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Everything You Ever Wanted to Know About …

by Daniel Vaillancourt

Everything You Ever Wanted to Know About DoxyPEP

Words by Daniel Hirsch

 

A hefty dose of antibiotics. A big syringe in the derrière. Getting treated for an STI is not fun — to say nothing of the symptoms and risks involved with contracting one like syphilis, gonorrhea, or chlamydia. With the CDC reporting rising numbers — gonorrhea is up 11% over the last five years, syphilis is up 79% — risk of infection is on the rise.

 

However, clinicians around the country, spurred by recently released guidance from the CDC, are recommending the antibiotic doxycycline as a means of post-exposure prophylaxis (DoxyPEP for short) to prevent the spread of STIs. I spoke with DAP Health Chief of Community Health C.J. Tobe about this prevention strategy.

 

Let’s start with the basics. What is DoxyPEP?

DoxyPEP, or doxycycline, is a 200 milligram pill that can be taken within 24 to 72 hours after sex. It reduces a person’s chance of contracting either chlamydia, gonorrhea, or syphilis by up to 70%. Doxycycline has been around for quite some time and is used to treat STIs and acne.

 

How sexually active do you need to be to justify a prescription?

It’s going to look different depending on a person’s lifestyle and the conversation with their provider. For example, if you have sex Friday, Saturday, and Sunday, you can take DoxyPEP that Monday morning and you’re good. Let’s say you’re having sex five times a week, then you should probably talk to your doctor about switching to DoxyPrEP.

 

And what’s DoxyPrEP?

DoxyPrEP would be taking 100 milligrams of doxycycline daily as a preventative measure. That’s typically for people who either want to make sure they’re protected, or they’re having frequent sex, or they may be a sex worker.

 

Are there side effects? Isn’t doxy tough on the GI tract?

A lot of the side effects that get reported are GI issues. So we recommend people take the medication with food or a carbonated drink. When people take a higher dose of doxycycline, like 200 milligrams twice a day, the side effects increase. If you go on DoxyPrEP, that’s just 100 milligrams once a day. And I can tell you it’s such a low dose that the majority of folks don’t have side effects.

 

One of my worst nightmares, and it’s one shared by the World Health Organization, is that an STI becomes resistant to antibiotics. Is that a concern with people regularly taking doxy?

Part of the medical community is hesitant to embrace this strategy because they don’t know what could happen in terms of drug resistance. The other half are saying, “We need to get people on it right now because it’s an important preventative tool.” There’s always going to be a risk of drug resistance when people don’t follow the dosing recommendation of a doctor. As a public health person seeing the rise in STIs, I think a patient who is having sex should have that conversation with their doctor and see if DoxyPEP is right for them. Personally, I’ve been on doxy since 2020 and it’s been a lifesaver.

Feeding a Family on a Budget

by Daniel Vaillancourt

Feeding a Family on a Budget

Here are eight tips for smart shopping.

Words by Maggie Downs

 

Feeding a family while on a budget can be challenging. But with strategic planning and smart shopping, it’s possible to provide nutritious meals without breaking the bank, says registered dietician Robert Davis from the Comprehensive Perinatal Services program at DAP Health. Here are his tips to maximize your budget while keeping your family well-fed.

 

Meal Planning

Start by planning your meals for the week ahead. Take stock of what ingredients you already have on hand and build your meals around those. Plan meals that use similar ingredients to minimize waste and save money. “Choose just one day to do your planning and shopping so you know what you have and can shop for just enough to take you through the week,” Davis says.

 

Shop With a List

Make a grocery list before heading to the store — and stick to it. This will help prevent impulse buys and ensure you have everything you need to prepare your planned meals. “Don’t get distracted by sale items,” Davis says. “So many times, the sale items are tricky at getting us in the door at the grocery store, but they tend to be the highly processed foods, like cookies or chips or crackers. Some of these foods won’t provide as much nutrition, and they might even make us more hungry.”

 

Don’t Skip the Frozen Aisle

Frozen produce is nutritious, readily available, and can be even more economical than buying fresh. It can also save time in the kitchen, since the produce doesn’t require trimming and washing.

 

Embrace Meatless Meals

Incorporating vegetarian meals into your weekly menu is an excellent way to save money. Beans, lentils, tofu, and eggs are all affordable sources of protein that can be used in place of more expensive meats and dairy. “Non-animal foods are very nutritious and budget-friendly as well,” Davis says. “Consider two days a week having a family meal that doesn’t involve animal proteins.”

 

Shop Seasonally

Purchase fruits and vegetables that are in season, as they tend to be less expensive and more flavorful. Visit the farmers market for fresh produce that supports local growers.

 

Buy in Bulk

Stocking up on staple items can save you money in the long run. Look for deals on larger quantities, and consider joining a wholesale club to access greater savings. “Some of the shelf-stable grain options can be created faster than going out and getting something from a restaurant,” Davis says. He recommends keeping the pantry packed with brown rice, whole wheat pasta, or quinoa, which are all high in fiber, offer B vitamins, and can be cooked quickly with some veggies and a protein.

 

Utilize Leftovers

Don’t let leftovers go to waste! Get creative and repurpose leftover ingredients into new meals. For example, leftover roasted vegetables can be added to salads or turned into a hearty soup. Davis likes myplate.gov for recipe ideas.

