Forty Years of Culturally Affirming Care

A few years ago, San Francisco’s health department pulled its own report card and did not like what it saw. HIV and STI rates in the city’s marginalized communities were through the roof, despite everything the city had been doing. The conclusion was uncomfortable: there is no universal fix. What reaches one community will not reach another. So the city went looking for organizations that could help them provide the best culturally affirming care.

It found Rafiki Coalition for Health and Wellness, which has been doing precisely that in San Francisco’s Black community since 1986. This year, Rafiki celebrates 40 years of helping communities thrive by recognizing that wellness is more than the “absence of illness.” Today it is the lead agency for the city’s African American health access point (HAP), a hub it calls Umoja HAP.

Umoja HAP, which served 1,500 people just last year and reached thousands more through community education events, is a one-stop prevention hub for Black and marginalized San Franciscans. It is built on the understanding that a person’s health rarely arrives as a single problem. In one place, Rafiki addresses sexual health and testing, mental health, housing, employment, youth engagement, addiction services, and basic needs. “We don’t say no to anybody,” says Andre Aikins, Rafiki’s director of programs. What Rafiki cannot provide, it finds and connects the person to the appropriate resource or care. “We don’t do warm handoffs, we do warm connections,” Aikins says. And staff stay with the person to make sure the care actually happens.

That matters because the barriers around health tend to outrank health itself. People do not have cars. They cannot afford to lose a shift at work. Those underlying factors, more than medicine, decide the outcomes. “I can’t think about my sexual practices as a priority because I’m worried about where I’m going to live,” Aikins says. “I’m worried about what I’m going to eat.” Clear those away and prevention becomes possible. “We want to get people out of living for survival and living life,” he says. “We want to provide a pathway, as well as information, and services so that people can actually experience life.”

The hub sits inside a much larger body of work. Rafiki offers comprehensive free and low-cost services that include: HIV prevention and care, mental health counseling, housing and economic support, screenings for chronic disease, fitness classes, nutrition programs, and complementary medicine including acupuncture, chiropractic care, and massage. Additionally, a food pantry has grown into a community market. All of it is culturally affirming, meeting people, across generations and across disabilities, visible and invisible, somewhere they feel seen.