“My belief is that people who use drugs should be treated decently, like anyone else,” says Michael Siever, PhD, director of behavioral health services at San Francisco AIDS Foundation. It’s a belief he put into practice when he founded the Stonewall Project, a family of counseling, treatment, and support services for men who have sex with men and who want to address their alcohol and other drug use. Now in its 15th year, the Stonewall Project has grown exponentially—and is on the cusp of expanding its services once again.
Siever started the program in response to an unmet need he saw in his community: services for gay men who were using crystal meth, a drug that boosts sex drive and lowers social and sexual inhibitions. “We’re talking about before the widespread use of protease inhibitors, so HIV was pretty much a death sentence, and gay men doing crystal meth were contracting HIV at an alarming rate,” Siever recalls. “It was definitely a public health emergency.”
The Stonewall Project tackled this crisis with a bold approach known as harm reduction. Unlike most models of substance use treatment, harm reduction programs “meet people where they’re at” without judgment and do not demand abstinence from alcohol and other drugs. “‘Harm reduction’ is basically any positive step in a direction for improved health and wellness,” explains Mike Discepola, director of the Stonewall Project. “Drug and alcohol use is one of the primary drivers of HIV infection and transmission, so starting there makes perfect sense.”
The program, which now addresses substance use beyond methamphetamine, is client-centered: “Guys are encouraged to determine what they want to do,” says Kevin Mosley, a Stonewall counselor for the past nine years. “They set the course of their treatment, which is different from most programs, where they’re told, ‘You have this problem; here’s what you do about it.’”
“One of the benefits of a harm reduction approach is that it really helps individuals figure out what’s right for them,” says Discepola. “If, for instance, someone’s choice is abstinence, our abstinence model is done with a harm reduction philosophy and frame—which means if you’re not able to meet your abstinence goals, we don’t kick you out of the program. There’s nothing restrictive or punitive about the style in which we work.”
“The Stonewall program provides a space for gay men and other men who have sex with men to not be judged about their drug use or their sexual behaviors,” adds Toivo Ollila, who joined the Stonewall staff eight years ago. “Along with connecting them with medical care and psychiatric care, I think that’s the key to them getting better.”
Psychiatric care was one of Stonewall’s earliest—and most controversial—services, at a time when few providers would prescribe psych meds to active drug users. “I was lucky to find some open-minded psychiatrists who were working from a harm reduction perspective and willing to prescribe to men who were still doing drugs,” Siever observes.
This particular need hits close to home for Ollila, who lost a family member to suicide in 1990 after doctors denied him psychiatric treatment because of his drug use. “He was never able to connect with the medication that he knew he needed,” Ollila says. “If Stonewall had been in place at that time, he would still be alive. I’m reminded every day, when I come here, that any one of these dudes could be him.”
Today Stonewall counts two psychiatrists, a pharmacist, and several counselors among its 20 staff members, and roughly 600 participants benefit from the program’s individual and group counseling sessions and walk-in services each year. But the program’s beginnings were humble, with Siever and two half-time counselors seeing 20 to 25 clients out of the psychiatry department of the University of California at San Francisco and San Francisco General Hospital.
Stonewall’s original home was also far from the Castro, San Francisco’s historic gay neighborhood, where Siever had hoped to locate it. “At that point, 18th and Folsom was like a vast wasteland of warehouses and nothingness!” he recalls. Seemingly minor changes made the space more inviting, like ditching hard plastic seats in favor of upholstered chairs and serving coffee and cookies to clients.
Creating a warm and welcoming environment has been key to the Stonewall Project’s programming ever since. “We serve the people who come in to our walk-in services, as a way to let them know that they really are welcome here and they really count,” notes Discepola. Such hospitality isn’t trivial: “People who are struggling with drugs or alcohol or mental health problems, oftentimes they’re treated really badly when they go for services. We want to change that experience right from the very beginning when people come in for services with us.”
Given the tremendous stigma and shame around substance use, treating people who use drugs as people is a part of what makes Stonewall unique and keeps clients coming back and working toward their goals, says Mosley. “That is the start of an intervention—just treating them like human beings. A lot of our folks don’t always get treated like that. Some of our folks have told me, ‘This is different. You treat me like a regular dude.’ When that comes up, it’s great to hear.”
That difference helped Ken, a former Stonewall participant, change his life for the better. Ken first learned about harm reduction through the foundation’s Speed Project, where he volunteered as a peer counselor and helped distribute sterile syringes to help drug users avoid HIV and hepatitis C infection.
“I used to shoot meth,” Ken says. “The folks at Stonewall were there for me when I needed them. I was living on the street when I first got hooked up with them, and they literally helped me save my life. If it weren’t for them, I do not know where I would be today.” Ken ultimately found abstinence fit his needs best, and he graduated from the Stonewall program after two years of consistently meeting the goals he set for himself.
“A big piece of our work is helping people understand what works for them,” notes Discepola. “And it’s an inspiration to see people reach their goals.” Ollila agrees: “Sometimes guys come in here and seem like they’re going to have a hard time—but in a couple years, they just blow your mind with the changes they’ve implemented.”
For Ken, those changes include a new career path. “I’m in college now to become a drug and alcohol counselor,” he says. “When it comes time to do my internship, I want to do it at Stonewall.”
The Stonewall Project has seen changes of its own since opening its doors 15 years ago, including joining San Francisco AIDS Foundation in 2007. “The Stonewall Project coming to the foundation was a perfect marriage. The foundation was able to offer our programs additional resources, and that allowed us to do more for the people we serve,” says Discepola.
“We’re in a really amazing place at Stonewall right now,” he adds. “We have over 20 groups a week. Six or seven of those are walk-in groups, and Monday through Friday we have walk-in individual services. Virtually every day, there’s at least one drop-in group. There are so many different opportunities for people to be able to engage in our services; we’ve really increased the opportunities people have at Stonewall.”
The program is poised for further growth, with the creation next year of a groundbreaking new health and wellness center for gay and bi men in at 474 Castro Street. While Stonewall will continue to serve the mid-Market-area community, the program will be co-located with Stop AIDS Project and Magnet, which offer community prevention groups and sexual health services, respectively. “The move means that access to different services will be seamless,” says Siever. “People can come for an HIV test and/or to get tested for other sexually transmitted infections but also make use of our substance use treatment services or the prevention case management that Stop AIDS offers—it will all be in the same building.”
Something that won’t change? Stonewall will still be part of a warm and welcoming space where gay and bi men can get their needs met. “One of the things I’m probably most proud of is that, for years now, guys have been telling me, ‘This is the first place where I’ve felt totally accepted, and like I can be myself and not be judged or shamed,’” Siever muses. “That was my goal when I started Stonewall, and I think we’ve succeeded in that.”
Have you seen the Stonewall Project’s impact in our community? Share your thoughts or words of encouragement in the comments below. Are you interested in making changes to how you manage alcohol and/or drug use in your life? Visit the program online or call 415-487-3100 to learn how you can connect with services.
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