 

Cook From Scratch

Pre-packaged and convenience foods are often more expensive than cooking from scratch. Invest in basic ingredients, and learn to prepare simple meals at home. Not only will this save you money, but the time spent with family can be priceless.

Everything You Ever Wanted to Know About …

by Daniel Vaillancourt

Everything You Ever Wanted to Know About Poppers

Words by Daniel Hirsch

 

Poppers. Not only are they a staple of disco dance floors, sex shops, and — more recently — gay internet memes, but openly queer pop star Troye Sivan recently placed them front and center in the mainstream by openly paying homage to them with his summer 2023 smash hit “Rush,” a song title that not-so-coincidentally is the name of a beloved brand of poppers.

But what exactly are poppers? What risks do they present users? And how can these risks be mitigated? I spoke with DAP Health Chief of Community Health C.J. Tobe and asked all of the tough questions.

 

What are poppers?

C.J. Tobe: Basically, poppers is the casual name for a liquid inhalant. Most people are probably familiar with using poppers on the dance floors in the ’60s, ’70s, and ’80s. Then they transitioned into being extremely useful during sex. There are four different chemicals that can make up poppers [amyl nitrite, isopropyl nitrite, butyl nitrite, and pentyl nitrite].

 

Why do people do poppers?

Because they feel good. They make sex even more enjoyable. It also helps relax people. So people who may have sex anxiety or need “liquid courage” (like we talk about with alcohol) may find poppers helpful.

 

What actually happens to your body when you use poppers?

When you inhale poppers, your blood vessels are going to expand, and it’s then going to increase the blood flow and oxygen level within your veins. So that’s what makes it feel euphoric. It’s like a rush, essentially. But while all that is happening, it’s also gonna decrease your blood pressure. Obviously, people with heart conditions are definitely advised to be very, very cautious.

 

Speaking of being cautious, if one were to do poppers, is there any way to do them more safely?

Probably don’t use them alone, because using them will increase your blood flow, which will then lower your blood pressure. Just in the event that you do pass out, you don’t want to be alone. So … poppers and porn? Not the best idea.

A lot of people who use poppers, especially during sex, are also taking erectile dysfunction medicine. That’s an added risk for decreasing blood pressure, which can eventually cause someone to pass out — potentially even vomit and die as well.

 

Are there any other risks to consider?

Generally, some research shows that using poppers can put you at a higher risk of getting an STI, including HIV. Everyone should regularly be screened for STIs and HIV. We also recommend considering being on PrEP (pre-exposure prophylaxis) or PEP (post-exposure prophylaxis) to prevent HIV, and/or on DoxyPrEP or DoxyPEP to prevent STIs.

Next one’s for the bottoms: Poppers make sex more enjoyable, but they’ll also give you a high, where you become dizzy and you don’t know exactly what’s going on. You could put yourself in a vulnerable position, where someone could take advantage of you. They could tie you up, or do a “booty bump” [insert unwanted drugs into your rectum]. It just makes you less aware of your surroundings, which also could increase the possibility of something negative happening.

 

What about the dreaded, so-called “poppers nose,” (aka chemical burns in one’s nostrils)?

My advice to prevent this would be to inhale through your mouth. Just like a cigarette [without putting your lips on the bottle]. It bypasses actually going up through your nostrils and won’t give you a headache. I learned that from an expert who reps a national poppers brand.

 

Can poppers be addictive?

There’s little research to prove or disprove the addictive effects. However, from a cognitive behavioral perspective, anything can become addictive, especially agents that produce pleasure, promote escapism, or assist in numbing.

Poppers create a sense of euphoria, so someone can very well become accustomed to this experience while having sex, and require it to allow for a full sense of pleasure due to the association. However, ultimately, physiological dependence? No. 

I would add to this: It is very much recognized as a relapse trigger for those in recovery. The erotic experience can create what is referred to as “euphoric recall,” which directly sets off a chain of thought and behavior patterns. So related to addiction, it is definitely high-risk. 

 

How come poppers are sometimes sold with code names like VCR cleaner or tar remover? Why the code names? Are poppers legal?

From my last understanding, it’s illegal to consume nitrite, as well as some of the things that go into poppers for recreational use. So, when you would go into a store, they’re sometimes number coded: “I want number two, I want number eight, I want the yellow or the red.” Legally, we’re not really allowed to state that you were there to get poppers in a sex shop or store. It’s legal to sell it, but it should not be used recreationally.

 

Anything else to add?

I know this is going to sound very corny, but talk to your doctor! I know it’s so basic to people. We can Google all day… But, ultimately, just tell your doctor you want to do poppers. Or let them know you’ve been doing poppers for 10 years. They can look at your medication list for any potential risks and ensure you are receiving sexual wellness support.

I think the more education and knowledge we have around health matters, the better. Even if your doctor may not be culturally competent on poppers, you can start that conversation to make them curious. Get them educated on poppers so they can help guide and educate some of their other patients.

And I just have to add, here at DAP Health, we are very culturally competent. We all know all about poppers. And we provide service without stigma, shame, or judgment. You can always ask your DAP Health provider anything.

 

Image courtesy of Not So Innocent adult entertainment store, 2100 North Palm Canyon Dr, Palm Springs, CA 92262

A Guide to Safely Hooking Up Online

by Daniel Vaillancourt

A Guide to Safely Hooking Up Online

While popular online dating and hookup apps offer a convenient way to meet new people, their relative anonymity can also leave you open to danger. It’s therefore essential that you prioritize your safety. This guide is aimed at those who use these apps and would like to reduce the risk of situations that are uncomfortable at best, and life-threatening at worst.

