Bridging Health Disparities: Callen-Lorde’s Mobile Clinic and Its Impact on LGBTQ+ Youth in New York City
June was a month of vibrant celebrations worldwide as communities commemorated Pride Month, honoring progress towards equality. Despite significant strides, the LGBTQ+ community continues to face substantial health disparities compared to their straight and cisgender peers. Studies show higher rates of cancer, diabetes, HIV, mental health issues, and substance use disorders within the LGBTQ+ community. These disparities are often rooted in chronic stress, economic inequalities, and discrimination. One-third of LGBTQ+ adults report unfair treatment from healthcare providers, and LGBTQ+ youth are more likely to face bullying, sexual assault, substance misuse, and suicidal thoughts.
Mobile clinics play a crucial role in bridging these gaps by breaking down stigma and increasing access to essential services. In this blog, we interview Aruna Krishnakumar, LCSW, Managing Director of Adolescent & Mobile Health at Callen-Lorde Community Health Center, a cornerstone of support and care for New York City’s LGBTQ+ community for decades. We explore how their mobile health services are breaking down barriers and building trust where it’s needed most.
Mobile Health Map: Tell us about Callen-Lorde’s mission.
Aruna Krishnakumar: The mission of Callen-Lorde is to provide sensitive quality health care and related services to LGBTQ+ communities in New York City. We’re a federally qualified health center, and our mission is to serve the community in all its diversity, regardless of ability to pay.
We’ve been around for over 50 years, starting as two separate grassroots organizations, the St. Mark’s Clinic and the Gay Men’s Health Project. They merged in 1983 to become the Community Health Project, and from there we’ve grown to become the Callen-Lorde Community Health Center.
Q: Please tell us about your youth program, and how your mobile health program emerged from that work?
Aruna Krishnakumar: The Health Outreach to Teens program (HOTT) program is one of the oldest programs at Callen-Lorde. It started during the early stages of the AIDS epidemic in 1983 when there was a clear need for a dedicated, safe space for young people.
As part of the HOTT program, we recognized a significant need for mobile health services to reach young people who may not have access to healthcare or the ability to come into our clinics.
Initially, in the early ’90s, our efforts involved walking around areas where young people were hanging out, distributing supplies, and offering medical advice. This evolved into our street medicine initiative. One of our doctors, Dr. Anthony Vavasis, would go around on a motorcycle to distribute supplies and provide medical advice. Our goal was to connect youth to the HOTT program in the clinic. Eventually, we acquired our first mobile medical unit (HOTT van). Today, we are on our fourth vehicle, continuing to provide vital health services to LGBTQ+ youth wherever they feel comfortable.
“Our mobile health unit gives us visibility in communities that are marginalized and have had a lot of distrust for many good reasons of the medical industrial complex.
It’s helped us build trusting relationships.”
Q: You have three brick-and-mortar locations in Chelsea, the Bronx, and Brooklyn. What role does your Mobile Clinic play compared to the main clinics?
Aruna Krishnakumar: Interestingly, our mobile health services have always been integrated into the fabric of Callen-Lorde working in tandem with our brick-and-mortar sites. The mobile clinic helps extend our reach, especially in areas that are disconnected from healthcare services. It provides immediate health services and connects individuals to our clinics.
But most importantly, our mobile health unit gives us visibility in communities that are marginalized and have had a lot of distrust for many good reasons of the medical industrial complex. It’s helped us build trusting relationships. For example, we go to a few sites almost every week — like a park in the Lower East Side, where we connect with a community partner. Many of the youth there are unhoused, living on the streets, using substances, and engaging in sex work. They’ve had very bad experiences going into a clinic. For them, having a mobile clinic there helps build trust with the providers. Many of our medical providers who work on the mobile medical unit also work in the clinic, so there can be continuity of care. They’ll see the same providers when they come in to one of our clinics, if they come in.
Q: Please tell us about the range of services provided by the mobile clinic?
Aruna Krishnakumar: Our mobile medical unit is fully equipped with an exam room, a mini lab for phlebotomy, and a small counseling room. We provide physicals, vaccinations, sexual health services, including HIV and STI screenings, Hepatitis C screenings, GYN care, and more. We also offer PEP and PrEP starts, and we can initiate HIV care. Additionally, we provide urgent care for issues like respiratory and dermatological conditions. Since the pandemic, we’ve been seeing more young people with respiratory issues, especially young people who are unhoused or are living in cramped close quarters that we can help right then.
