A Clinic By Sex Workers, For Sex Workers Has a New Home

(From left) Leticia Brown, Stephany Ashley, Anita Durt O’Shea, Aria Said, Juba Kalamka, and Kalash KaFae MagentaFire pose for a portrait in the colorful lobby of St. James Infirmary’s former space in San Francisco’s Tenderloin District (Photo by Jessica Christian for SF Weekly)

If you’re in the business of sex work, it can be difficult to be totally frank with your doctor.

Take the case of the dominatrix with neck and shoulder pain from repetitive stress using paddles and whips. Her doctors told her to stop whatever was causing the pain.

They didn’t understand that would compromise her ability to earn a living. “At St. James [Infirmary], she was able to be honest and truthful about the source of her pain,” said the clinic’s volunteer medical director, Dr. Pratima Gupta. “We were able to help with alternative therapies.”

St. James Infirmary has served current and former sex workers and their families since 1999. It’s the first occupational health and safety clinic in the country run by sex workers, for sex workers, and has eight full-time and 13 part-time staff. Late last year it moved to a new home at 730 Polk St., 4th floor, where it shares space with its partner, the San Francisco Community Health Center.

“They gave us space to feel like a true clinic,” said St. James Infirmary Executive Director Toni Newman. The participants can check in at a medical reception desk and be seen in a real exam room. St. James Infirmary also has two therapy rooms for mental health and substance abuse counseling, a conference room, office space, and more.

St. James Infirmary Executive Director Toni Newman (left) and Lisseth Sanchez, program coordinator for Mujeres Latinas en Acción, for trans Latinxs. Photo credit: Geri Koeppel

The walk-in clinic is only open from 6 to 8:30 p.m. Wednesdays and offers a hot meal, STD testing, clothing and shoes, HBO, and a general sense of being with people who “get it.” It’s also open from 1 to 4 p.m. Thursdays for individuals transitioning, and offers therapy and case management by appointment.

But most of the work is done via a mobile outreach van that roams the Mission at bars and clubs three nights a week from 10 p.m. to 3 a.m. It serves between 150 and 200 people a month giving care packages, condoms, and HIV and STD testing. “Wherever you’re at, that’s where we meet you,” Newman said. There are plans to expand the mobile unit to Oakland, where many sex workers are being pushed to live due to the exorbitant rents in the city.

Newman herself used street sex for survival when she was younger and eventually became a successful dominatrix. She tells her tales in her book, “I Rise –The Transformation of Toni Newman.”

Dr. Gupta emphasized that although human trafficking has been in the news a lot lately, “In our community, people are engaging in sex work by choice.” And being able to relate to employees who have done some of the same things the participants are doing fosters a sense of safety and belonging. Newman said, “We don’t try to change them or judge them.”

St. James Infirmary now has a real exam room. Photo credit: Geri Koeppel

Barbary Rose, a pseudonym for an Oakland sex worker, said St. James Infirmary “Allows sex workers to be honest about the work they’re doing and the risk behaviors we have, because I feel a lot of people feel shame or a stigma around sex work and don’t access the kind of medical or mental care they need. It creates a place where you can be honest and get the care you need.”

So what do we mean by the term sex worker? “We’re talking about a wide range,” Newman said. It can include survival sex, webcam work, exotic dancing and more. Rose said she does everything from cam work and porn to pro dom and escorting.

What kinds of illnesses are treated? “Our urgent care drop-in clinic, the most common things we see are rashes, bad colds and routine health checkups, pap smears,” Dr. Gupta said. “We actually have a very similar, if not lower, rate of sexually transmitted diseases than the general population,” she added. “The sex worker community is very empowered and very careful. Using protection is an important part of the culture.”

St. James Infirmary also provides syringe access, but in terms of the number of substance use disorders, Dr. Gupta said, “I wouldn’t say they’re necessarily higher. We are a free clinic; we are serving people who have food insecurity and are marginally housed.” Those populations are understandably at a higher risk.

A shrine at St. James Infirmary. Photo credit: Geri Koeppel

Dr. Gupta, who has been with the clinic since 2005 and has served as its medical director since 2006, said she got involved because when she was in medical school, she’d helped out at a sex worker clinic in Ecuador for a year. People were being turned away from traditional doctors, she said, and “I was really struck by this injustice.”

Rose said here, “The biggest thing that has resonated with me at St. James if the ability to find medical providers who are competent and non-judgmental.” Even though she now has health insurance, she still attends some of the events and visits “If I feel like I really need a special service they have.” In the past, she said, she’s accessed services such as STD testing and acupuncture.

St. James Infirmary has an annual budget of $1.1 million and gets funding mainly from the San Francisco AIDS Foundation (an outlet of the Centers for Disease Control), the San Francisco Department of Public Health, the Department on the Status of Women, and the Mayor’s Office of Housing and Community Development. It also solicits donations and holds fundraisers.

To celebrate its 20th anniversary, the clinic is hosting a gala—the Hooker’s Masquerade Ball—at 6 p.m. June 2 at Terra Gallery & Events, 511 Harrison St. Tickets are $200, with an after-party for $50 more. That might sound steep, but Dr. Gupta assures, “We throw really good parties.“