 

Before

Define Expectations
Discuss intentions and desires openly. Talk in detail about what you’re both looking for, including any kinks/fetishes. If either
of you uses drugs, communicate your preferences and boundaries clearly.

Exchange Face Pics
Insist on receiving recent face pics. If they refuse to share, that’s a red flag. Move on.

Get a Phone Number
Swap phone numbers, then give a call or send a text. If they refuse to share, that’s a red flag. Move on.

Take Screenshots
Capture the person’s profile, face pics, and all your texted conversation, including their phone number. This documentation can be vital if issues arise later.

Tell a Friend
Share details (who, what, where) with a trusted friend. Ask that they check up on you if they don’t hear from you within an agreed-upon time.

Secure Valuables and Beware of Scams
Be cautious and secure your valuables. Be vigilant about scams and fraudulent behavior.

Install a Security Camera
If you have security cameras, such as a security doorbell or surveillance system, use them to observe the person before opening your door. If you don’t have cameras, you can still lessen potential risk by telling the person you do.

Trust Your Instincts
Above all, no matter what, listen to your gut. It rarely lies. If anything feels off at any point, you have the right to end the interaction at any time — even during or after sex. Consent is continuous, and you can withdraw it at any moment.

 

During

Trust Your Instincts

Above all, no matter what, listen to your gut. It rarely lies. If anything feels off at any point, you have the right to end the interaction at any time — even during or after sex. Consent is continuous, and you can withdraw it at any moment.

Note Physical Characteristics
Pay attention to distinctive features such as scars, tattoos, or birthmarks. This may be useful to identify the person later.

Bondage
Be extremely careful when using bondage and restraints with someone you don’t know.

Stay Sober
Don’t play when you’re under the influence of drugs or alcohol, which can lead to poor judgment and leave you very vulnerable.

Engage in Safer Drug Use
If you do choose to use drugs, do so as wisely as possible. And test them beforehand, whether they’re from an unknown source or not. Free fentanyl and xylazine testing strips are widely available — including at DAP Health — and can help prevent accidental overdoses.

 

This Isn’t Fun Anymore!

Drugged and/or Assaulted?
You may suddenly find yourself incapacitated, or unable to consent. Common symptoms of having been drugged include drowsiness, disorientation, dizziness, and/or excessive intoxication despite having consumed a minimal amount of alcohol or drugs.

Collect Evidence
If you can do so safely and discreetly, take photos or videos of your attacker, yourself, relevant objects, and your location. This evidence could help legal action you may choose to pursue.

Leave
If you believe you’ve been drugged, or are in immediate danger, try to leave safely.

Stay, Scream, Fight Back
If leaving isn’t possible, scream to attract attention, and/or use any available object to defend yourself.

Call 911
If you can, call 911. Explain your situation as clearly and calmly as possible, providing your location. If you’re unable to speak, stay on the line to allow emergency services to trace your call.

 

After

Remember It’s Not Your Fault
It’s important to recognize that shame and embarrassment are common responses, but please know you are not to blame. Assaults can happen to individuals of all genders, and you are innocent in this situation.

Seek Medical Attention
This is crucial to ensure your well-being and to collect any potential evidence.

Make a Police Report
If you’ve experienced a crime, reporting it to the authorities can help prevent further harm to others. Also, remember that reporting a crime won’t result in trouble if you’ve been using drugs.

Embrace Support
Recognize you’ve endured emotional and physical trauma, and that seeking help is a courageous step. Whether you reach out to friends, family, or specialized support organizations, countless others have walked similar paths. You’re not alone in this journey. Support is available to uplift and guide you through it.

 

These are simply suggestions, and it’s essential to use what works best for you and your situation.

 

 

A Guide to Hookup App Lingo

This glossary is your dating app decoder.

[+] HIV-positive

+/- Interested in HIV-positive/negative

420-friendly Into marijuana

Admin Short for administer (injecting someone with drugs)

Anon Short for anonymous (a preference for not knowing personal details before connecting)

On Deck Having drugs for sale

BB (AKA Bareback, Raw, Breeding, Taking Loads) Condomless anal sex

DDF Drug- and disease-free

Discreet Closeted or in a relationship but looking

DL On the down low (closeted or in a relationship but looking)

DTF Down to f***

Host Hooking up at their place

Looking Interested in hooking up

NSA No strings attached (sex without emotional fidelity or future expectations)

Party Into drugs

PNP Party and Play (refers to drugs and sex)

T Tina (crystal meth)

Travel Not hooking up at their place

March is Colorectal Cancer Awareness Mon …

by Daniel Vaillancourt

March is Colorectal Cancer Awareness Month

Here’s the 101 so that you can keep yourself and those you love safe.

Words by David Russo

 

“Colon cancer is the battle we can win with early detection and regular screening.”

                                                                                                               — Unknown

DAP Health’s Associate Chief Medical Officer Dr. Silas Gyimah is fond of that inspiring citation of unknown derivation. As the founder of the Palm Springs-based, queer-led nonprofit Cheeky Charity — whose mission is to facilitate colorectal and anal cancer prevention, early detection, and support, with a focus on the young and LGBTQ+ populations — so am I.

