Our sixth episode of Vibrant features a great conversation with Tim Smith, one of our incredible HIV & STI testers at Pivot, a testing program of CAP. With AIDS Walk Northwest coming up next week and National Gay Men's HIV & AIDS Awareness day following closely on its heels on September 27th, the topic of HIV testing is popping up a lot. So Tim is here to give us a look into the services Pivot provides, and why these services are so critical to reducing HIV & STI transmission in our men who have sex with men (MSM) communities. Listen to or read the full episode below!

EPISODE TRANSCRIPT

Intro: Welcome to Vibrant. An Affirming Healthcare podcast from CAP, Our House and Prism Health. I'm your host, Dustin Vance, and I'll be here sitting down with folks across our agency to get the inside scoop on the work they do to provide compassionate, affirming care to all those in our community. Let's get the show started!

Dustin: Hi, folks, welcome back to another episode of Vibrant. We're so excited to have you here today. Coming up on September 27 is National Gay Men's HIV & AIDS Awareness Day. In 2019, gay, bisexual and other men who have sex with men accounted for 69% of new HIV cases in the United States and its dependent territories. Because the MSM community makes up such a large portion of these new cases, we thought this would be a great opportunity to highlight Pivot, a program of Cascade AIDS Project which provides free HIV and STI testing to the MSM community and beyond. Joining us today is Tim Smith, one of the incredible HIV and STI testers, who helps in the program, to talk a bit about Pivot, what it does, and how you can get tested at Pivot if that's something that's of interest to you. Hi, Tim, welcome to the show. Do you mind giving us a brief introduction of yourself and how you came to be at CAP?

Tim: Great. Thank you, Dustin. I appreciate being here. My name is Tim Smith. My official title is HIV & STD Testing Counselor. I've been with CAP for several years. I started seven years ago as a volunteer, actually doing varieties of things, and then I found myself as a volunteer doing HIV testing. I did that for three years in a great variety of settings, in bars, in homeless camps, in veterans events, on college campuses, et cetera, et cetera, and had the opportunity to interact with a great cross section of communities that in my regular life I don't normally interact with. So that was really exciting for me. And then an opportunity arose where I could be hired, and I wasn't exactly entirely looking for that, but it was a really nice opportunity because it would take the skills that I had learned during those three years and expanded them, and to be able to do a greater variety of testing with some of those very same communities. So I come to having a concern and interest around HIV because in my sixties., I grew up at a time when I remember… I have had many friends who have died of HIV, at a certain time when it seemed like it was almost like leaves falling off of trees in the fall. And I have numerous friends today who have been HIV positive since the 80’s, some of them since the early 80’s. And amazingly, most of them look the picture of health. That is how far the amazing medications have evolved over the years to provide that. And so it is not the death sentence that it was at one time anything close. And so I moved to Portland from Eugene, where I had done volunteer work at the HIV agency there, HIV Alliance. I did volunteer work there for a number of years, doing varieties of things, interacting with clients. And when I moved to Portland about eight years ago, I wanted to plug in in a way that involves community building. And there were a number of options for me to choose from, but CAP really was on the top of my list as an organization through whose work community building takes place. And that's where I wanted to be. And so that's where I've been for seven years.

Dustin: Wow, what an incredible journey you've been on. Would you maybe give those of our community who aren't really familiar with Pivot an idea of what the Pivot program is and the services you provide for our community?

Tim: Yeah, let me just read a little statement that really encapsulates a lot about Pivot. Born of the recognition that 70% of new HIV infections in Oregon continue to come about among men who have sex with men, Cascade AIDS Project opened Pivot, formerly known as the Gay Men's Wellness Center, in 2006 to provide culturally relevant and competent HIV prevention, education, referral, social opportunities, and more. Thousands of people in the community have been tested and have taken advantage of services from Cascade AIDS Project and through Pivot. Pivot remains a trusted source of affirming and competent sexual health care for the queer community, as well as a one stop shop for resources and referrals.

Dustin: Sounds like Pivot really does offer some really incredible testing services and ensuring that folks have access to take charge of their sexual health. So could you maybe give us an idea of what a day to day experience might be like at Pivot for a client or patient who is accessing services?

Tim: Okay, so Pivot is the testing arm of Cascade AIDS Project, and I would call it to some extent the bread and butter of the organization in terms of missions. It's not the only bread and butter. There are a lot of other awesome things that the organization does and provides. But I primarily today work out of Prism Health, which is a primary care clinic on the east side of Portland on Belmont Street. And it is a new clinic. It's about three and a half years old that was started by CAP. I think my understanding is that CAP, five or ten years ago, looking to the future, doing strategic planning, came to the conclusion that potentially in five to ten years from now, there might not be HIV. And so what does an HIV nonprofit organization do in a world where it's central mission is going away? And so Cascade AIDS Project, along with many other HIV agencies around the country looking for options, settled on primary care for the LGBT community, a niche of clients of patients that don't always feel understood or even welcome sometimes in traditional health care settings. And so with that mandate opened, with great fanfare and risk, the Prism Health, and it's been there four years and has been a smashing success. Anyway, Pivot is the testing arm, and we use the facilities there in the evenings primarily when primary care isn't occurring. People sign up for testing. And it used to be prior to COVID that people just dropped in, and on a typical day for testing they would be a line of 8,10, 12, or 15 people. And you come in, you get a number, you fill out some paperwork and then you're told when your appointment is. And it could be two or 3 hours later in the afternoon, and you have to go wander around and come back and then get your services. But now someone will make an appointment and they will come in and I will come in from the back and grab that person and bring them into one of the testing rooms and spend about a half an hour with them. And we offer a full STD panel for them to take advantage of if that's what they want. A full STD panel would be testing for HIV, chlamydia, gonorrhea, syphilis and as of about a couple of months ago, we've added Hepatitis C testing to the lineup. An HIV and hepatitis C test will share a fingerprick,. and we just take a couple of little drops of blood from this little fingerprick. And the person will get to walk out of the room in about 30 minutes with their test results for those tests. And then we go through a process of asking a number of questions and some of those questions, the answer to those questions sometimes lead into places where people are wanting information or people are wanting, maybe insight isn't the right word, or just sort of to bounce ideas off of. And a whole range of things come up around sexuality, around risk taking, around identity. And I consider myself a peer counselor, and so I always make sure that the client understands that I'm not a physician. And so sometimes they want to show me a rash, and I have to say no, I'm not a doctor, so I hesitate to step into those shoes and be a doctor. So we refer people to primary care if they have issues that are greater than just the relatively narrow arena of doing SC testing. We send them to the restroom to take several samples on themselves. How many samples will depend on how they answer certain questions as we go through our script, and then they will leave and their test results will come through a computer program called My Chart. When the lab finishes processing their samples, they'll get an email that says hey, you have test results or you have a new message. They go into that email, enter the user ID and password and there will be the test results. Typically, if they do a full panel there will be nine test results. So it's a really comprehensive service that we offer, and it's one of the only places in the community where you can go and get a full STD panel for free, completely for free. That same service would cost hundreds of dollars in the community if you went to urgent care or that kind of thing. And so we're delighted to be able to offer that service for varieties of people who come in to get tested for varieties of reasons.

