Street Medicine and Shelter Health Nurses Hit the Streets to Protect San Francisco’s Homeless from Hep A
Hepatitis A outbreaks in San Diego and Santa Cruz counties caused major concern across California in 2017. People were becoming sick and dying at alarming rates, and the homeless community was the hardest hit. With a large homeless population numbering over 10,000, San Francisco needed to act quickly to prevent an outbreak of Hepatitis A from taking hold here. A city-wide effort involving many SFDPH programs and partners was initiated to educate and immunize those people at greatest risk. Some of the most challenging and critical outbreak prevention work was taken on by the SFDPH Street Medicine and Shelter Health teams.
With their highly skilled nursing teams and well-established trust as healthcare providers to the homeless community, Street Medicine and Shelter Health staff got out and provided field vaccination services rapidly and efficiently. Working in pairs, nurses were literally “meeting people where they were at” says Kristen Matteson, Shelter Health Nurse – providing shots in RVs, through fences, on street corners, in tents, under the freeway and in parks. On busy days, Kristen and Angella David, another Shelter Health nurse, were able to vaccinate more than 70 people in just over three hours. In all, these small nursing teams gave over 900 Hep A shots in a 4-week period.
What factors contributed to their success? One of the keys was collaboration: Shelter Health nurses took time away from their normal work in the shelters and teamed up with Street Outreach Workers from the SF Homeless Outreach Team. Teamwork was integral to ensuring they got the vaccine to encampments and other hard-to-reach street sites. Street Medicine and Shelter Health effectively utilized their network of service providers throughout the outbreak prevention effort, partnering up with the San Francisco Sobering Center, Glide, Sixth Street Harm Reduction, and Homeless Youth Alliance to expand their reach.
Another success factor was the strong rapport that the nurses have built with the homeless community, combined with the fact that many homeless people were already concerned about the outbreaks in other California cities. “Many people have the false belief that people experiencing homelessness do not care about preventive medicine to maintain their health. This effort clearly shows otherwise,” says Gina Limon, Charge Nurse with Street Medicine. In general, the people they approached were happy to be offered protection from Hep A. A successful strategy was to reach out to the “street mom” of a specific area first, who would then encourage others to get vaccinated. For anyone who had questions, the nurses and outreach workers used their skills to communicate in relatable terms about the risks of Hep A and why it made sense to vaccinate. These thoughtful, community-minded approaches to outreach were critical in making sure even the most hard-to-reach people were offered vaccine.
To date, San Francisco has not had an outbreak of Hep A among the homeless population. Thanks to the Street Medicine and Shelter Health nurses who got out in front of the situation and went to great lengths to outreach, educate, and immunize some of the most vulnerable members in our community, Hep A will have a hard time spreading here in the future. Our outbreak prevention effort is not over, but we’ve made huge strides on the contributions of a small team of dedicated health professionals.
Provider Spotlight: Magnet (a program of the San Francisco AIDS Foundation)
Pierre Crouch’s patients often ask him about the sparkly crown sticker on his name badge. Along with all of his colleagues at Magnet, Pierre – Magnet’s Director of Nursing — wears the sticker to signal that he received this year’s flu shot. And that begins the conversation about flu vaccination. By creating an opportunity during every patient visit to talk about and offer the flu vaccine, Magnet staff have immunized more than twice as many community members this flu season as last season.
You might not guess that flu vaccinations would be a part of Magnet’s repertoire. As a clinic devoted to the sexual health of gay, bi, and queer men, Magnet is known across the Bay Area as a go-to resource for STI testing and prevention. Magnet also offers innovative approached to HIV prevention, including PrEP (Pre-Exposure Prophylaxis) – a medication to prevent HIV infection — and PEP (Post-Exposure Prophylaxis) – medication administered after exposure to HIV. But Magnet was founded on the conviction that sexual health doesn’t exist in a vacuum. Instead, promoting complete physical, mental and social well-being of gay men is at the heart of Magnet’s mission. With this in mind, Magnet offers a range of vaccinations in addition to flu, including hepatitis A, hepatitis B, and Tdap. When a meningococcal outbreak hit Southern California this past summer, Magnet stepped up to make sure the outbreak didn’t find its way to San Francisco. “If I have an opportunity to engage with the client as a whole, I take advantage,” says Pierre. “Being vaccinated helps people feel empowered. They know they’re safe.”
Attention to the whole person defines all of Magnet’s work. Magnet is among the many programs that the San Francisco AIDS Foundation (SFAF) hosts in its inviting community space, Strut. Strut is at once an art gallery, lounge, and a home to a range of direct services for GBTQQI (Gay, Bisexual, Transgender, Queer, Questioning, Intersex) men. Clients can come to Magnet for clinical services and immediately be connected to other SFAF services and social networks like DREAAM for African Americans men under 30, the Elizabeth Taylor 50-Plus Network for men 50 and over, Positive Force for HIV+ men, and Bridgemen, with monthly meet-ups, social events, and community service projects for all GBTQQI men. Strut’s adage, “No agendas, no lectures, and no finger wagging!” captures its spirit – a client-centered and non-judgmental space for nurturing community health and encouraging community building.
The SFDPH Immunization Program has been honored to partner with Magnet over the past several years to support the organization’s vaccination efforts. Thank you, Magnet staff, for all that you do to create a healthier San Francisco!