“At every visit, we verify records to see if a patient is due for a screening,” Gyimah says. “If they are, we schedule them, focusing on FIT [fecal immunochemical test] and colonoscopies as our primary screening methods. This is a true implementation of the quote above.” 

Let’s delve more deeply into this largely preventable and curable disease.

 

Colorectal Health: Understanding and Prevention

Colorectal cancer (CRC), once predominantly a concern for older adults, is now increasingly affecting younger individuals. This shift necessitates a renewed focus. Understanding the nuances of colorectal health is vital for individuals of all ages.

 

Understanding Colorectal Cancer

CRC originates in the colon or rectum, part of the digestive system. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time, some of these polyps can become colon cancers.

 

Symptoms To Be Aware Of

CRC might not cause symptoms right away, but if they occur, they may include changes in bowel habits, rectal bleeding or blood in the stool, persistent abdominal discomfort, a feeling that the bowel doesn’t empty completely, weakness or fatigue, and unexplained weight loss. It’s important to consult a health care provider if any of these symptoms are experienced.

 

Risk Factors

Certain factors increase the risk of developing CRC. These include older age, a personal or family history of CRC or colorectal polyps, inflammatory intestinal conditions, a low-fiber/high-fat diet, a sedentary lifestyle, diabetes, obesity, smoking, and alcohol use. Genetics also play a role, with some inherited genes increasing the risk.

 

Prevention Strategies

Prevention of CRC starts with lifestyle changes. A diet rich in fruits, vegetables, and whole grains — and low in red and processed meats — can reduce risk. Regular physical activity is crucial. Maintaining a healthy weight, avoiding smoking, and moderating alcohol consumption are also recommended.

 

The Importance of Screening

Screening for CRC is one of the most powerful weapons for preventing the disease. It’s generally recommended to begin screening at age 45. Screening can find precancerous polyps, which can be removed before they turn into cancer. For people at higher risk, such as those with a family history, screening may be recommended earlier.

 

Navigating the Rising Trend in Young Adults

The rising incidence of CRC among young adults is a complex issue that involves a combination of genetic, environmental, and lifestyle factors. It’s important for young adults to:

  • Be aware of their family history.
  • Minimize known risks.
  • Incorporate healthy preventative habits into their lifestyle.
  • Regularly check for symptoms.
  • Discuss screenings with their health care providers if they have risk factors.

 

Conclusion

As our understanding of colorectal health evolves, it becomes clear that CRC is not just a concern for the elderly. The increase in cases among younger adults emphasizes the importance of awareness and proactive health measures across all age groups. Through lifestyle modifications, regular screening, and early detection, the impact of CRC can be significantly reduced.

 

Resources

Colorectal Cancer Alliance, colorectalcancer.org

American Cancer Society, cancer.org/cancer/types/colon-rectal-cancer

Centers for Disease Control and Prevention, cdc.gov/cancer/colorectal

Cheeky Charity, cheekycharity.org

 

In a partnership between DAP Health and Cheeky Charity — and in honor of Colorectal Cancer Awareness Month — 50 eye-catching banners will be flown throughout downtown Palm Springs during March to help raise awareness and reduce stigma.

Where Did All This Peanut Allergy Come F …

by Daniel Vaillancourt

Where Did All This Peanut Allergy Come From?

Words by Ellen Bluestein

 

According to the American College of Allergy, Asthma & Immunology, as of 2017, 2.5% of children in the United States have peanut allergy. While that percentage may seem small, it translates to more than 1.8 million kids with a potentially fatal condition. 

 

“Probably about 20 years ago, it was clear that this was not only a growing problem, but it had already become a public health problem in the United States and around the world,” says Dr. Andrew Liu, a pediatric allergist at the University of Colorado. “I don’t know that we’re sure why or how peanut allergy has become so prevalent. But I think it’s pretty clear that it’s real.”

 

Researchers have been exploring several possible hypotheses. One — the hygiene theory — explores the idea that with the advent of germ-killing cleaning products, our environments no longer provide the exposure to microbes that the immune system recognizes and learns to fight off.

 

“What is a microbe-rich environment? One where we’re living around a lot of animals,” says Dr. Liu. “There have been a lot of studies where it looks like allergies are less common in kids growing up in farming environments or in developing nations where people live very closely to their animals. Some people think … that the immune system doesn’t see enough of those microbial exposures early because we’ve gone and cleaned up our environment.”

 

Early exposure to peanuts — between four and six months of age — may be one way to reduce the allergy. “The original observation was in Israel, where they had this teething cracker called Bamba which has peanut in it,” says Dr. Liu. “And they observed that within communities where this was a common cultural practice, the prevalence of peanut allergy in the kids was really low compared to what they were seeing in other communities.”

 

This led to more research and ultimately a definitive study on prevention. Children were given Bamba or a derivative, and then followed. Those who received the cracker were unlikely to develop peanut allergy compared to those who didn’t get it. “It looked like early exposure … when our bodies are learning about what is safe … is an essential time period,” says Dr. Liu. “If the immune system learns that the peanut is not something to be concerned about, then that stays.”

 

While there is still much to be discovered, Dr. Liu is optimistic that there will be remedies for those who suffer from the life-threatening condition. “There’s work going on to develop treatments to either reduce or prevent the severe reactions to those who are peanut allergic,” he says. “There continues to be investment in a lot of research … to try to get to that place where there are treatments that can be helpful for people and young kids who are allergic.”

