Bay Area Reporter - October 20, 2005
Matthew S. Bajko, m.bajko@ebar.com

"You can do it. An agency could do it. You just need to have a dedicated staff willing to work those hours," said lead researcher Valerie Rose.

Rose and her research team from the city's AIDS Office nicknamed their work the "Late Night Breakfast Buffet" study. The buffet - offered inside the confines of a van parked in the Castro, Polk Street, and South of Market areas on different nights - included harm reduction counseling, clean needles, condoms, lube, water, juice, and Clif bars donated by the company.

The research team conducted its street outreach last fall, working between the hours of 2 and 5 a.m. Over the course of a six-week period, they saw 600 clients, had 233 people request needle exchange services, exchanged 2,000 needles, and handed out 4,500 condom and lube packets.

"There are hundreds of men out and about between 2 and 5 a.m. I was very surprised by how many people we saw," said Rose, who, along with her team, presented the study results at the October 13 meeting of the HIV Prevention and Planning Council.

"The Castro can be quite hectic at 2 a.m. in the morning," added Ari Max Bachrach, project coordinator for the study. "The Castro proved to be a spot to do it. Maybe that population is not getting hit by those services."

The team suggested Magnet, the gay men's health center on 18th Street, as an ideal place to offer late night services. The team parked its van Fridays in the Castro right outside Magnet's doors. HPPC members agreed not only would Magnet make the most sense, but also funding should be set aside to pay for late night services.

"It would be a great thing if Magnet could stay open until 5 a.m.," said HPPC member Israel Nieves Rivera.

However, when asked how many of the HPPC member's agencies would offer late night services, few raised their hands. When asked if any had included such services in their funding proposals, none said they had. HPPC member Frank Strona suggested the city make offering late night services a requirement in order for agencies to receive funding.

"It is not ethically right for agencies to say their staff doesn't like the hours so they can't do it," said Strona.

Steve Gibson, Magnet director, said during Magnet's planning process, what hours to be open was a key part of the discussion. Its advisory board said the center needed to be open and accessible when gay men are in the Castro, and Gibson said that does include late hours.

But, he added that hiring and retaining staff for such a shift would be difficult and that the center does not have the funding at this time to do it.

"We can't be a 24-hour clinic even though people would come to us 24 hours," said Gibson. "I have always had as a goal late night or extended hours."

While he would not disclose the details because no agreement has been finalized, Gibson did say he is in talks to find a partnership with another agency to offer late night needle exchange at Magnet.

"I am trying to get creative with resources to help make services, including access to needles, more widely available to gay men in the Castro," he said.

Stop AIDS Project program director Mark Utterback said his agency "absolutely" would offer late night services if it had the funding and capability to do so. The agency is looking to purchase a van and is asking private donors to cover the estimated $40,000 cost to buy the vehicle. Stop AIDS plans to offer both HIV and STD testing, but would not be equipped to do needle exchanges, inside the van.

Study results

Over the course of the six weeks, the researchers noted that some of the men made repeat visits to the van, bringing along friends. If the study was longer, Bachrach speculated that the results would be even more telling of the need for late night services.

"Our numbers would be way up if we were out there one more month," said Bachrach.

While the 600 clients in the late night services study had "a minimal uptake" of testing services for HIV and sexually transmitted diseases, 21 people did test for HIV, with six returning for their results. Two people tested positive, with one "successfully linked" to HIV health and social services. As for STDs, only 12 people got tested, with four returning for their results. All tested negative.

"We didn't recruit. We just showed our presence," said Rose.

Added Bachrach, "We tried not to focus on people coming out of the bars."

According to the study, the low interest in testing stemmed from the fact it was confidential. Most clients preferred anonymous testing as well as rapid testing. Rather than having to return for test results, the study found most of the men said they wanted to have their results that night.

"People didn't want to use the services because it was confidential," said Rose, meaning they were required to give the researchers a name.

The same problem could arise if Magnet offered late night HIV testing. The center only does confidential testing.

"It is not anonymous primarily because it is easier for them as well as us. Our clients really aren't that concerned about confidential testing," said Gibson, who noted clients are only required to provide a name.

"It is not Magnet's policy to check identification," he said.

As part of its research, the team did interview 55 men and asked them questions on a number of issues. The men had to be older than 18, had engaged in sex with a man within the last three months, and able to be located, whether at an address or street corner, for a follow-up interview three months later.

Of those 55 study participants, 64 percent identified as being gay, 27 percent as bisexual, 6 percent as heterosexual and 4 percent identified their sexual orientation in other ways. About 35 percent of the men ranged in age from 36 to 40 while 25 percent were between 21 and 25.

A majority, 51 percent, were white men, with 24 percent Latino, 15 percent black, 7 percent Native American, 2 percent Asian, and another 2 percent citing other ethnicities.

Regarding the men's socioeconomic status, 38 percent fell under the federal poverty level. Thirteen of the men said they dealt drugs to make a living while 25 reported sex work, four of whom were HIV-positive. As for their living situations, 12 reported owning a home, 23 were homeless or on the streets and 20 said they were marginally housed either at hotels or staying with friends.

On average, the men reported having nine sexual partners (whether male or female) in the past three months. All 55 of the men reported "ever" being tested for HIV, while 17 said they had never been tested for an STD. Eleven had had an STD in the past year. Sixteen were HIV-positive, nine of whom were currently receiving care.

When asked about using drugs, 78 percent had used speed in the last 90 days, 69 percent alcohol, 40 percent poppers, and 29 percent GHB. Thirty-two had been in drug treatment, while 17 said they needed treatment now. However, of those, eight said they did not want treatment while three said they were on waiting lists.

The team's findings were somewhat surprising, said Bachrach, when it came to which services men in the Castro requested.

"At the Castro site what surprised me was it was the most often site for needle exchange. People were using it," said Bachrach. "We also had a couple of groupies who were really psyched to see us out there. They would come by every week to chat."

Rose added that, "We do think we got people to use needle exchange more often."

One problem the researchers faced, which an agency with a secure setting presumably would not, stemmed from the fact they did not have a storefront to work out of and instead used a mobile van. The team had to load and unload the van every night, cutting down on the number of hours they could be present on the streets; the van was broken into; and one night they found themselves locked out of the van.

"Logistically, it was kind of crazy at times," said Rose.

As for working in the dead of night, she said, "We drank a lot of coffee and Red Bull and ate a lot of doughnuts."

051020
BR051004

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