Dustin: That's incredible! Who are the folks who you see most often at Pivot? Or who are the populations who typically utilize Pivot’s services the most?

Tim: Yeah, so we see a broad cross section of people in the community. I would say it's mostly young men. And it's mostly young men who have sex with men. But we see straight people, we see folks in the trans community, and the sex worker community.. all over the place. I would say that potentially a third of the clients that we see are people of color. Anyone is welcome. I also do testing once, sometimes twice, a month at Steam, which is the bath house. And in that setting we offer just HIV and syphilis testing. We don't have the ability to do the full panel. And that venue tends to attract somewhat, it's somewhat of the same audience that we attract at Prison Health. But [at steam] we also attract a larger number of older guys who are, I guess you would say, on the down low. They're married, they don't identify as gay or queer, and they're in that facility scratching an itch. And so they come in and sometimes they'll come in and get tested. Sometimes they just want to talk. I remember one older man, mid 70’s, came in and he asked me — was straight identified — and he asked me, he said, “Am I cheating on my wife?” And I said, “Wow, that's an amazing question. I'm honored that you would entrust me with having discussion around that.” And of course as part of my answer I said that only he could answer that question. But I suspect that there's not necessarily a right or wrong answer. It would depend on the nature of the relationship that they have with their spouse. And so in all our interactions with clients, we approach things, everything, in a non judgmental manner. And people are coming to get tested from varieties of walks of life, and we'll interact with them in that way.

Dustin: Got you. So if someone wants to access testing services at Pivot or wants to become a client or patient, how would they go about doing that?

Tim: So if you Google Pivot testing or if you google Cascade AIDS Project, on the homepage, it'll say testing and you click that and then these services, and we do testing in various locations. We have a clinic that does STD testing in Vancouver, we do testing weekly in Clackamas, in Hillsboro, in Beaverton, and in all kinds of one shot events. We do testing specifically seeking to outreach to as broad a community as we can. And so there's a bunch of staff that does a lot of that outreaching. College campuses is another venue. That's a really kind of fun venue to go. I've done testing on college campuses a number of times, and sometimes people will come to get tested who, during the course of answering the questions that we pose to them, that it become apparent that they've never been sexually active with anyone before. And so I'll say, “I'm curious.. this is testing for STDs. Not having been sexually active before, your risk would probably not be pretty high. So, what is the attraction?” And so the typical answer is that it just sounded something fun to do. All their friends were getting tested, they wanted to know what that felt like. Their friends would be talking about it, and they wanted to not have been left out. So they come in to get tested. And that's really special when that happens.

Dustin: That's so funny. I mean, talk about positive peer pressure, right? So I guess as we get ready to close out, what thoughts do you have regarding Pivot, HIV and STI testing, National Gay Men’s HIV & AIDS Awareness Day, or anything else that you think you might want to leave our community with?

Tim: Well, I would say, first of all, that it is amazing that we have such a day to remember something so important, something that a lot of people have kind of forgotten. You take a red hot ember out of a fire and you put it to the side and it's going to cool down and disappear. And so for many in the community, HIV is something of the past. But I guess the main focus and the main concern and the main message, I would say, is that it's not over, that HIV is still around, it is still a risk, and it is a different kind of risk. We've made dramatic, wonderful improvements, but it is still risk. And so we offer these testings. I encourage people to get tested, and if you're sexually active at all, come in and get tested at Prism Health, at Pivot, you can get tested for free. You can get tested often. We recommend once every three months at the earliest, unless you are starting to have symptoms of some kind. Or unless you have gotten a call from a recent central partner who says, “Hey, I tested positive for XYZ, you may want to get tested.” Those would be reasons to come in sooner. But about once every three months, you can get tested for free and walk away and have the confidence of knowing where you stand.

Dustin: Well, thank you so much again for joining us today, Tim, and for your time. It's been incredible to learn about Pivot and the work you all do to provide culturally affirming testing services, and also just for the reminder of why it's important to have routine sexual health screening.

Tim: Thank you, Dustin, I appreciate it very much that you are making this conversation available to the community.

Outro: Well, that's our show for today, folks! Thanks so much for tuning in for another episode, and we can't wait to share a new one with you really soon. In the meantime, if you have questions or comments, feel free to reach out to us at comms@capnw.org. Until then, stay Vibrant.