After a day of community outrage and protest, at least one sexual health center in Los Angeles will continue—at least until the end of March—providing free STD and HIV testing. On Monday, the Los Angeles LGBT Center announced that, due to funding cuts by the Los Angeles County Department of Public Health (DPH), it would end almost all free STD and HIV testing. Eliminating these free services would have caused “tens of thousands to go untested, undiagnosed, and untreated,” said the Center’s CEO, Lorri Jean, in a statement Monday.
On Tuesday, the Center announced that it reached a temporary agreement with the DPH to reinstate funding for testing. Other services, including HIV treatment services, which come from another funding stream, had not been threatened.
“Services were saved and are continuing—for now. That is crucial,” said Jean, in a follow-up statement Tuesday. “And, between now and the end of March, we will work with … the Department of Public Health to find a long-term solution that ensures care and treatment for our community. We are hopeful, but nothing is guaranteed. Clearly our community stands at the ready to re-engage should this become necessary.”
The temporary agreement happened because of community engagement, according to Ward Carpenter, M.D., co-director of health services for the Center.
“The outrage and mobilizing yesterday made all the difference in getting a moratorium on funding cuts from the county, and this will sustain us until we can agree (with the DPH) on a long-term solution,” Carpenter told TheBody.
The Center’s funding crisis came in two stages, according to Carpenter. The first came in December, when the Center received its notice from the DPH for 2020 funding. “When we did the math, we found that it [was] $1 million less than the previous year for HIV and STD prevention programs, the same programs [the DPH] had been funding for decades,” Carpenter said. The second blow came earlier this month, when the county announced that it would transfer all costs for lab testing onto its grant recipients, including the Center. “That came without warning and would [have] eaten up our whole budget,” Carpenter added.
It is not clear whether other organizations receiving grants for STD/HIV testing from the Los Angeles DPH reached the crisis point that the Center did. Two of those recipients, AIDS Healthcare Foundation and AIDS Project Los Angeles, did not respond to requests for comment.
The DPH also had not responded to multiple requests for information by publication time. However, Los Angeles County Supervisor Sheila Kuehl, who serves the third district, where the Center resides, said in a statement that the Board of Supervisors only recently heard about the proposed funding cuts. “We are working closely with the Center and the Department of Public Health to resolve the issue and ensure that the Center can continue to serve a vital role in the county’s system of free STD testing and treatment services,” she said.
What makes the Los Angeles LGBT Center especially vulnerable to government funding cuts, Carpenter said, is the population they serve and cover. Approximately 50% of their clients have no insurance or are underinsured, with high deductibles and co-pays, Carpenter said.
Although the January funding change from DPH came without warning, Carpenter said, the Center has been in a similar predicament. Last year, according to Carpenter and Kuehl, a funding cut announced by the DPH also brought community outcry, leading the LA County Board of Supervisors to pass an emergency bill allocating $5 million over two years to the DPH to subsidize the costs of STD testing by the Center and other nonprofit health organizations.
The possibility of eliminating any free testing services comes at a time of rising STD rates in Los Angeles. Over the past five years, there has been a 98% increase in primary and secondary syphilis; an 81% increase in gonorrhea; and a 25% increase in chlamydia cases in Los Angeles County, according to the DPH. The epidemic disproportionately impacts communities hardest hit by health inequities and stigma, including young gay and bisexual men, women, people of color, and transgender people.
Nationwide, STD rates continue to rise, as well. The 2018 Sexually Transmitted Disease Surveillance Report, published in October by the U.S. Centers for Disease Control and Prevention (CDC), showed that cases of three STDs—syphilis, gonorrhea, and chlamydia—were up for the fifth year in a row.
Philip Chan, M.D., M.S., medical director of the only publicly funded STD clinic in Rhode Island, part of Providence's Miriam Hospital, is sympathetic to the funding crises faced by the Los Angeles LGBT Center and other providers. “STD clinics across the country struggle to cover the uninsured and under-insured, even here in New England, where there is Medicaid expansion,” Chan told TheBody.
Chan, who is also a consultant with the Rhode Island Department of Public Health, started the STD clinic at APRI from scratch after a state-sponsored STD clinic closed more than 10 years ago. “We have been lucky by getting support from not only the DPH, but also hospitals. But most clinics have to be very creative in how they can sustain care and preventative services for affected and vulnerable populations. Even the cost of $100 for each test, which is a discount from the approximately $500 list price, is not affordable for many people.”