In the last 10 years, the St. Louis area has seen an alarming increase in new diagnoses of HIV and sexually transmitted infections among 13- to 24-year-olds. Of the new diagnoses of HIV each year, 30 percent are among adolescents and young adults, who are often disconnected from the health care system or support services. Nationwide, St. Louis has among the highest rates of sexually transmitted diseases in this age group. To head off this trend, Project ARK (AIDS/HIV Resources and Knowledge) and the Adolescent Center in the Department of Pediatrics, in collaboration with community partners, have launched the SPOT (Supporting Positive Opportunities with Teens), aimed specifically at the 13 to 24 age group.

The SPOT is a one-stop, drop-in center for youth that provides testing for HIV and sexually transmitted diseases, health care and counseling, social support, prevention and case management services from School of Medicine physicians and staff — all at no cost.

"This is a public health epidemic that we have to address," says Katie L. Plax, MD, medical director for the SPOT, assistant professor of pediatrics, and director of the Adolescent Center. "Leaving it unchecked means rates of sexually transmitted diseases and HIV will continue to climb. With cuts to Medicaid and the economy getting worse, it's not surprising this epidemic is on the rise; young people have fewer places to turn."

The SPOT's Youth Advisory Committee, clockwise from left: Markysha Marks, Lauren Periasamy, Chelsie Smith, Amelia Cashen, Sarah Castaneda and Ebony Marks.

Kimberly Donica, program director of Project ARK, says the SPOT's mission is to dramatically reduce the number of infected youth. "We also want to prevent repeat sexually transmitted diseases and reach their partners to prevent future infections," Donica says.

The SPOT opened in mid-September at 4169 Laclede Ave. after more than a year of planning. The colorful and modern drop-in center has a living room with cozy furniture, a flat-screen TV, computers, offices for physicians and staff, exam rooms, a kitchenette, shower and laundry facilities. The staff wants it to be a welcoming place where young people will feel comfortable.

"We are excited to get the message to teens that this is a safe space," says Regina M. Whittington, program director of the SPOT. "We hope to provide a place that will establish regular health care for them as they transition into young adults."

Kelly Krahl, left, an epidemiologist with the City of St. Louis Department of Health, Lawrence Lewis, drop-in coordinator for the SPOT, Regina Whittington, program director of the SPOT, and Brandii Mayes with the City of St. Louis Department of Health chat at the SPOT's Open House for its community partners.

In its first few months of operation, the drop-in center was averaging up to 15 clients a day. When youth come into SPOT, they are asked only their name, birth date and what they need that day.

"If they just want a shower or to use the computer to check e-mail, that's fine," Whittington says. "We don't want anyone to feel threatened. We want to be a drop-in, low-threshold, high-engagement center. We hope that once they are in, they realize that the people who work here are cool and that they can talk to us. When that conversation begins, we can find out what they need, whether it is an HIV test, an STD test or a GED."

Whittington came to the SPOT from the St. Louis County Health Department, one of the community partners involved in the project. The rest of the SPOT staff includes physicians, nurses, social workers, case managers, health educators, counselors and a psychiatrist.

Regina M. Whittington, the SPOT's program director, speaks to community leaders during the Open House held on October 8.

Gregory A. Storch, MD, the Ruth L. Siteman Professor of Pediatrics, director of the Division of Infectious Diseases in the Department of Pediatrics, and medical director of Project ARK, says the SPOT is one of the most exciting programs he's ever seen.

"We've realized over the last few years from what we're seeing in the pediatric HIV clinic that there is a tremendous need for increased efforts for prevention," Storch says. "We view the current HIV/STD situation in St. Louis as a community crisis. This is one way to respond to that crisis."

Prior to the SPOT's opening, many of these youth sought health care from an emergency room or did not seek care at all, Storch says.

"We are looking for the disenfranchised youth who are disconnected because of barriers or perceived barriers to the health care system," Donica says. "Many times youth don't realize that they can get services at a low cost. We will try to address these barriers and connect them into the system to prevent future infections. If a patient comes in with an STD or symptoms, we don't want anything to prevent care."

The SPOT offers rapid HIV tests, which provide results in about 20 minutes, and is open weekday afternoons for testing, medical care, counseling and other services. It was modeled after the Broadway Youth Center in Chicago.

A youth advisory committee (YAC) — comprised of interested youth, Project ARK clients and volunteers — was instrumental in the program's design, Whittington says. "Everything here has a youth touch, from the paint to the carpet to the marketing and the services we offer," she says. "The group helped with the design of the space and told us they wanted a 'homey' feel, which included having access to food and a kitchen area. Now they feel a real sense of ownership and want to be here because they designed it."

Whittington says the youth had three main requests of the SPOT: job training, mental health services and health care services. They also are involved in the leadership of the programs offered at the SPOT and even helped hire the staff.

Ebony Marks, a sophomore at Belleville West High School, says that being part of YAC has had a maturing effect on her and fellow committee members. "Being a teenager, you think you know about everything already, but being a part of the meetings here, I realized I didn't," she says.

Amelia Cashen, a senior at Rosati-Kain High School, was a volunteer at Project ARK before joining the group. "Being involved in YAC gives me a real sense of accomplishment and has opened a lot of opportunities," she says.

In one instance, Cashen and two SPOT staff members spoke to a School of Medicine class about ways to present safer sex practices. "I never expected to be a part of that," she says. "I really feel like I have a place in the community."

Among the university disciplines contributing services to the SPOT are the Department of Pediatrics' Adolescent Center and its Division of Pediatric Infectious Diseases and the Department of Medicine's Division of Adult Infectious Diseases. The SPOT also benefits from the services of Jeffrey F. Peipert, MD, PhD, the Robert J. Terry Professor of Obstetrics and Gynecology and principal investigator of the Contraceptive Choice Project, which offers contraception at no cost; Denise M. Willers, MD, assistant professor of obstetrics and gynecology, and Daniel T. Mamah, MD, instructor of psychiatry.

Supporting the project financially are the Barnes-Jewish Hospital Foundation and St. Louis Children's Hospital Foundation, BJC HealthCare, the MAC AIDS Fund, City of St. Louis and Missouri Foundation for Health, which provided a three-year, $870,000 grant. The Substance Abuse and Mental Health Services Administration has awarded a grant that will allow SPOT to provide substance abuse and mental health services.

The SPOT will rely on a variety of community partnerships for clients and services, including Youth in Need, Epworth Children and Family Services, Planned Parenthood/St. Louis Region, St. Louis Area National Council on Alcoholism and Drug Abuse, St. Louis Agency on Training and Employment, and the St. Louis County, City of St. Louis and Missouri Departments of Health.

"Our community has really built this program, with the university taking a role in public health," Donica says.

Social worker Lawrence Lewis, drop-in program coordinator for the SPOT, says the project is different from anything else available in St. Louis.

"We are making the commitment to foster the interdependence between childhood and adulthood and to help these youth develop the skills needed to be successful as adults," Lewis says. "We can't afford to let young people experiment without guidance."