For some residents of Washington, D.C., seeing a 10-foot-by-10-foot canvas tent has become a regular part of running errands to the grocery store and the laundromat. That tent belongs to One Tent Health, a mobile pop-up HIV screening initiative that has been operating for the past four years in D.C.’s neighborhoods most impacted by HIV. In a year when in-person sexual-health services were forced to innovate, One Tent Health’s model made it adaptable to responding to the additional impacts of COVID-19 and voter-suppression efforts.
Mackenzie Copley is the co-founder and CEO of One Tent Health. After going through his own first-time experience with testing, Copley began volunteering with a local private clinic offering on-site mobile services. However, what he saw frustrated him. “They were turning away people every day because they didn’t have insurance,” he recalled in our conversation. “That bothered me, especially because they had waited in line.”
In 2016, Copley reached out to former classmate David Schaffer, M.D., who was finishing up his residency at University of North Carolina Medical School. Schaffer had been working on global stigma and sexual-health research, and Copley thought he would have the medical background to provide oversight to a nonprofit that would seek to reduce barriers to testing, like cost and not having insurance coverage. That partnership started One Tent Health.
What Happens at the Tent?
On its first day, in October 2017, 18 people walked into the tent to test. It was 18 more than the One Tent Health team expected.
Like many community-responsive organizations, One Tent Health looks to the data when deciding where to set up camp. Using epidemiology maps, the team can see where newly diagnosed people with HIV are living.
According to the latest epidemiology report from D.C.’s Department of Health, HIV incidence from 2015 to 2019 was highest among Black men who have sex with men (36%) and Black heterosexual women (16%). One Tent Health’s own data shows that 82% of clients are Black. Additionally, of all clients who have tested, one in six are men who have sex with men. Overall, 13% of clients never had an HIV test in their lives.
From there, they narrow their neighborhood searches based on clinic availability. D.C.’s Southeast and Northeast quadrants have been called “a health care desert” by hospital professionals throughout the District. In 2018, Providence Hospital in Northeast D.C. shuttered, leaving the 50,000 patients seen annually in the emergency room—a place that offers emergency HIV testing, prevention, and treatment services—without a local provider. In 2019, D.C. Council voted to close United Medical Center, Southeast’s last public hospital, by 2023.
The final step in identifying where to set up is reaching out to community hubs with lots of foot traffic. The organization has partnered primarily with grocery stores and laundromats. “For people waiting the 60 minutes it can take for the laundry cycle to finish up, we can test, refer, and counsel them and still have 45 minutes to spare,” said Schaffer.
Schaffer makes it clear that One Tent Health is not meant to replace medical prevention and treatment services. “Linkage to care is really important for us,” Schaffer said in a past interview. While providing direct medical services or HIV treatment is not part of the organization’s mandate, working in partnership with local HIV providers, like Whitman-Walker Health and Mary’s Center, makes it possible for One Tent Health to be that initial touch point for the community. In the same interview, Schaffer summed it up by asking, “What’s the point of doing all this screening if the people that we screen don’t get treated for HIV?”
Community members can also get same-day pre-exposure prophylaxis (PrEP) through a partnership with Us Helping Us, a bedrock community-based organization devoted to HIV support for Black LGBTQ residents since 1985.
Rapid PrEP initiation was a result of a model that initially led to many people not seeking follow-up preventive care. When the partnered organizations noticed that sending PrEP referrals to LabCorp for labs to start taking the medication was a barrier, they decided to remove LabCorp from the equation. Instead, they opted for getting phlebotomy certification for core volunteers and staff.
Co-founders Copley and Schaffer had spent almost a year planning their launch. Self-funded through cutting lawns and working at local bars, making testing accessible for residents as well as the One Tent Health program was an important consideration. As a model, One Tent Health is about making cost savings go farther. The program is able to keep costs low thanks to a partnership with the D.C. Department of Health, which supplies no-cost HIV rapid-test kits. Additionally, the decision to use a $300 canvas tent instead of a $50,000 mobile van was key. Finally, the volunteer base is the final component to their low-cost model and its unique structure as a combination prevention and training program.
Building Youth Leadership
Youth leadership makes One Tent Health possible. According to their website, everyone involved—from volunteers to staff to board members—is between 18 and 27 years old.
“Youth mobilization is the most unique component of our program. It’s also the most important,” Copley said in our interview.
Daniel Zhang is a junior pre-med student at the University of Maryland who initially signed up to volunteer in order to fulfill volunteer-hour requirements under his program. “I had no idea how big of an impact it would have on my life,” he admitted in our interview. “After the first screening, I figured out this wasn’t about hours anymore.”
Zhang is the volunteer development chair for the One Tent Health student advisory board at his campus. University of Maryland is one of five universities in the D.C. area that recruits volunteers—the others are Howard University, American University, Georgetown University, and George Washington University. Each campus aims to have three student leaders holding leadership positions to get volunteers recruited, trained, and out in the community.
These leaders are responsible for taking the volunteer base from 45 students to 2,000 in less than three years.
Zhang notes that volunteering can be a learning curve. “The hardest part for me is having that first conversation with someone who tests positive. A large gap between client and volunteer opens up at that moment,” he says. Part of what the student leadership that trains volunteers strives for is figuring out how to reduce that gap as they walk a participant through their next steps once they walk out of the tent.
Early on, Copley committed to ensuring that participants faced low barriers accessing testing and care, and personnel could easily make their way to testing-site locations. Wanting to support Black, Indigenous, people of color (BIPOC) student volunteers, One Tent Health partnered with rideshare service Via to offer low-cost rides to and from testing locations.
“We knew that having two white guys [Copley and Schaffer] screening in historically Black neighborhoods in D.C. was not going to fly,” Copley said in our interview. Mobilizing BIPOC students attending Howard University, the District’s historically Black college/university (HBCU), was a priority in providing better community-centered care.
Building Up Services in an Anti-Black, Pandemic-Centered World
Evaluations that One Tent Health asks participants to fill out have been a guiding star in expanding other pop-up health service offerings. “Our new programs are led by BIPOC voices that we hear through the evaluations,” Copley says.
Over the summer, the uptick in anti-Blackness and threats of voter suppression led One Tent Health to add another service: voter registration. Community members waiting in line to receive their test could sign up to vote in a matter of 30 seconds.
Partnerships with Black-led organizations with decades-long impacts in the community, like Us Helping Us, have been integral to One Tent Health’s success. Copley says this is more important than ever and has provided unique opportunities for incentives to test. Cherry Blossom CBD, a local Black-owned business, has donated over 1,000 CBD products for participants who complete screening.
The program operates in the three majority-Black wards of the city, where COVID-19 death totals are triple those of majority-white wards. These same communities are where One Tent Health has put their resources, time, and energy for HIV prevention. As a result, One Tent Health now includes COVID-19 testing in its offerings.
Looking to the future, the team hopes to add naloxone distribution and training, especially as 2020 overdose rates hit an all-time high in the wards where One Tent Health operates. According to a report from the D.C. Office of the Chief Medical Examiner, 84% of all reported opioid fatalities from January 2016 to October 2020 were among Black D.C. residents.
“We are constantly learning and recommitting ourselves to this work,” Copley shared as we ended our interview. He and the larger One Tent Health team hope to see this low-cost, community-responsive model replicated throughout areas of the U.S. where disparities in access to care prevent people from taking control of their health.