Prioritizing Sexual Health

Columbia Mailman student Jennifer Britton recounts the lessons she learned while developing an HIV Outreach Program in New York City.

November 21, 2018

I’ve learned a lot since moving back to New York City: how to cook lobster mac and cheese, that Governors Island is an easily accessible getaway, and how studio apartments are made delightfully cozy with the addition of a cat. But the most useful knowledge I've gained was through my summer practicum with

Project STAY, a program administered through New York-Presbyterian, Harlem Health Center, and the Columbia Mailman School that works with people most vulnerable to sexually transmitted infections (STIs) who lack access to healthcare services. Project STAY provides free education, outreach, and testing services to communities throughout the city. As part of my practicum, I developed and implemented a Street Outreach Program at Project STAY that connected vulnerable communities to STI testing services via peer health advocates. When individuals tested positive, I helped get them into treatment.

Which brings me to the most resounding thing I learned during my practicum: that sexual health is a privilege. In my four months working with Project STAY, I met many clients who were vulnerable or overlooked and had a diverse set of basic needs that were not being met. It was not uncommon to have clients in the program who seemed unconcerned about getting tested, despite engaging in unprotected sex with multiple partners, having been tattooed in prison, or engaging in sex work, all of which made them very high risk for possible STIs. To my surprise, many people did not prioritize getting treated when they tested positive for an STI.

As someone who has always been able to address my sexual health needs, it was hard to fathom testing positive for gonorrhea and letting it go untreated for months or even indefinitely. But after learning about the situations that many of our clients were facing—homelessness, drug addiction, discrimination, reacclimating to society post-incarceration—I discovered how much of a privilege it is to be able to worry about sexual health, let alone get services. For many, food, shelter, safety, or employment was their most immediate concern, and sexual health was much farther down on their list of priorities. While somewhat rare, Project STAY does occasionally get clients who were actively trying to contract HIV—known as “bug chasing” —in order to get the social services that are offered to those who are HIV positive.

Working with these at-risk individuals demonstrated to me the need to integrate sexual health services with other healthcare and social services, such as housing, job assistance, and mental health. Our main goal in the Street Outreach Program with Project STAY was to connect to communities and engage clients in HIV and STI testing and education; we were able to do this successfully with the peers, who were members of the communities we were serving. However, many of the people who participated in our program had more pressing needs; it was common for someone to initially decide to participate because of the free snacks, a reprieve from the heat and sun, or that day’s incentive (typically a small item like a water bottle). The top priority for many was mental health referrals or housing assistance, with their sexual health taking a back seat. Our health educators did their best to address clients’ many needs and still ensure they received much needed sexual health services as well, in a safe and comfortable environment.

With the Street Outreach Program, we linked clients to other services by making referrals to Project STAY’s free health clinic, but it was not a formalized part of our fledgling program. The key to the success of Project STAY is a parallel approach that offers community social services while bringing individuals into the healthcare system. The Street Outreach Program I helped create this summer has a strong start, but will be made even stronger if it can formalize and expand its referral system to other social services.

I have been working in and studying sexual and reproductive health for years, but this summer gave me a new perspective. Being forced to confront one of the ways in which privilege impacts service delivery in this field left me with a greater understanding of the importance of outreach, referral systems, and service integration. Moving forward, I know these lessons will inform my approach to sexual health and public health as a whole.

Jennifer Britton is a second-year MPH student in the Heilbrunn Department of Population & Family Health. She received her BA in Psychology and Spanish from Skidmore College. 

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