New York City shuttered all but one of its eight sexual health clinics at the start of the COVID-19 crisis, a move that prompted criticism from public health experts and advocates in the LGBTQ community. The clinics, supporters argued, serve as lifelines in poorer communities, catering to those who have limited or no insurance.

More than two years later, although the recovery is well underway, only four sexual health clinics run by the city are currently back up and running at full steam. The closures come as the city reports increases in sexually transmitted infections over the last two years. The other sites are not offering sexual health services, though they remain open for other activities.

The city health department has also admitted to staffing shortages, a problem that has affected several municipal agencies amid abnormally high attrition of city workers during the pandemic. In a statement to Gothamist, the health department acknowledged the need for the clinics and said it is working to reopen them.

“This administration understands the importance of providing sexual health services and we are working to get these clinics back to full force in order to meet the needs of New Yorkers,” said Patrick Gallahue, a department spokesperson.

Gallahue said the sites have been repurposed during the pandemic, from providing sexual health services to COVID-19 testing and vaccination. More recently, two of the clinics — one in Harlem and another in Corona, Queens — were used to distribute the limited supply of monkeypox vaccinations.

But capacity remains reduced due to those staffing challenges at the sexual health clinics that are open. Those include locations in Morrisania in the Bronx, Jamaica in Queens, Fort Greene in Brooklyn, and Chelsea in Manhattan. The clinics typically close at 3:30 p.m. Only two clinics — the ones in Chelsea and Fort Greene — offer extended hours on Tuesdays.

Beyond monkeypox, public health experts have also expressed concern over what impact the closures will have on other sexual and reproductive health needs.

Dr. Jay Varma, a former deputy city health commissioner for disease control who oversaw the revitalization of city-run sexual health clinics between 2015 and 2017, argued that if the department could hire sufficient staffing, there is no reason the city could not offer both COVID-19 vaccinations and sexual health services at the clinics.

“In fact, they must provide both,” he told Gothamist, adding that he was especially concerned about the closure of the city’s clinics in Corona and Crown Heights, low-income neighborhoods home to many uninsured residents of color.

Two other clinics that are currently closed for sexual health services are located in upper Manhattan — one in Harlem and another on the Upper West Side.

However, Gallahue said that in some cases, space constraints may also prevent some of the clinics from resuming sexual health services.

Reports of long wait times

Monkeypox has not been determined to be an STI in global studies of the ongoing outbreak. But the city and federal government has directed some of its messaging to the gay community, given that most cases so far have been among men who have sex with other men.

There has been disagreement over the city’s approach. The New York Times recently reported on an internal debate within the health department on whether to tell gay men to reduce their number of sex partners amid the monkeypox outbreak. On Thursday, Gothamist reported that the senior epidemiologist who favored that view and spoke to the New York Times was reassigned to another division inside the department.

As of Friday, New York City reported more than 1,200 monkeypox cases. Monkeypox infections are not restricted to gay communities — with 1.4% of incidents so far in New Yorkers who identify as straight and 46% who have not disclosed their orientation. Early cases have likely also been missed due to a lack of testing.

Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University, cautioned that while monkeypox may be currently affecting a particular community, the situation could evolve.

“Viruses don’t discriminate,” she said. “They can be transmitted to anyone.”

It might be a herpes lesion, or it might be monkeypox, but it would make sense to go to a provider that is going to have, hopefully, all of those things on their radar.

Joseph Osmundson, a molecular microbiologist at NYU

Monkeypox skin lesions can appear all over the body, but most have occurred on the genitals and anus, driving some to seek treatment at sexual health clinics that offer free and trusted services.

“It might be a herpes lesion, or it might be monkeypox, but it would make sense to go to a provider that is going to have, hopefully, all of those things on their radar,” said Joseph Osmundson, a molecular microbiologist at NYU who also serves as an LGBTQ advocate for public health policies.

After an initial bottleneck, there are now more testing options for monkeypox. Clinics and primary care facilities which collect specimens can now send them to commercial labs for processing. Earlier, only federal or local health officials could approve testing by non-government health providers. Those restrictions were recently eased. In addition to the city’s public health lab, there are at least five commercial labs that also offer monkeypox testing to New York City health care providers, according to the health department.

In addition to being free, advocates say the city’s sexual health clinics are a familiar and trusted resource within the gay community. They were considered an integral part of the city’s battle against HIV and AIDS as well as the destigmatization of STIs. The health department rebranded the facilities, which were once called STI clinics, as sexual health clinics several years ago.

“If you were a gay person and I said, ‘Find a free doctor in the city,’ the sexual health clinic is going to be your first thought,” Osmundson said.

According to a city employee familiar with the city’s clinics, the facilities are currently overwhelmed by patients, including those worried about monkeypox. (The person asked not to be named because they were not authorized to speak to the press.) In addition to staffing shortages, they said treating monkeypox requires more time, and in some cases, staffers at the clinics have had to turn away patients waiting in line before noon.

On Wednesday, there were around 16 people waiting outside the clinic in Chelsea. Most of them declined to be interviewed, although several said they were not seeking tests or treatment for monkeypox.

Luno Reginato, a 27-year-old downtown Manhattan resident who was not there for monkeypox testing, said he visits the clinic around every six months and that wait times have gotten considerably longer compared to his experience before the pandemic, when he said the wait time was around 15 minutes. That morning, he had already been waiting 20 minutes.

“It's super important to have a resource like this for people who don't have health insurance,” he said.

What happens without sexual health clinics

In June, Varma wrote a New York Times op-ed in which he argued that the U.S. was likely missing monkeypox cases because of a lack of clinics that specialize in sexual health, due to declines in government funding.

El-Sadr is currently working on a survey to determine how many monkeypox cases New York City may have been missed. She said she suspected there may have been mild cases in which the infected individual did not seek care and got better on their own.

She said she was not surprised to hear about the health department’s staffing challenges. Across the country, public health workers have reported feeling burned out by the pandemic and quit their jobs.

El-Sadr said, given the circumstances, the city had done a good job in expanding access to monkeypox testing by eliminating barriers for providers to send specimens to labs. That in turn, she predicted, has allowed for faster diagnoses.

During an unrelated press conference on Tuesday, Mayor Eric Adams said the city’s health commissioner, Dr. Ashwin Vasan, had not informed him of any staffing shortages.

Adams emphasized that monkeypox was being treated as a priority, although he focused his remarks on the delivery of monkeypox vaccinations.

The commissioner, Adams added, is getting “whatever he needs.”

Correction: A previous version of this story misstated the timeframe in which the clinics were closed.