The Science of Positivity

by Daniel Vaillancourt

The Science of Positivity

“Never say never because limits, like fears, are often just an illusion.” — Michael Jordan

Words by Kay Kudukis

 

In the 1990s, a recurring skit on SNL called “Daily Affirmations with Stuart Smalley” had Al Franken portraying an insecure, support group-addicted, self-help schlub in a cardigan. He was the antithesis of the popular, flashy, mindset gurus like Tony Robbins. Stuart would frequently look at himself in the mirror and say, “I’m good enough, I’m smart enough and, doggone it, people like me.”

Although Franken was poking fun at the new fad, it wasn’t very new. Over 3,000 years ago, the Greeks were writing meditations and guidelines touting the best ways to live. The idea is actually 5,000 years old, but back then there was no alphabet, which made writing hard.

By the 1800s, poets and renowned authors were onto it, but scientists didn’t take notice until the 1970s, when they asked, “Is there anything to this?” It took a few decades, and a lot of studies, but the answer is — in wildly unscientific terms — it’s definitely a thing. Turns out, there’s true power in the science of positivity!

Yes, science. The University of Chapel Hill conducts a Positive Emotions and Psychophysiology Laboratory studying “how positive emotions affect people’s thinking patterns, social behavior, health, and physiological reactions.” Johns Hopkins and the Mayo Clinic promote positive thinking to lower blood sugar and high blood pressure, and to reduce the risk of heart attacks and strokes by lowering cortisol.

The human brain is the most complex thing in the known universe, and yours is fueled by your thoughts. Ever heard that if you repeat a lie long enough it becomes the truth? If your brain is filled with negative self-chatter, it will come to believe it. If your inner monologue is positive, the brain responds, and your stress levels decrease along with your blood pressure.

There is another tool called “reframing” that makes you more productive. It’s where “I hate doing the dishes” becomes “I can’t wait to get these dishes done and have a nice clean sink.” Such positivity releases dopamine and serotonin into your system, and if you add a smile? Well, a study at the University of Kansas concluded that smiling is such a powerful source of endorphins that your stress levels go down even when you fake a smile. So now you’ve got a buzzy cocktail of dopamine, serotonin, and endorphins in you, and the dishes are done.

If you need a little extra help, DAP Health is here for you. Its medical professionals won’t do your dishes, but they do have some unique Wellness Services, including a Zoom group based on positivity and related to achieving goals.

Michael Jordan didn’t get to be the GOAT by talent alone. In fact, he attributes his success to positive thinking. He never told himself he couldn’t. “I can accept failure,” he famously said. “Everyone fails at something. But I can’t accept not trying.”

So be like Michael. Flip that switch. It’s not going to make you a great basketball player, but you’ll absolutely, positively, win at this game we call life.

Safer Drug Use Saves Lives

by suelowe

Safer Drug Use Saves Lives

 

Improving Fentanyl Overdose Outcomes Is Just One Facet Of DAP Health’s New Harm Reduction Program

 

Words by Jim Macak

 

Tom (not his real name) is a tall, thin, handsomely weathered 67-year-old Maui native raised in Long Beach. He’s been HIV-positive for 17 years, unhoused in Palm Springs for 12, and a moderate crystal meth user for 10. 

He discovered DAP Health’s Harm Reduction Program about a year ago, thanks to his daily attendance at Well in the Desert’s hot meal service. DAP Health’s team — Community Health Harm Reduction Supervisor Neil Gussardo, Educator Bree Clark-Pharr, and longtime volunteer Suzanne Petersen — shows up twice a week at this location. Tom recalls that, without any reservation, he jumped at the chance to benefit from their provision of clean bubble bowls, which are the part of glass pipes where methamphetamine is heated.

“They’re completely compassionate,” Tom says of Gussardo, Clark-Pharr, and Petersen. “They’re sensitive to your needs. They want you to have the safest equipment for your drug use. They’re very supportive without ever pushing recovery on you.” In fact, he recommends the program to all his unhoused friends who use drugs.

Gussardo is no newcomer to serving people experiencing substance use disorder. He has worked in the field for more than 20 years, beginning his career in San Francisco, then transitioning to the Betty Ford Center in Rancho Mirage. He has been with DAP Health since February 2022, and explains that the Harm Reduction Program has two priorities. The first is to provide equipment that will reduce the transmission of HIV, hepatitis C, and other illnesses. 

Specifically, the program provides fresh syringes, gift cards as an incentive for those who bring in used syringes, alcohol swabs and cotton filters for injections, test strips to determine if a more dangerous synthetic opioid like fentanyl is mixed in with other drugs, cookers to help convert drugs in solid form to liquid, and clean pipes, glass bubble bowls, pipe extensions, and foil used in smoking opiates.

The second priority, Gussardo says, is to distribute opioid overdose treatments proven effective, such as injectable naloxone and the nasal spray Narcan (recently approved for over-the-counter sales by the FDA, and likely available by late summer). Persons who overdose cannot typically self-administer such aids, so the products are provided to fellow users who can come to the rescue should need be. Proper training for administering overdose therapy is provided as well.

