Visitors relaxed as a disc jockey spun ambient music at this place
they call Magnet, just a stone's throw from 18th and Castro streets in San
Francisco. Employees laid out a Twister game in the center's entrance, which
resembles a hotel lobby, although among the few men who stopped by that
evening, no one seemed interested in playing games.
A week before, a man perused art and magazines and checked out the center's
social events - book readings, game nights. Just minutes before, he was
getting tested for syphilis at the very same center.
It's a strange dichotomy - a health clinic on one hand, a social venue on
the other - but the Magnet health center, which opened in July, is the latest
example of a growing movement in the gay community to switch from focusing
solely on AIDS and instead take a wellness approach.
The holistic gay men's health movement is slowly spreading around the
country with regional men's health conferences in cities as far flung as
Raleigh, N.C., and Boulder, Colo., and a handful of health centers in places
such as Seattle, Philadelphia and more recently Tucson.
"We've maxed out on the effectiveness of narrow HIV approaches to gay men's
health," said Eric Rofes, a Humboldt State University professor of education
and a founder of the gay men's health movement. "Working with people around a
single virus might be effective in a crisis moment like the 1980s, but 20
years later some of us believe it has led to health disparities visited upon
gay men."
Rofes said the aim is to get gay, bisexual and transgender men, their
doctors and public health officials to recognize the diverse array of ailments
afflicting gay and bisexual men, from tobacco use and high cholesterol to
depression, addiction and prostate cancer.
Rofes said change will come about once people accept some truisms of gay
life: Gay men have more sex, with more versatility, and they take more risks
when it comes to sexual behavior and substance use. In Rofes' utopian vision,
gay men will know their bodies intimately and the real risks they are exposing
themselves to when they engage in a particular behavior.
"Rather than scare the community through an HIV-prevention approach or
pretend the challenges aren't there," he said, "we should be inculcating a
deeper understanding of health and wellness into community culture."
Their goal is not to ignore AIDS, but rather to look at other health
problems as well. The movement prides itself on its big-tent philosophy. And
there are plenty of differing viewpoints on the best approach.
Given the new AIDS therapies, the lethality of HIV has been "put out there
a ways," said Dr. Tom Coates, a professor in the division of infectious
diseases at UCLA and a leading AIDS prevention expert.
"We have an opportunity to step back," Coates said. "HIV is still a big
problem, but there are a lot of other things that need to be looked at. The
problem is when you talk about disease prevention and health promotion you're
not talking about an unfettered lifestyle. The gay movement has a strong
libertarian approach. Music, sex, drugs - people like those things. Convincing
them that over the long haul it may help them to curtail some of that activity
- that's going to be one of the main challenges."
Visitors to Magnet are greeted by a "concierge" who hands out a menu of STD
services. The center's Web site advertises the services offered with punchy
headlines: "Check your dipstick," "Hot links," "What's goin' on" and "Happy
homo." Local gay, bisexual and transgender artists display their work on the
center's walls, and there are plans to have several computers with free
Internet access and an espresso cart outside. One wall is covered in
galvanized steel with alphabet magnets available for visitors to spell out
favorite phrases or sayings.
"Welcome to the future of gay men's health," chirped the center's director,
Steve Gibson.
Besides Gibson, the center, which operates on a $450,000 annual budget from
city and corporate grants, is staffed by a skeleton crew. There is the
concierge, a physician's assistant and an outreach coordinator.
"We've identified that HIV and syphilis infection rates are going up among
gay and bisexual men," Gibson said. "Now we're trying to do something
different.
"Magnet's mission is to improve gay men's health individually and as a
community. The medical model up to now has forgotten the individual and the
context of gay men's lives."
A recent forum at the center covered crystal methamphetamine use among gay
and bisexual men, which health experts say is contributing to a rise in risky
sexual behavior and the spread of HIV; as well as a spirited debate over
whether the format of the popular Castro Halloween celebration should be
changed to minimize its appeal to troublemakers.
Counselors at the center ask whether clients have experienced depression or
substance abuse - topics organizers say few physicians and clinic counselors
delve into.
