After a tumultuous year of change and loss due to Covid, economic crisis, an overdose epidemic, and more, the St James Infirmary has solidified their dedication to the sex worker community and to themselves. The 22 year old organization was founded by several sex worker activists and healthcare advocates, including the recently dearly departed San Francisco icon, Margo St James. Now a group of seasoned program directors have taken the helm and committed to sharing the responsibility of the organization in a new, horizontal leadership structure, without hiring an Executive Director.
“The organization runs like spokes on a wheel. All of our programs have an experienced director and teams of amazing staff and volunteers,” says Operations Director, Anita “Durt” O’Shea. This is a bold and promising move for a progressive organization. “What makes us even more unique is that most of us have had real lived experiences similar to the people that we serve: sex work, homelessness, drug use, and losing our loved ones as a result of a broken system.”
St James Infirmary is a free clinic run by and for sex workers, but their programs extend beyond just primary healthcare. They offer therapy and case management, syringe access supplies and overdose prevention services, and new online workshops, including a mindfulness and meditation class for sex workers, a support group for sex worker parents, a sex workers’ writing group, and more. In 2019, the organization created a new program to house Transgender and Gender Non Conforming people. “Housing is one of the key needs for the sex worker and especially the Trans and Non Binary community.” Joaquin Remora, director of the OurTransHome program explains that trans people are 18 times more likely to be homeless. So beyond just being able to get tested for an STI, a prescription for gender-affirming hormones, or a yearly physical exam, St James has expanded to better address health concerns for sex workers in a holistic way. This focus on social justice and the social determinants of health is reflected in their choice to have a more lateral leadership structure at the top.
“We’re restructuring, and experiencing the benefits of that decision,” says Corrie Varga, Mental Health Services Director at SJI. “It feels like the natural next step for us to envision the kind of organization we want to work for, instead of continuing to try to stick ourselves into the mold of every other non-profit.”
Economic responses to Covid, including mass layoffs and limitations on safer sex practices that in turn can limit sex work, have had a devastating effect on the sex worker community. St James has been there throughout the pandemic to offer assistance and care to a community that is otherwise forgotten, or worse, scapegoated and blamed for their experiences of poverty and ill health. The “Naughty Nurse Mobile” goes out late at night for sex worker outreach. During the pandemic, the outreach team started home deliveries of food, safer sex supplies, safer drug use supplies, and PPE such as masks to sex workers. The outreach team is constantly observing the interactions between street-based sex workers and the police, while building trust and meaningful connections to create better roads to health and well-being for some of the most vulnerable people.
The surge of overdoses in the Tenderloin, where the clinic is located, have also tragically affected sex workers and their loved ones. The Harm Reduction Program at St. James has responded vigorously to the overdose crisis, more than doubling their overdose training and distribution of Narcan. They have expanded programming to initiate two cohorts of “Community Navigators,” who are learning about safer drug use, and disease and overdose prevention. These groups are using a mutual aid model for community-based empowerment, sharing knowledge and resources while running syringe access services. This programming continues the long history in which St James has taken a strong stance against the criminalization of sex workers and drug users, responding with a peer-based model for community survival. “People who use drugs are not monsters, and should not be depicted as such. We’re friends, parents, siblings, neighbors, and people trying to take care of ourselves and each other.” Brooke Lober, Harm Reduction Services Director, states. “Instead of investing in policing, the city needs to address the harms associated with drug use, and the current overdose crisis, with increased access to care. We should be serving the needs of sex workers, drug users, people with disabilities, and people living in poverty, not punishing them. We need dignified housing options and healthcare for all.”
“We’re up for this,” says Celestina Pearl, Outreach Director. “We have been calling for the decriminalization of sex work as a longer term solution to the stigma and suffering of our community since our founding. Margo St James was able to make all these connections back in the 70’s and 80’s. People are able to put this all together and see that the system needs radical changing.”
St James Infirmary provides all services for free to current and former sex workers of all genders and ages, and adjacent communities impacted by criminalization and stigma. They have a full calendar of services on their website, and you can call to make an appointment or to find out more about how to be a part of this organization and this movement.