The reaction to this program has been positive. But occasional negative comments are not uncommon from passersby who learn what services Gussardo and his colleagues supply. “We absolutely encounter folks who think we’re enabling drug use rather than reducing the risk of harm,” he says, adding that by diminishing disease transmission, the program is saving society a considerable amount of money and time spent treating people infected with HIV or hep C. “We’re helping alleviate a drain on the system, person by person.”

More importantly, according to Gussardo, “It’s been reported to us from our participants that they’ve used either naloxone or Narcan provided by DAP Health to reverse 104 overdoses from September through January. That’s 104 lives saved.” 

The Harm Reduction Program took root in the middle of 2022, at a time when overdoses from fentanyl had become an epidemic throughout the country. The drug is a legally prescribed painkiller, but in the last 10 years it has become a widely used street drug that’s up to 50 times stronger than heroine and 100 times stronger than morphine, according to the Centers for Disease Control and Prevention (CDC). It’s often added to other drugs because of its extreme potency which, according to the CDC, makes substances cheaper, more powerful, more addictive, and much more dangerous. The number of overdose deaths involving fentanyl, the CDC reports, shot up from 1,615 in 2012 to more than 71,000 in 2021.

According to the California Department of Public Health, there were 408 overdose deaths involving fentanyl in 2021 in Riverside County. Statistics on confirmed overdose deaths for 2022 are not yet available. Sheriff Chad Bianco told City News Service last October that the rate of fentanyl poisonings is soaring, and that the number of confirmed deaths “is going to increase significantly.” 

The majority of participants in DAP Health’s Harm Reduction Program, Gussardo says, are unhoused. Twice a week, his team drives its van to churches on the western end of the Coachella Valley, linking arms with the aforementioned Well in the Desert, a nonprofit that provides hot meals five days a week for working poor, persons without homes, and others. 

When Gussardo, Clark-Pharr, and Petersen aren’t with Well in the Desert, they look for encampments. And if people at these locations are interested, the team works with them, too.

“We’re not doing counseling,” maintains Gussardo, “but we do see people on a repeat basis. Sometimes we see the same person twice a week. And we’re building a rapport with them, building trust, and providing referrals for additional services.”

Gussardo reveals the Harm Reduction Program has started reaching out to another group he refers to as “the party and play crowd” — gay men who, in sexual situations, occasionally use crystal meth, and who “potentially share syringes” — by establishing a Thursday evening presence on Palm Springs’ Arenas Road, where a number of gay bars are located. While still in its infancy, that initiative is slowly but surely building a clientele. 

Next steps, Gussardo says, will include strategically based vending machines allowing for 24-hour access to complimentary safer-use materials such as Narcan and clean paraphernalia.

One theme Gussardo stresses in terms of harm reduction generally is how much of the population stigmatizes those who use drugs. Based on his experience in talking with those who use, he says that when these people reach out for help, they’re often met “with all the stigma of addiction. They’re met with people who don’t treat them as human beings, which then becomes a barrier to any kind of treatment.”

Part of the solution, Gussardo maintains, would be to reference “a person who uses drugs” as simply that, or as a person with a substance use disorder — rather than as a drug addict. This is part of a “people first” use of language to reduce the impact of stigma that Gussardo and other Harm Reduction team members emphasize.

Does this approach really work? According to Tom, it definitely does.

Anyone interested in receiving clean supplies is encouraged to visit DAP Health’s Harm Reduction team in the field.
Call 760.323.2118, Extension 504, to inquire about schedules and locations. 

The Vision is Moving Forward

by suelowe

The vision is moving forward

 

DAP Health’s campus expansion gains momentum

 

Words by Ellen Bluestein

 

Vision Forward, DAP Health’s 10-year strategic plan, continues to gain momentum in 2023. The initiative, which will expand the organization’s ability to serve clients — from 10,000 to 25,000 annually — is slated to be complete by 2025.

The impetus for DAP Health to grow is a result of the Affordable Care Act (ACA). “With [the ACA], lower-income Californians gained access to health insurance for the first time,” says DAP Health CEO David Brinkman. “All of a sudden, demand increased dramatically, and that’s when we knew we needed to be able to respond to this opportunity to increase the health and well-being of our community.”

The first phase of the campaign included purchasing the former Riverside County Health structure (renamed the Annette Bloch CARE Building) adjacent to DAP Health’s Barbara Keller LOVE Building, and renovating it to accommodate three primary care clinics and a sexual wellness clinic. “To me, it’s all about creating more access points to people in our community,” says Director of Community Health and Sexual Wellness C.J. Tobe. “And opening these new clinics in this capital expansion — that’s exactly what it is. It’s going to serve more people, and people are going to be healthier and happier. 

“Sexual wellness is really a gateway for people who don’t have access to community resources or to any primary care, behavioral health, or dental care,” continues Tobe. “They use sexual wellness as the first step to engage in some system to get support. And so, when you talk about opening a clinic … you’re opening a door to a community to say, ‘Hey, let’s have a conversation about your health and wellness.’”

With the clinics complete, the focus is on working with the Coachella Valley Housing Authority to create a second permanent supportive housing structure, named Vista Sunrise II, that will offer 61 new affordable-housing units on DAP Health’s Palm Springs campus. “The construction is moving fast,” says Brinkman. “It’s just a few months behind, and its completion impacts the next phase of construction.”