"Jake," who declined to give his real name, said his friends jokingly call
Magnet "Club Clap."
The 52-year-old learned after being tested at Magnet that he had chlamydia
and was given medication on the spot by the staff physician's assistant. While
he didn't want his real name published in the newspaper, he said the services
were excellent and he liked that he didn't have to wait.
"At City Clinic (a government-sponsored STD clinic), I watched the entire
movie ÔStar Wars' on closed circuit while waiting to see a counselor," Jake
said. "I also like that Magnet is neighborhood-based."
Gibson said in the future Magnet will offer 15-minute massages and
chiropractic care.
"The social piece, someone coming in to be a DJ, that's great," said Renol
Ratchford, a 27-year-old youth counselor from Oakland, who visited Magnet
recently to receive an STD test and find out more about the services for the
gay kids at the neighborhood center he works for. "Your normal clinics don't
do that. It breaks the barrier that this is primarily a health clinic.
"That's helpful in a time where gay men still have to deal with homophobia,
not only from society at large but from doctors. It provides an environment
that is nonjudgmental, deals with specifics and creates an atmosphere where
you can feel comfortable and motivated to talk about your concerns."
Around the country, in metropolitan areas, health officials are seeing
surges in HIV and STD infection rates among gay and bisexual men. Researchers
have also found evidence of higher rates of sexual abuse, addiction and child
sexual abuse in this group, each epidemic contributing to higher risk-taking
behavior.
"What we've found is there is this interlocking web of epidemics among gay
men - HIV is only the most famous," said Ron Stall, chief of HIV prevention
research at the Centers for Disease Control and Prevention in Atlanta. "The
more problems you have, the more likely you are to put yourself at risk for
transmitting HIV. What it tells us is that we should be raising all the health
boats, rather than just one."
Magnet's one-stop shopping approach is a good start, Stall said, and one
that health experts will be studying to see what effect it has on overall
community health.
In Seattle, recent newspaper headlines have trumpeted an alarming rise of
HIV in Seattle and King County. Fred Swanson, the executive director of Gay
City, a health center similar to Magnet that opened in 1995, took note and
helped organize a town hall meeting, which was attended by more than 250 men.
As a result of criticism expressed at the meeting, Gay City plans to spread
the HIV prevention and wellness messages more widely.
"Guys at the meeting said no one is talking about these issues. We are
planning a mass media campaign, getting out to bars to talk about the myriad
issues affecting gay men - not only HIV, but mental health problems, substance
abuse and general wellness," Swanson said.
Derek Turner, a 23-year-old bartender in San Francisco, could be a poster
child for the gay men's health movement. He hears a lot about safer-sex
fatigue and gay men not using condoms and rising STDs and HIV infection rates.
But he manages to stay healthy.
"I'm vigilant about HIV. I'm doing everything I need to to protect myself,"
Turner said in an interview after dropping by Magnet for an STD checkup.
He quizzes his sexual partners about their health and has a strict policy
of using condoms at all times during anal sex. "I'm worth taking care of.
Maybe it has to do with my self-esteem. I was brought up by very supportive
parents, and that certainly helps.
"A more holistic approach is really appropriate because simply being HIV or
STD negative doesn't necessarily mean you're healthy. There are a lot of ways
that gay men's well-being can be improved."
Steven Tierney, director of HIV prevention for the San Francisco Department
of Public Health and a member of Magnet's advisory board, said the movement
will succeed when a new community norm is established.
"The HIV prevention approach we've had for the past 20 years has helped,"
he said. "We had 8,000 new infections in 1984 and now we have 1,000 in a year.
We've seen progress, but we need to jump-start something for the core
population that is still getting infected. Perhaps it comes down to
establishing a community standard that you're worth taking care of and so are
the rest of us. Get a checkup every six months and take good care of your
partners.".
Magnet, at 4122 18th St., is open 3 to 9 p.m. Wednesday through Friday and
noon to 6 p.m. Saturday. Visit Magnet on the Web at www.magnetsf.org or call
(415) 581-1600.
E-mail Christopher Heredia at cheredia@sfchronicle.com.
