A West Baltimore clinic that treats and tests thousands of people for HIV and other sexually transmitted infections stopped seeing patients sometime in August. City health officials can’t say when it will reopen.

The Druid Sexual Health Clinic is in disrepair, and the staff can only send patients off with an appointment at a clinic across town and a voucher to help pay for transportation. Treatment used to be free to everyone and now comes at a cost.

It’s a potentially devastating setback in a city that has long had high rates of STIs and a population not always able to pay for treatment. Advocates and providers say the clinic closure and other major cuts to services for those with HIV could lead to unchecked illnesses and a spike in new cases.

“We are in an STI emergency, not just HIV, but syphilis, chlamydia and gonorrhea,” said Lynda Dee, executive director of AIDS Action Baltimore. “Now is not the time to be playing around.”

The most recent data shows Baltimore’s STI rate is three times higher than in the rest of the state and the nation.

When the latest numbers from last year are tallied, Baltimore health officials say they are bracing for a rise in cases of adults and newborns with syphilis, a bacterial infection people don’t always realize they have until it becomes more serious. Left untreated, it can cause heart and brain damage, blindness, deafness and paralysis. Maryland reported 781 cases in 2022, plus 46 babies born with the infection. About 40% were in Baltimore.

Officials also don’t expect HIV rates to drop, counter to health department goals. Other impacts are less clear, such as how many people get vaccinated against mpox, the virus formerly known as monkeypox.

The myriad threats make the Druid clinic’s closure more troubling to advocates because it’s located in one of the poorest parts of the city, where people have few alternatives. Druid and its counterpart serve about 15,000 people annually.

Druid workers now man a second-floor desk where they reschedule walk-in patients for an appointment at the East Baltimore clinic. Blair Adams, a Baltimore City Health Department spokeswoman, said the new process and the transportation vouchers will “help minimize the impact on our clients.”

Adams said the closure, which is not reflected on the clinic’s website, is due to “ongoing facility related issues and repairs.” It’s not clear when normal operations will resume, or what work has been completed and remains, including a persistent leak from the ceiling.

Officials also didn’t say if staff would return to the clinic or if positions are eliminated.

Budget constraints had left the clinic in disrepair, with rodent infestations and excessive heat detailed in a 2021 report by the city’s Office of the Inspector General.

The site also is among several inspected for a 2022 report by officials from the City Union of Baltimore, which represents workers at the Druid clinic.

“Parts of it were not what we would want patients, nor employees, to be subjected to,” said Antoinette Ryan-Johnson, the union president. “We were concerned about the safety issue that we observed, such as locked emergency exits, chemicals sitting around unsecured, etc.”

She said the union wanted to work with the city on safety improvements.

It’s not clear how fast the Druid building can be repaired or what hours it will be open. The city’s sexual health clinics can be costly, but only began billing patients in June. Adams said this brings them in line with other city clinics, which charge on a sliding scale based on income for those uninsured, but continue to see patients unable to pay.

She said, however, they don’t expect revenue to be sufficient or come quickly enough to prevent a drop in clinic hours.

Waning support for people with HIV

At the same time, a big drop in federal money for HIV support programs administered by the city faced a massive cut this summer, drastically reducing the number of patients they can serve.

Adams said the city would prioritize future funding for programs aimed at Black men who have sex with men, who are at highest risk for HIV transmission, and ensuring people in treatment reach viral suppression, where they are healthy and unable to spread infections.

HIV, or human immunodeficiency virus, attacks the immune system and makes it harder for the body to fight infections. There’s no cure, but with daily medication the illness won’t progress to life-threatening AIDS, and won’t be transmissible to others.

Maryland has the 12th-highest rate of infection nationally, with an estimated 31,600 people living with HIV. An estimated 3,200 are undiagnosed.

The lost funding came from rebates issued by drug manufacturers for HIV medications used in Maryland, including health and wellness programs, psychiatric services, housing and transportation support, and outreach to encourage testing. It’s one of several pots of money under the Federal Ryan White HIV/AIDS program which pays costs not covered by insurance or other programs.

State health officials said the rebate pool had grown unusually large due to a quirk in the law that prevented them from spending it for years. But the funds ran out this year, said Chase Cook, a health department spokesman.

Dee, the executive director of AIDS Action Baltimore, said providers were not given enough notice of the cuts to find other funding, and that they’d expected cuts to be much smaller. The funds dropped from $17.9 million in the last fiscal year to $5.3 million this year.

The Maryland Commission on LGBTQIA+ Affairs, created through state legislation in 2021 to assess challenges to the community, grew so concerned it issued an “urgent call” to address the shortfalls.

The groups reported 20% of new cases are among youths ages 13 to 24 and only 61% of those infected have achieved viral suppression. The letter also said about a quarter of new diagnoses came so late they had advanced to AIDS, “underscoring the urgent need for widespread availability of HIV testing, prevention methods, treatment and related delivery-support services needed to keep people in care.”

Among the programs cut were those at Project Plase, which helps people who lack housing, including those with HIV, find shelter, food and clothing. Mary Slicher, executive director, said the organization lost 66% of the funds it puts toward helping people find shelter and get to medical appointments that help keep their infections at bay.

“Our services are reduced, and this is felt already,” she said.

At LifeBridge Health and its flagship Sinai Hospital, some programs were put on hold and officials are looking for other sources of funding and community partners, said Sharon Boston, a spokeswoman.

“Our patients overwhelmingly tell us that the psychosocial support services we provide, including support groups, a wellness program and health coaching, are vital in keeping them engaged with their health care providers and maintaining their viral suppression,” she said.

Federal funding for HIV programs has been flat for a decade, and some lawmakers have proposed cuts, said Jordan Grossman, deputy administrator of the U.S. Health Resources and Services Administration, which oversees the Ryan White funding.

But Grossman said the agency recently announced grants for programs for women and children affected by HIV that will go to Johns Hopkins University and MedStar Health Research Institute. Baltimore also is eligible for more funding as a high-prevalence city.

“We see disproportionate impact on the Black community and other underrepresented minorities, the LGBTQ community, and we want to make sure we are addressing disparities,” he said. “More funding is always better.”