Given the current cost and availability of construction materials and labor, delays will actually help the project. “It behooves the organization to take its time, hoping that material supply-chain issues will be resolved, and inflation, materials, and labor will normalize,” says Principal Architect Maria Song of International Design Corporation, the firm leading the project. “That’s important because I think people are going, ‘Why is it taking so long?’ But there’s a real benefit to waiting right now.”

Once Vista Sunrise II opens, the next phase — building the Desert Care Network Health Pavilion — will accelerate. The 19,000-square-foot structure will bridge the Barbara Keller LOVE Building and the Annette Bloch CARE Building, and will boast a central registration area for all clinical services, a diagnostic lab, a pharmacy, and a café with outdoor seating that will be open to the public and staffed and managed by clients of DAP Health’s Return-to-Work program.

A driveway will route clients to this new main entrance, and pedestrian-friendly pathways will link it to the rest of the campus. The existing entrance on Sunrise Way will be repurposed into a service entrance for deliveries, and a new entrance will be created by Vista Sunrise II. The Vista Chino entrance will remain as is.

“These are really impressive plans, both literally and figuratively,’ says Song. “And it’s going to make such a huge difference to [DAP Health’s] programs and what’s offered.” According to Song, it will take a year and a half to complete the pavilion. Current estimates for its opening range from June 2024 to the end of that year.

The overall campus design, including the pavilion and the housing project, was approved last year by the city of Palm Springs during what is called the entitlement process. “This is when the campus developer submits to the city the entire design and legal information of what they propose to do based on a general plan,” explains Song. Next is the plan check, which “means that the plan examiner of the city’s Building Department will be reviewing the plan for construction to see that it meets the building code, the energy code, the plumbing code, and the
structural code.”

While working with the Building Department during this process — which can take up to six weeks and involves correcting and reworking any code issues that are found — Song and her team will develop a tenant-improvement plan which fleshes out the plans for the interior of the buildings. Once permitting is approved, Song will select the general contractor and all the subcontractors, making sure the project comes in within budget.

“The city of Palm Springs Building Department has been very collaborative,” Song reveals. “DAP Health is an established and important organization here in the valley. The city knows and supports that.” 

Collaboration has been a key part of the entire Vision Forward planning process, and it will continue as DAP Health’s leadership works with Song to finalize the interior design. From the beginning, the goal was to create the look and feel of bringing the outside indoors, which will be achieved by using organic materials throughout the pavilion. With that, “those qualitative words now become quantitative in specification material selection,” says Song.

Song identifies the expansion as two separate projects: the west space (which includes the pavilion) and the east space (which is mostly facade improvements, exterior building upgrades, and smaller additions). The east space “is more of a site design,” says Song. But because the buildings are exposed and visually integrated with the image of the city, “any design that we do would have to go as a major architectural application so that [when] we get the concept approved … we can start developing the plans for construction,” she continues. 

Design of the east space will begin as construction is underway on the west area. That way, by the time construction is finished on the latter, plans will be approved for work to begin on the former.

As plans continue to evolve, input from staff becomes a vital part of the process. It also speaks to DAP Health’s mission of inclusion and collaboration. “There’s a saying that goes, ‘If it involves me, involve me,’ and so that’s what we do,” says Chief of Clinical Operations Carol Wood. “We really do get right down to the root of it, even to the extent of asking nurses and medical assistants, ‘What’s going to make your job more efficient, and how are you going to be able to do a better job for your patients in your role?’”

With the expansion of the campus comes the expansion of the definition of health care itself. No longer does it just include traditional physical well-being. “We have a very unique campus model,” says Brinkman. “It’s one that acknowledges that health care is access to housing, health care is access to acupuncture and chiropractic and meditation. Our model understands that health care is proper nutrition combined with good mental health care and substance use counseling and, last but not least, that it should be accessible to all, regardless of one’s ability to pay. To be able to go from offering all this to 10,000 folks today to 25,000 people at the completion of this campaign is extremely exciting.”

Extinguishing Workplace Burnout

by suelowe
DAP Health Magazine

Extinguishing Workplace Burnout

 

With a novel approach to wellness benefits, DAP Health ensures employees remain in their happy place

 

Words by Victoria Pelletier

 

DAP Health understands that the key to helping individuals navigate through times of crisis is to meet the hurting ones where they are in their personal journeys. This deeply empathetic approach to healing — especially healing rooted among those in the LGBTQ+ community — requires listening, compassion, and a commitment to connecting those seeking healing with a variety of tools that support it. To make all this possible, DAP Health leans on the passion of its employees, individuals who innately understand what it’s like to experience exclusion, as well as emotional and physical pain. 

DAP Health’s leadership cadre, led by CEO David Brinkman, recognizes that health care providers and other related professionals need vigorous health and wellness benefits themselves due to the tremendous stress associated with providing care to others. “Our wellness specialist and all the healers take health and wellness very seriously,” Brinkman notes, a sentiment that underscores the organization’s intent to combat the burnout pervasive in most work settings in the post-pandemic environment. “DAP Health honors all people,” Brinkman maintains, as the organization is “built around respect, admiration, and listening — values that create not only relationships but a community we all want to be a part of.” 

