. Know your status. It's yours. Don't spread STIs, spread knowledge.
MARC
All righty, amazing!
DAVID
Perfect.
MARC
Thank you so much!
DAVID
Thank you both.
David
Thank you for listening to this episode of the Men's Health Foundation podcast. The information and opinions shared in this podcast are for educational purposes only. For medical advice, please talk with your primary care physician or a medically licensed professional.
Marc
To learn more about Men's Health Foundation, please visit our website at menshealthfound.org. You can also follow us on Instagram at “menshealthfound” and subscribe to our YouTube channel.
This transcript has been edited for clarity and readability.