PROVIDENCE – Ray Sirico survived the AIDS epidemic of the 1980s and early 1990s, but the callous pronouncement of a healthcare professional he visited when he feared he might have the disease soured him on medical care for the next three decades.
“It was 1985 and everyone around me was sick and dying. Everybody was testing positive for HIV and AIDS,” said Sirico, a gay man and former president of Rhode Island Pride.
Concerned about sores that had developed on his body, “I went to a community medical center in Boston, where I was living,” Sirico said. A staff member examined him “and said, ‘I think you should plan on what you’re going to be doing for the rest of your life because it looks like you have AIDS and you’re going to die,’” recalled Sirico, 58, a real estate agent today.
He didn’t have AIDS but rather “a really bad skin irritation,” perhaps caused by stress as he was finishing college, Sirico told Ocean State Stories.
“I packed up my life and I did not go on to grad school and I left Boston and I moved back home to my family because I thought I was going to die,” Sirico said. “I didn’t go to a doctor for a very long time, about 30 years, unless I was extremely sick.”
Then he heard about Open Door Health, which provides primary care and sexual health services to the LGBTQ+ community. During his first appointment, he met Dr. Philip A. Chan, Open Door’s Chief Medical Officer and a practicing physician.
“It’s been great ever since,” Sirico said.
And not just for him, but for the many thousands of individuals who have become Open Door patients since it opened in early 2020.
During a recent visit, Chan and Open Door Executive Director Dr. Amy S. Nunn recounted the history of the center, which addresses a growing need for the services it offers. One ambition, they said, was a place where staff would not only understand LGBTQ+ individuals but welcome them, too – not discriminate, as some medical practices still do, three decades after Sirico’s distressing experience.
“This clinic was built off pretty much a decade of work from Dr. Nunn and I,” Chan said. “As an infectious disease specialist, my specialty has really been HIV, STIs, sexual health and HIV pre-exposure prophylaxis,” also known as PrEP, a medication typically taken daily that significantly reduces the risk of HIV infection. A related medication, post-exposure prophylaxis, or PEP, is effective at preventing infection after possible exposure. An STI is a sexually transmitted infection.
Primary care for LGBTQ+ individuals, Chan said, was another critical factor.
“One thing that I’ve heard a lot of times in the community is ‘I didn’t feel comfortable talking to my doctor about sex, about STI, I want a place to go where I can talk about these openly as a gay man, as a queer woman,’” Chan said.
READ A Q & A WITH DR. PHILIP CHAN
In preparing for opening the center, Chan and Nunn conducted a “listening tour” to hear from the populations Open Door would serve.
“A lot of our transgender patients said ‘I don’t even go to the doctor. I don’t feel comfortable going to the doctor at all because every single doctor that I have seen has discriminated against me. I don’t even want to go through the door because I get anxiety just even thinking about it,’” Nunn recalled.
Along with their roles at Open Door, Nunn and Chan hold professorships at Brown University and are principals in the Rhode Island Public Health Institute. Their research has been published in the journal AIDS and the Rhode Island Medical Journal, among other places. Both testified last week before the House Health & Human Services Committee in favor of a bill, H5744, that would require insurance coverage for PEP and PrEP.
READ ABOUT FOOD ON THE MOVE, A R.I. PUBLIC HEALTH INSTITUTE INITIATIVE
Like Ray Sirico, thirty-eight-year-old Richie DeFilippo, who identifies as gay, encountered discrimination before becoming an Open Door patient.
“Especially in the early days of the use of PrEP, doctors did not have the training and understanding of its use,” DeFilippo declared in an interview. “It was not until I found the care of Dr. Chan that I was given the opportunity to control my personal risk level of acquiring HIV and also the comfort and confidence that I was not putting my partners, and furthermore the community, at risk of contracting HIV from me.”
DeFilippo, Box Office Supervisor at Providence Performing Arts Center who also is employed by EGO Providence, an LGBTQIA+ dance club, is outspoken in his support of Open Door.
“After experiencing the COVID-19 Pandemic and the outbreak of the Mpox virus, our community needs equitable, affirming and accessible care more than ever,” he said. “Open Door Health’s response to both of these occurrences proved that they were focused on providing the best for all of the Rhode Island community, with keeping the needs of LGBTQ+ folks in the forefront.
“Whether it was providing access to COVID testing, COVID vaccines, or Mpox vaccines, Open Door Health worked at record speed to ensure the community had a source to receive the care that was most important to their continued health. Now more than ever we need health resources like this available. We all deserve it.”
Former Rhode Island Department of Health director Dr. Michael D. Fine joins DeFilippo in applauding Open Door.
“Centers like Open Door are a critical service for addressing the medical and mental health needs of all our communities,” Fine said. “All Americans and all Rhode Islanders need primary medical, dental and behavioral healthcare provided by health professionals who know them, their lives, their stresses and joys, and their communities.
“People who are cared for in this way are way more likely to seek care when needed and way more likely to be open to the many opportunities we can provide to prevent disease and to enter treatment for infectious disease, important because treatment prevents disease transmission; and be open to counseling and treatment for mental and behavioral disorders and substance use disorder, which is killing too many Rhode Islanders.”
READ A Q & A WITH DR. MICHAEL FINE
Although attacks on LGBTQ+ rights and access to healthcare are on the rise in parts of the United States, little opposition has surfaced against Open Door, according to Nunn and Chan. What came, they said, was anonymous.
“We’ve gotten some nasty voice mail with people just saying they think what we’re doing is disgusting and that we should go to jail for taking care of LGBTQ+ people, but I have to say the reaction has been overwhelmingly positive,” Nunn said. Objections, she added, “keep me motivated, actually, because I think we have a long way to go.”
Said Chan: “Sometimes it’s difficult to make everyone happy but I do agree that the overwhelming feedback has been really positive.”
The same holds true for other medical practices that Blue Cross & Blue Shield of Rhode Island has certified as LGBTQ+ “Safe Zones” after meeting requirements that include “staff training specific to the care of LGBTQ patients, protection for patients and staff from discrimination based on gender identity or expression, gender neutral bathrooms, inclusive forms and procedures, and a public commitment to connecting with and serving the LGBTQ community,” according to the insurer.
In closing his interview, Ray Sirico described the gratitude he hears for Open Door, saying: “We’re very fortunate that Drs. Nunn and Chan opened up that facility for our community. They are here helping us to maintain our wellness and to make sure that we’re getting our regular visits with a physician and make sure we’re taking care of ourselves.”
That, he said, is important for all but “especially within the trans community and the BIPOC community,” two groups that are often severely marginalized.
“I have a lot of friends that are gay,” Sirico said. “I have a nephew who is trans. I have a cousin that is trans. And there are always issues with finding a new healthcare provider and going to a new doctor because you don’t know what to expect. You don’t know how you’re going to be received and if they’re going to treat you the way you want to be treated, both mentally and physically.”
At Open Door you do know, he concluded, which is why he chose it for his healthcare.