By the Numbers

While burnout is on the rise across demographics, young workers seem especially vulnerable to a trend we might expect to see among those who have been in the workplace for a while. A recent study of 1,000 Gen Z workers conducted by the Mary Christie Institute found that half of respondents had “experienced mental and emotional hardships in the past year.” A closer look at the data showed that 43% of respondents reported anxiety symptoms, while 31% described symptoms consistent with depression. Worst of all? A whopping 53% of the Mary Christie survey respondents reported experiencing significant burnout in the previous year. Without targeted interventions and long-term supports in place, many of those experiencing burnout will join the ranks of the Great Resignation within the next 12 months.

Influence of “Quiet Promotion”

Along with the advance of the Great Resignation, the Quiet Promotion dynamic continues to gain a beachhead in the workplace, leading to greater risk of burnout among those choosing to remain in their jobs. “Quiet Promotion” refers to those tasked with managing more responsibilities in the workplace due to the expansion of employee resignations and absences. 

Human resources guru Matthew Owensby of Aflac notes that employers, as well as employees, feel the pinch of all the turnover, and remain concerned that the personal suffering behind the resignation and promotion trends are here to stay. Owens notes, “A major concern of employee burnout is the impact on their well-being and how it affects engagement and retention.” In fact, an in-house study conducted by Aflac shows that in 2022, “more than half (59%) of American workers are experiencing at least moderate levels of burnout, a notable increase over 2021 (52%) and on par with the levels reported in 2020 at the height of the COVID-19 pandemic.” Amid his insights on burnout and overall employee health, Owensby notes “employers are looking for new ways to offer benefits that help improve their employees’ mental health balance.” 

For DAP Health, innovation means immediate access to resources and benefits that can address challenges in employee health before they become overwhelming. More about that in a bit. 

Burnout Defined

Burnout is pervasive in the workplace and can sap employee energy and motivation. But what is it, exactly? Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. The phenomenon leaves employees feeling overwhelmed by their work, emotionally drained, and often being unable to meet the demands in their portfolio of responsibility. Unchecked, burnout can spill over into one’s personal life, impacting the quality of relationships, personal health, and the ability to find enjoyment in activities and routines that once offered joy. Perhaps the most vexing aspect of burnout is that it can be slow-moving. The symptoms of burnout may gradually increase over time, until the one impacted is well beyond a place of healthy functioning.

Burnout in Health Care

DAP Health Employee Wellness Specialist Desiree Loredo and People Operations Manager Trish Sisneros understand that people serving in organizations like theirs are especially susceptible to burnout because of all the time invested in patients at various levels of wellness. Coupled with the recent history and lingering impacts of a global pandemic, the daily stress of work in health care can wear down even the most resilient employees. 

Both Loredo and Sisneros agree caregivers seem to be the worst at self-care, a reality that means prevention is not enough. Self-care measures must be continuous, varied, and exciting. One of the assumptions Loredo and Sisneros make in their wellness approach at DAP Health is that it’s okay to be human and not get everything done. 

Inasmuch, Loredo and Sisneros are proponents of mental, physical, and emotional “breathers” for DAP Health staffers, so that these compassionate caregivers will have the stamina and passion to offer ongoing support to those who need care. Further, breathers are just good medicine for everyone. Stepping away from the demands of work from time to time elevates one’s quality of life. 

A Robust Approach to Wellness

For DAP Health employees, the benefits/wellness program continues to cultivate feelings of connection, longing, and value. Along with the typical health, dental, and retirement offerings you might expect from an organization with a large staff, DAP Health also provides a host of wellness perks to employees that underscore ongoing self-care, not just prevention. With the complete support of CEO Brinkman and DAP Health’s board of directors, the benefits/wellness program includes partnerships with local fitness programs, credit unions, and other service providers; access to yoga, massages, and Transcendental Meditation (TM); mobile apps to manage personal wellness options and meditation; provisions for “self-care days” in addition to traditional sick leave; and, among other perks, the ability to use a DAP Health gym. 

Of course, the real strength of DAP Health’s benefits/wellness program is that it is people-focused, not cost-focused. Not too long ago, DAP Health employees participated in an organization-wide survey to measure the impact of burnout and the health of employee/management relationships as related to wellness. Out of this important work, initiatives were put in place that create healthy dialogue among employees and management, while also honoring the importance of employee input in crafting innovative wellness offerings. Employee engagement with Transcendental Meditation is one of DAP Health’s noteworthy innovations.

Meditation for Everyone on the Team

Bob Roth, CEO of the David Lynch Foundation, understands the positive impact of meditative practice. “Research shows that a simple meditation practice can reduce stress, prevent stress disorders, and improve cognitive function,” he notes. With more than 50 years of experience teaching TM, Roth sees meditation promoting wellness in a way a traditional medical model cannot. For a DAP Health employee, a 45-minute TM session can potentially lower their body’s level of cortisol, a hormone released as part of the body’s “fight, flight, fear” response to stressful inputs. While pointing out that “stress is destroying workplaces, families, and health,” Roth believes that educating people about the benefits of meditation, and then encouraging them to adopt a meditative practice, will mean better wellness outcomes for many. The data, and the anecdotal evidence offered by DAP Health employees who take advantage of this novel benefit, affirm Roth’s work and assertions about the benefits of meditation. 

Burnout is on the rise. The Great Resignation and Quiet Promotion phenomena are outward, measurable signs of the ways burnout impacts great organizations. Ultimately, however, great workers and the people who love them are the silent sufferers of burnout. Hopefully, novel and robust benefits/wellness programs offered by organizations like DAP Health will turn the tide and bring more joy and passion to the workplace.