Two weeks after San Francisco's only medical and social service organization built by and for sex workers quietly announced that it's shutting its doors, questions about how this hole in the city's safety net will be filled are still unanswered.
But officials from both the city and St. James Infirmary, which will pass into history just months from now, assured the Bay Area Reporter that they're working on it.
"I can tell you as of this morning it looks like both of our housing programs are going to have really great new homes, but I can't say who those are," Dana Hopkins, the chair of St. James' board, told the B.A.R. on August 29. "You can circle back and we can share about one or another of them by the next day or two. We're looking for orgs that share our values, housing in particular, that are trans knowledgeable, have trans staff, and are trans competent."
Pau Crego, a trans man who is the executive director of the city's Office of Transgender Initiatives, stated as much August 25. As the B.A.R. has extensively reported, in 2019 the mayor's office awarded over a million dollars to two nonprofits — St. James and Larkin Street Youth Services — to provide case management and disbursement of funds, respectively, for the city's first rental subsidy for transgender people.
"MOHCD is in the process of identifying an organization that would have the capacity and expertise to deliver these life-saving services without interruption, but at this time a selection has not been made," Crego stated, referring to the Mayor's Office of Housing and Community Development that funds the program. "OTI [Office of Transgender Initiatives] has been working closely with MOHCD and SJI [St. James Infirmary] to ensure a seamless transfer of this program."
Crego referred "questions about SJI's sunsetting timeline, and other questions related to SJI as an organization" to Hopkins.
When asked about how St. James' demise affects Larkin Street, as well as where St. James' current clients should go, Sherilyn Adams, the CEO of Larkin Street Youth Services, responded with a brief statement.
"Larkin Street Youth Services is deeply appreciative of the St. James Infirmary's decades of service to our community," Adams stated. "We are committed to supporting St. James Infirmary as they work to transition their programs, including Our Trans Home subsidy, to other providers over the next six to 12 months."
'Painful decision'
Hopkins called the decision to close a difficult one and said that as a result, St. James will close definitively over the next six to nine months.
"It was a really painful decision," Hopkins said. "It was made with the board and the board emeritus. The decision was reached only days before there was any kind of announcement; we weren't working on this for months without telling anyone. It's heartbreaking, but it's also the nature of nonprofits."
St. James first opened in June 1999 as a health and safety clinic to provide non-judgmental services to current and former sex workers. It came about after an agreement between the late Margo St. James, a longtime advocate for sex workers, and the San Francisco Department of Public Health, whereby the city would stop nonconsensual tests for sexually transmitted infections in jails, but the sex workers themselves would run their own clinic.
Its offices are in the city's South of Market neighborhood, once a hotspot for the city's sex clubs, now represented by gay Supervisor Matt Dorsey.
"I was really saddened to hear the news," Dorsey stated to the B.A.R. "I've always had tremendous respect for the organization, and I actually stopped by its new location on Mission Street shortly after I joined the Board of Supervisors to introduce myself and get an early tour.
"I think the closure is also sad because it was part of the legacy of Margo St. James, who passed away just a few years ago," Dorsey added. "Margo was such a groundbreaking advocate for sex workers and a colorful San Francisco character for many years. That mostly preceded my time here, and I didn't know Margo personally. But I have reached out to a couple of our mutual friends to see if there is anything the city should do to ensure that Margo St. James' legacy endures in some way."
St. James died in 2021, as the B.A.R. previously reported.
Recent woes
Bay Area Workers Support, which advocates for sex worker rights and safety, issued its own statement demanding accountability and transparency.
"St. James was more than just a clinic; it was a place of acceptance, a community space, and a source of life-changing care," the statement reads. "Regrettably, we must address that these peer-based essential programs, such as mental health support and medical care, have already been dissolved without warning or reassigning clients to other services. The repercussions of this decision have caused harm to our community members and service providers, and they underscore the necessity for further accountability throughout the closure process."
BAWS enumerated three specific demands: that the St. James board provide "comprehensive explanation for the closure of this cherished institution and an end to any practices that suppress current employees from speaking to the media or other stakeholders;" that it "be proactive in transitioning its programs to other community organizations that can ensure the same level of dedication and compassion for staff and participants;" and that it respond to allegations of "unsafe and unreasonable labor conditions" levied against it by Our Trans Home SF staff.
"So far, the only public response from SJI has given is to shut down entirely," BAWS stated. "The OTH staff bravely put their jobs on the line to call out the mistreatment of themselves and the homeless trans community, and the silence they've gotten in return speaks volumes."
