Young Man, There’s a Place You Can Go
For decades, researchers and advocates have been calling for sexual and reproductive health programs to increase their attention to the needs of men. One program that has been heeding that call and providing services to a target population of 13–30-year-old men since 1987 is the Young Men’s Clinic, located in New York City’s upper Manhattan neighborhood of Washington Heights. In 2003, Perspectives published a special report on the YMC—written by its director, Bruce Armstrong—that described the clinic’s history, strategies, activities, funding and challenges. To engage men in the community and address their health needs, the clinic—the first of its kind in NYC—offered a limited package of services focused on sexual and reproductive health (e.g., screening and treatment of STDs, and condom education and distribution) in an environment designed to be accessible and culturally sensitive. And what it was doing seemed to be working: The YMC served some 1,450 men in 2002—nearly three times the number seen in 1998.
Fifteen years later, the YMC is still providing health services to the city’s men. We talked with David Bell—who has been the clinic’s medical director since 1999—to see how things have changed since the publication of the special report.
PSRH: In 2002, the YMC saw nearly 1,500 men, of whom 95% were Latino. Have things changed in terms of the number or demographics of clients seen per year, and if so, how has the clinic responded?
DB: In 2002, the Young Men’s Clinic operated four clinic sessions per week. With Robin Hood Foundation support, we have been able to expand to eight patient-care sessions per week and have added a full-time clinician, which have allowed us to serve up to 3,400 unique patients per year for the last seven years. We also have expanded our target age-group to include men up to 35 years of age. Other demographic changes reflect the changing population of the historically immigrant neighborhood. With increases in non-Hispanic blacks and non-Hispanic whites, the proportion of Hispanics has decreased to 85%. The economic mix of our patients has remained consistent because of programmatic specifications.
PSRH: Has the clinic widened its outreach activities since 2003, or needed to change any of its strategies to engage men?
DB: Under the guidance and leadership of Dr. Armstrong, the clinic began outreach to justice-involved young men, a population that is particularly hard to engage. With the clinic’s expanded presence, the local community—and, to some extent, the broader NYC community—considers the clinic to be an integral and stable part of the neighborhood services in Upper Manhattan, with a specific expertise in young men’s sexual and reproductive health. Referrals have increased by word of mouth among community workers, clinicians and patients.
PSRH: According to the special report, about half of the clinic’s annual operating expenses of $311,000 were funded through Title X, and a quarter were covered by Medicaid reimbursements and client fees. What does the funding picture look like now?
DB: Since 2003, funding has remained stable overall. We continue to be a part of NewYork-Presbyterian Hospital’s Title X family planning grant, but the Young Men’s Clinic lost designated funding. As I mentioned earlier, we were able to secure funding from the Robin Hood Foundation that allowed us to expand our clinic staff and operating hours. The ACA did increase health care insurance coverage for a proportion of our young men. A significant minority, however, obtained only catastrophic care coverage under the ACA mandate; that coverage will pay for emergencies, such as motor vehicle accidents and injuries, but not primary care and sexual and reproductive health services.
PSRH: Over the next 15 years, what will the clinic’s priorities be? In what new directions would you like to see the clinic move, and what do you see as the greatest challenges?
DB: In the current political and funding climate, we hope to maintain the same priorities. In the near future, we hope to provide programming aimed at helping young men to increase their awareness of how concepts of masculinity impact health overall, inclusive of mental health; health care–seeking behaviors; and relationships, including sexual relationships.