One inescapable fact of life is that sometimes, if you want something done right, you have to do it yourself. And so, there is, in an Adams-Morgan townhouse on 18th Street NW, the Whitman-Walker Clinic, a health center for gays.
Established in 1973 in the basement of a Georgetwon church as the gay men's VD division of the Washington Free Clinic, the Whitman-Walker Clinic provides services not readily available from other sources for homosexual men and women.
The clinic continues to be a place where gays can come for help without fear of being ridiculed of identified, explains one of the clinic's 200 volunteers. Tuesday and Thursday evenings and Saturday afternoons, the clinic is open to treat sexually transmitted diseases (STDs) in men; a problem for gay men that calls for special attention, Whitman-Walker volunteers believe.
No longer is the term venereal disease adequate to describe the wide range of infections that may be transmitted from one sexual partner to another. Now hepatitis, herpes virus, intestinal parasites and others join the standard fare of syphilis and gonorrhea. (The absence of vaginal penetration betweeen lesbian partners is why few STD problems are seen in gay women).
Because most gay men are quite active sexually, they run a high risk of contracting these diseases, says John Heath, chief of the District's VD control program. According to some clinic workers, syphilis is rampant in the city's gay community. It is perhaps 10 to 20 times more common among gays than heterosexuals, says Dr. James Curran at the Centers for Disease Control in Atlanta.
In addition, sexually transmitted hepatitis B is fast becoming the most serious health problem for gays. Curran says studies in the nation's gay clinics indicate that 60 percent of patients have been exposed to hepatitis, and 5 to 6 percent of those individuals have become seriously ill. Hepatitis can lead to cirrhosis and cancer of the liver.
Why the marked rise in STDs?
"In some respects," says John Conley, vice president of the clinic "gay liberation may have encouraged more sexual activity . . . gay baths, bookstores and clubs are flourishing, so there's more anonymous sex (and hence more exposure to disease)." Even student health facilities at District universities report that they are aware of growing problems among young, single men.
In its attempt to stem this surging tide, Whitman-Walker has become one of the largest STD clinics of its kind in the United States. It serves men from throughout the metropolitan area. About 10,000 patient visits are handled each year, says clinic president Jaime Fernandez. There are about 800 patient visits each month compared to only 60 to 80 when the clinic opened eight years ago.
Among the clinic visitors are a large number of transients, military personnel and students. Conley says he isn't sure whether the number of gays living in this area is increasing or whether more gays are willing to admit their homosexuality.
Nathan Woodruff, medical director of the clinic, contends there is a "profound" cultural bias among some doctors and public health workers against acknowledging the existence of homosexuality. "There are some real horror stories," he says.
Ignorance among gays, doctors and heterosexuals about the diseases that are peculiar to the sexual practices of gay men accounts for much of the misdiagnosis and inadequate treatment received at facilities designed primarily for heterosexuals.
Bacteria and viruses are harbored in the throat and rectum as well as the penis.
It takes a well-informed and tactful person to properly interview all the individuals seen in a public STD clinic. "It's a touchy business," says Dr. Rosalie Turner, medical director of the city's Southeast VD clinic, located on the grounds of D.C. General Hospital.
"Some people get insulted when asked about their sexual practices; we just try to explain we're trying to fully screen them."
"We see quite a few gays, some are regulars from Northwest D.C., Virginia and Maryland," Turner says. "I hear," she laughs, not sure if she's flattered about it, "that the word in the bathhouses is to come see Dr. Turner."
The word around town is also that gays are more comfortable with the way they are treated by the staff at the Southeast clinic than at the Upper Cardozo clinic in Northwest.
Can the city's two public clinics adequately serve the needs of Washington's gays? Yes, says VD control director Heath, "To the extent that it's practical and realistic . . . but considering finances, we can't cater to a special group."
In an attempt to improve those services, he says, the city supplies private STD clinics with medications to treat gonorrhea and asks that positive syphilis patients be referred to the public clinics for treatment.
In addition, the city has given Whitman-Walker $25,000 for their STD program. Heath believes the gay clinic's use of volunteers makes them able to get the most for the money.
Donations are the primary source of Whitman-Walker's $100,000 annual operating budget. A $15 donation is requested for clinic visits, although no one is denied treatment.