EVERETT – Every Monday morning, someone read aloud a list of names. Staff then moved flowering plants into the atrium, one for each person who had died of AIDS in the previous week.
It was the 1990s, and then-29-year-old Dennis Worsham was new to the Snohomish Health District. He came out as gay in college and joined the public health sector to fight the disease that kills gay men at a horrific rate. At the time, gay and bisexual men accounted for about three-quarters of AIDS cases in the United States, according to the Centers for Disease Control and Prevention. Patients often lived no more than two years after diagnosis.
Worsham, in charge of sexually transmitted disease management in Snohomish County, saw the flowers fill the atrium at the Rucker Avenue building. He wondered if this was also his destiny.
“You’re coming out as a gay man and you see all these other men dying around you,” Worsham said. “It was a community that was very scared.”
Worsham, now the county’s health director, has seen firsthand how AIDS prevention, treatment and attitudes have changed dramatically in recent decades.
By September 1990, Snohomish County had seen 96 AIDS cases, and 91% of those cases were men, according to a county report. The county had an HIV prevention program, a free testing clinic and a case management team.
But more than half of Snohomish County’s AIDS patients were traveling to King County for treatment and support services, the report said. Many doctors here had refused to work with AIDS patients, The Seattle Times reported in 1987. LGBTQ-friendly resources, such as the Snohomish County AIDS Project and Everett’s then-gay bar Stage Stop, grew to help overcome the gap.
“(Gay) communities have historically been disproportionately affected by a number of STIs,” said James Lewis, Snohomish County’s current health officer. “And that group has often been uncomfortable in more traditional medical settings.”
Nationwide, stereotypes linking gay men with the disease influenced health care policy. In one infamous example, in 1985, the federal government banned gay and bisexual people from donating blood. This ban has been gradually eased only in the last decade.
When Worsham started at the health district, he was the first gay staff member in his position.
“There was a lot of homophobia,” Worsham said. “Being gay did not put you at risk for HIV. Sexual behavior puts people at risk.”
‘People need to feel safe’
LGBTQ+ people continue to face disproportionate emotional and tangible barriers to health care, said Kate Rowe, a Kaiser Permanente nurse serving residents in King and Snohomish counties. This is partly due to “stigma and discrimination against sexual and gender minorities,” according to a National Institutes of Health study published in 2023.
A Granite Falls resident, who requested anonymity to protect family from backlash, met Rowe at a “Gender Affirming Health Care” workshop at Lake Stevens Pride earlier this month. The 51-year-old resident said they are biologically male, identify as non-binary and have not used a urinal in 20 years.
In the last three years, the resident has spent weeks in local hospital beds due to serious health conditions. Regardless of their preferences, nurses only gave them the option of using a urinal, they said.
“People need to feel safe,” Worsham said. “I don’t just mean physically safe, but it’s emotionally safe, where they can come and be who they are, and they don’t have to put on a facade in order to navigate in good health.”
Rowe said most local providers are still years away from providing comprehensive health care. LGBTQ-specific needs aren’t usually taught in medical school, Rowe said, but they should be.
That includes gender-affirming health care — a growing need in the region, Rowe said. Few providers in the area offer puberty blockers, hormone therapy, and cosmetic procedures.
“If you can manage someone’s insulin, you can manage someone’s hormones,” Rowe said.
Recently, Worsham helped facilitate a conversation with Kaiser staff about local gender-affirming care needs. Kaiser has one of the few gender health programs in Washington.
Rowe said the Ingersoll Gender Center in Seattle is another “shining light” of gender-affirming health care in the state. But Snohomish County’s resources are few. Often, the best chance of finding a supportive health care provider is through word of mouth.
“Their best resource is their community,” Rowe said.
‘A constant battle’
In the 1990s and early 2000s, the Snohomish Health District funded the Gay Men’s Taskforce to co-lead HIV interventions, as well as Globe, an adolescent and youth prevention group. PFLAG, the Lesbian and Gay Parents and Friends Group and the University of Washington were also critical of the district’s outreach, Worsham said.
“Often in public health, we’re very focused on what’s going wrong and trying to change those behaviors,” he said. “Now, I’m always conscious of pointing out what’s positive within the data. Speaking of resilience and strength within communities, not attaching the stigma of illness to one population.”
By 2009, AIDS deaths had declined thanks to the development of life-saving drugs. But as cases fell, state and federal funding for sexual health dried up.
The Snohomish Health District was forced to close its STI clinic. Community-based prevention efforts declined. Many longtime advocates for LGBTQ-friendly health care moved out of the county to continue their work elsewhere.
By 2022, all sexually transmitted infection case rates in the county had at least doubled since 2009. For years, the county had sought money to help reopen the clinic, but the state agreed only after a group health care experts in 2022 made recommendations to control a nationwide increase in sexually transmitted infections.
Last winter, after 14 years, the Snohomish County Health Department reopened its free STI clinic. Once again, the clinic offers free testing, treatment, education and case management to those in need, regardless of insurance status.
In the first three months, the clinic saw 390 visits. Providers identified 64 new cases – two tested positive for HIV, eight for syphilis and 17 for gonorrhea. People who identify as LGBTQ+ make up a “large proportion” of clients, and the clinic is an LGBTQ-friendly environment, said Lewis, the public health officer.
“In order for us to successfully mitigate the spread of these diseases, we need to be able to gain trust,” Lewis said. “We need to have staff familiar with the community and sensitive to the concerns that the community has.”
About $1 million in state money used to reopen the clinic was a one-time grant that lasted two years. The health department plans to collaborate with lawmakers and create a data report on its care efforts to help secure the clinic’s future.
“All this money comes in when you have a health problem,” Worsham said. “Then you get it under control, and the funding is withdrawn and you’re at risk again. It’s an ongoing battle in public health.”
Aside from the clinic, Lewis said he was unaware of any public health care programs or campaigns targeting Snohomish County’s LGBTQ+ demographic. Globe, the local Everett-based LGBTQ+ youth support group, is looking to expand, Worsham said.
“It’s really hard to try to provide services to a community where people don’t feel supported,” Worsham said. The goal is “understanding the sensitivity and raising the voice of people who have experienced as part of the work”.
Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; Tweet: @_sydneyajackson.
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