As the B.A.R. reported earlier this year, St. James staffers were accused of sexual retaliation against a trans woman living at the Bobbie Jean Baker House. The city instructed St. James to pause evicting the tenant while her claims that she was being evicted because she wouldn't accompany two staffers to a sex club were investigated.
That tenant, Blanche Kriege, told the B.A.R. that she is "saddened but not at all surprised" at St. James' demise.
"The city (mayor's office) bears the lion's share of this blame," Kriege stated. "The indicators of SJI's demise were public and well known to them and the BOS [Board of Supervisors]. It would appear that rather than guiding a shiftless pack of hyper-triggered juveniles (management) to practicality, they opted to enable pettiness and tantrums."
Kriege continued that "on paper these programs do work and they do save lives. The affected parties would be well-advised to restructure the affected programs under Larkin Street Youth's [Services] more solid track record."
A spokesperson for Mayor London Breed did not return a request for comment for this report by press time.
Hopkins said that the departure of Anita O'Shea as interim executive director on August 15 — the day staff learned St. James would be shutting its doors — "has nothing to do with our sunsetting" and that reports that the board is "scaling back" staff is "absolutely not" true.
The San Francisco Chronicle reported that no reason was given for St. James' demise — only that "Despite everybody's best intentions, we don't quite have the capacity to do this," the paper reported Hopkins as saying — but multiple anonymous sources said that the nonprofit buckled amid mismanagement.
The B.A.R. reported on the rapid and opaque changes at St. James firsthand. In 2020 — just weeks before the COVID pandemic lockdown — Executive Director Toni Newman announced she was departing, effective the same day, to move to Los Angeles.
Then, St. James staff and board members wouldn't say who was in charge — going so far as to shut its doors on a B.A.R. reporter March 2, 2020 after first denying, then confirming, that there was an interim executive director.
The next year, St. James announced it wouldn't be having an executive director but would be having a co-directorship.
"We discerned we'd been running as a co-directorship, and decided to go forward with that new leadership style," O'Shea, then operations director, said at the time. "We are taking in a lot of philosophies talking about communication and the advice process [and] conflict engagement."
But earlier this year St. James changed tact again. Hopkins said that "fundraisers wanted to see a more traditional leadership structure," and that O'Shea stepped in as interim executive director, but was always going to leave August 15 and "did on very, very good terms." O'Shea could not be reached for comment.
Future of services murky
St. James administrative assistant Trille Galli stated to the B.A.R. that there is not yet an "official end date."
"Fortunately our remaining programs will be absorbed and carried out through new community non-profits," Galli stated.
This was confirmed by Anne Stanley, communications manager for the mayoral housing office, who stated that "MOHCD is in the process of identifying an organization to take over the contract [for the housing subsidy] with minimal interruption to services." But like others contacted for this story, Stanley was not more forthcoming about specifics.
Crego did state, however, that there are many clinics in the area that have experience with the sex worker community, including Lyon Martin, City Clinic, the Berkeley Free Clinic, and Planned Parenthood.
These agencies did not return requests for comment as of press time, except for City Clinic, which is under the auspices of the San Francisco Department of Public Health.
"SFDPH is working closely with St. James Infirmary on the possible transition of existing clients to other providers," the DPH spokesperson stated. "This work is ongoing as we continue to review and determine transition program[s] for these clients."
The spokesperson stated that "Under SFDPH Whole Person Integrated Care (WPIC), we provide medical care and behavioral health services, including sexual and reproductive health services, as well as gender affirming care, to people who do sex work and are experiencing homelessness at multiple sites including shelters, navigation centers, street, clinic, and permanent supportive housing sites."
The All Love Project is a "safe space within WPIC" for female-identified, trans and nonbinary people experiencing homelessness.
"This effort focuses on people with needs related to gender and evaluates reproductive and sexual health from structural influences like gender-based violence," the spokesperson stated. "All Love addresses these barriers by collaborating closely with community-based organizations including those that serve people doing sex work."
The spokesperson continued that "our staff receive regular training in trauma informed care, cultural humility, implicit bias, and working with patients from diverse backgrounds," and that besides City Clinic, good locations for sexual health services include Strut, the Castro Mission Health Center (which includes the Transgender Life Care Program and Dimensions Youth Program), and the Tom Waddell Urban Clinic.
San Francisco Community Health Center was also contacted but did not respond to a request for comment. In March, the nonprofit opened the city's first stand-alone facility dedicated exclusively to serving San Francisco's transgender and gender-nonconforming communities.
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