Our supportive services include psychosocial evaluations and referrals to specialists or our clinics. We aim to provide comprehensive care to meet the diverse needs of our community. At some of our locations, we also have a social worker. In our counseling room we can provide crisis intervention, short term therapy, and referrals to provide long term therapy.
We also provide snacks, basic clothing, and MetroCards. If you ask anyone who works on the mobile health unit, they’ll say this is one the most important things we do. We often overlook these, but they are key to connecting and building trust. Often, when a young person comes to our mobile clinic, the granola bar we give might be the first thing they’ve eaten all day. It’s crucial that we offer these services and have warm or weather-appropriate clothing available for them.
Whatever people are coming in for, we see them, we meet them where they’re at, we offer the referrals, if they take it, they do if they don’t, they don’t.
Q: Are all your services are free of charge?
Aruna Krishnakumar: Yes, that’s correct. If people have insurance, we bill, but we make all our services available free of charge. This is particularly important for young people who may not be out to their families and are on their family’s insurance. In those cases, we are intentional about not billing and offering free services to protect their privacy and safety.
Q: How do you ensure that services provided by the mobile clinic are inclusive and affirming for all LGBTQ+ individuals?
Aruna Krishnakumar: Inclusivity is at the core of our mission. From the registration process, where we ask about gender identity, pronouns, and preferred names, to the signage and language we use, we strive to make our services welcoming. We ensure that all our staff, from providers to case managers and outreach workers, are trained to use inclusive language.
We focus on creating materials and using language that is accessible and inclusive. For example, instead of saying “Gynecology,” we say “GEN services” or “pelvic exam.” In posters for example, we highlight the faces of our patients to show representation. Young people have told us that seeing someone who looks like them on a poster when they walk into the clinic, or the mobile medical unit is very important.
Our hiring practices also reflect our commitment to inclusivity and representation.
“Inclusivity is at the core of our mission. From the registration process, where we ask about
gender identity, pronouns, and preferred names, to the signage and language we use,
we strive to make our services welcoming.”
Q: How have you overcome cultural barriers?
Aruna Krishnakumar: When we work with immigrant communities, many may not be familiar with pronouns or LGBTQ+ language. It’s our role to educate and offer inclusivity in an accessible way. This allows young people to explore their own identities. They might realize, “Oh, that is how I identify,” or “I do prefer this name.” We give them the opportunity to understand and express themselves.
Q: What has been the most significant impact of the mobile clinic on the community in New York?
Aruna Krishnakumar: One of the biggest impacts has been within the house ballroom community in New York. The house ballroom community is a vibrant and inclusive subculture where LGBTQ+ individuals, particularly Black and Latinx, come together to compete in elaborate dance, fashion, and performance events known as balls, fostering a sense of family, creativity, and self-expression.
By attending these late-night events and being a consistent presence, we’ve built trust and provided care to youth who are transient, who may be couch surfing in and out of New York City, and who might not otherwise access health services.
Young people are going to these events just to have a good time, connect with their community, explore their own identity, and maybe win a prize for voguing. But then having our mobile health unit right outside invites them to get a screening and HIV test, or just come on to see what we’re about. Just being there, at those late-night events has been really helpful. We’ve seen people there who may never come into the clinic. Providing continuity of care through the mobile medical unit has been really important.
We’ve also been involved in larger coalitions and initiatives, which helps us stay connected with and serve this community effectively.
Q: How do you evaluate the success of your mobile clinic’s efforts?
Aruna Krishnakumar: Evaluating success for mobile health is tricky because it’s not always about the number of patients seen per session. It’s more about the quality of care and the continuity we can provide.
With the mobile medical unit, we evaluate how many young people get connected to ongoing care and the consistency of our presence at sites. There are two types of mobile medical unit sessions: field outreach and fixed sites. Field outreach involves engaging young people at parks, under bridges, or subway stations. Fixed sites, like shelters and community centers, are easier to evaluate. We partner with places that serve similar communities but lack medical services, visiting regularly. We rely on community partners to promote us and bring youth needing various health services. We assess success by engagement levels, youth attendance, and feedback from community partners. It’s tricky with mobile health because there’s no set number of patients.
Success is when we engage young people who haven’t accessed care in a long time or ever before, especially for services like HIV testing. That’s how we define success.
More than 150 clinics on our Mobile Health Map are providing vital healthcare services to the LGBTQ+ community. Use our Mobile Health Map Impact Tracker to learn more about them. If your clinic is not on the map, add your information now!
