EVERETT — Every Monday morning, someone read aloud a list of names. Staff then moved blooming plants into the atrium, one for each person who had died of AIDS the previous week.
It was the 1990s, and then-29-year-old Dennis Worsham was new to the Snohomish Health District. He’d come out as gay in college and joined the public health sector to fight the disease killing gay men at a terrifying rate. At that time, gay and bisexual men made up about three-fourths 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, tasked with managing sexually transmitted diseases in Snohomish County, watched flowers fill the atrium in the Rucker Avenue building. He wondered if that was his destiny, too.
“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 as the county health director, has seen up close how prevention, treatment and attitudes around AIDS have changed dramatically in the past 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, free testing clinic and case management team.
But more than half of Snohomish County 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 AIDS Project Snohomish County and then-popular Everett gay bar, the Stage Stop, stepped up to help bridge the gap.
“(Gay) communities historically have been disproportionately impacted by a number of STIs,” said James Lewis, the current health officer in Snohomish County. “And that group often has not felt comfortable in more traditional medical settings.”
Nationwide, stereotypes aligning gay men with the disease affected health care policy. In one notorious example, in 1985, the federal government banned gay and bisexual men from donating blood. That ban has been gradually relaxed only in the past decade.
When Worsham started at the health district, he was the first openly gay staff member in his position.
“There was a lot of homophobia,” Worsham said. “Being gay didn’t put you at risk for HIV. Sexual behaviors put people at risk.”
‘People have to feel safe’
LGBTQ+ people continue to face disproportionate emotional and tangible barriers to health care, said Kate Rowe, a Kaiser Permanente nurse who serves residents in King and Snohomish counties. This is partly due to “stigma and discrimination towards sexual and gender minorities,” according to a study the National Institute of Health published in 2023.
One Granite Falls resident, who asked for anonymity to protect family from backlash, met Rowe at a “Gender Affirming Health Care” seminar at Lake Stevens Pride earlier this month. The 51-year-old resident said they are biologically male, identify as nonbinary and haven’t used a urinal in 20 years.
In the past three years, the resident has spent weeks in local hospital beds due to serious health conditions. Despite their preferences, nurses only gave them the option of using a urinal, they said.
“People have to feel safe,” Worsham said. “I don’t mean just safe physically, but it’s safe emotionally, where they can come and be who they are, and not have to have a facade in order to navigate good health.”
Rowe said most local providers are still years away from providing inclusive health care. LGBTQ-specific needs are not typically 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 few gender health programs in Washington.
Rowe said Ingersoll Gender Center in Seattle is another “shining light” of gender-affirming health care in the state. But Snohomish County resources are slim. Often, the best chance at 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, a prevention group for teens and young adults. PFLAG, the Parents and Friends of Lesbian and Gay Group, and the University of Washington were also critical to the district’s outreach, Worsham said.
“Oftentimes in public health, we are very focused on what is not going well and trying to change those behaviors,” he said. “Now, I’m always mindful of pointing out what is positive within the data. Talking about the resilience and strength within communities, not attaching the stigma of disease to a population.”
By 2009, deadly AIDS cases had abated thanks to the development of lifesaving medication. But as cases declined, state and federal funding for sexual health dried up.
The Snohomish Health District was forced to close its STI clinic. Community-based prevention efforts tapered off. 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 asked for money to help reopen the clinic, but the state only agreed after a group of health care experts in 2022 made recommendations to control a statewide rise in sexually transmitted infections.
Last winter, after 14 years, the renamed Snohomish County Health Department reopened its free STI clinic. Once again, the clinic provides free testing, treatment, education and case management for those in need, regardless of insurance status.
In the first three months, the clinic saw 390 visits. Providers identified 64 new cases — two positive tests for HIV, eight for syphilis and 17 for gonorrhea. People who identify as LGBTQ+ make up a “large proportion” of clients, and clinic is a 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 who are familiar with the community, and sensitive to the concerns the community has.”
The nearly $1 million in state money used to reopen the clinic was a one-time grant to last two years. The health department plans to partner 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 issue,” Worsham said. “Then you get it under control, and the funding gets pulled, and you’re at risk again. It’s a constant battle in public health.”
Aside from the clinic, Lewis said he didn’t know of any public health care programs or campaigns targeting Snohomish County’s LGBTQ+ demographic. Globe, the local LGBTQ+ youth support group based in Everett, 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 lived experience as part of the work.”
Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; Twitter: @_sydneyajackson.
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