One of the few free medical resources in Portsmouth is fighting to stay afloat.
ETSI Health Clinic, which stands for Ending Transmission of Sexual Infections, was founded two years ago by Nyonna Byers.
Byers identifies as a Black transgender woman and says she’s the first to own a free and charitable clinic in the country.
The clinic provides HIV testing, treatment and prevention services in a city that continues to face high rates of HIV and syphilis.
ETSI keeps roughly 120 patients in HIV care and serves people experiencing homelessness, substance use disorders and other barriers to accessing health services.
“I have seen so many Black and Brown people die from AIDS and HIV because they are ashamed,” Byers said. “They don't have the support.They don't feel comfortable. I know how serious HIV can be when it's untreated.”
Now, Byers said the clinic is facing serious financial strain.
With annual operating costs totalling around $400,000 — including staffing, rent and patient support such as transportation and food assistance — Byers said funding gaps have forced her to cut the staff from 12 to six over the last year while falling three months behind on rent.
She said she’s paid more than $100,000 out of pocket to keep the doors open.
Byers noted Portsmouth has limited health care infrastructure compared with neighboring cities. The city has two hospitals, Bon Secours Maryview Medical Center and Naval Medical Center, primarily serving military patients.
While Portsmouth Health Department, LGBT Life Center and Portsmouth Behavioral Health offer free HIV testing, Byers said there are few options in the city focused specifically on HIV prevention and long-term care for underserved residents.
“The impact is to make Portsmouth happier, healthier, and to provide a service to the city of Portsmouth that Portsmouth doesn't have,” Byer said.
At the same time as ETSI is struggling, resources like the LGBT Life Center have scaled back HIV care as the Virginia Department of Health has cut funding amid its own financial pressures. The loss of tax credits and drug rebates to cover insurance mean that many living with HIV will lose state-subsidized healthcare coverage meant to cover both HIV medications and other medical expenses.
Byers said she has repeatedly sought financial support from city leaders to try to keep her clinic afloat, submitting three funding applications that were ultimately rejected.
“I have countless emails reaching out to the city management office. They always say they can't donate. I have countless text messages sent to the mayor. He has told me that he was going to help, but never helped,” Byers said. “Now he doesn't even respond. He doesn't answer. He doesn't even talk to me.”
In a statement sent to WHRO, Public Affairs Officer J.D. Sumner said the city provides funding to community organizations through an established application and review process to ensure transparency and accountability, and that all groups must follow the same requirements.
“We want to be clear that funding decisions are made solely on the basis of process compliance,” Sumner said in the statement.
This week, Byers learned state legislators approved $50,000 for the clinic in each of the next two years, a development she said will help but will not fully close the funding gap.
She is also working to secure contracts with the Norfolk Health Department to provide HIV and syphilis testing and is exploring additional revenue through the federal 340B drug pricing program, which allows certain clinics to purchase medications at reduced cost.
“That can't happen unless we have more funding coming into the business, because it takes money to do marketing for people to come in,” Byers said.
