This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

NEW ORLEANS—On any given night in New Orleans, a diverse swath of LGBTQ patrons gathers at Good Friends, slouching over the massive mahogany bar and enjoying strong drinks poured under the dim, Technicolor glow of neon signage and pop music videos on loop. A two-story complex in the heart of the French Quarter, Good Friends’ first floor resembles an old pirate bar, if the pirates had all been fans of Kylie Minogue and frozen cocktails with names like “The Separator” (because it separates you from your friends, good or otherwise). Upstairs, in a room known as the “Queen’s Head Pub,” the bar looks like it was decorated by a 19th-century brothel madame, complete with heavy purple drapery and chaise lounges. Since 1988, Good Friends has stood as a safe space in the Quarter for New Orleans’ diverse queer community to meet, dress up, and dance.

But in a southern city still suffering from some of the highest rates of HIV infection in the country, the past decade has seen Good Friends become more than just a campy watering hole. On Tuesday nights, between rounds of drag queen karaoke, patrons can discreetly slip upstairs to meet with representatives from a community health care clinic for a free rapid test and, if needed, to enroll in treatment on the spot.

In America, the South is ground zero for the country’s ongoing HIV epidemic. According to statistics recently released by the Centers for Disease Control and Prevention, in 2017 the region produced 52 percent of the country’s new HIV diagnoses (19,968 out of 38,739).

Additionally, 45 percent of all people living with HIV in the United States live here, even though the south only accounts for about 38 percent of the nation’s total population.

Against this dispiriting backdrop, however, Louisiana is showing signs of progress. In 2018, the state posted its lowest number of new infections in a decade and, according to CrescentCare, the leading organization tackling the epidemic in southern Louisiana, the extension of clinics into New Orleans’ gay bars like Good Friends have played an outsize role in the shift. According to Joseph Olsen, CrescentCare’s counseling and testing manager, gay bars are “a crucial point of contact” for reaching key populations with the resources they need.

Given that the model is working so well, you’d hope it could be replicated everywhere. But there’s a challenge: Just as recent breakthroughs like PrEP and rapid HIV testing are making remote outreach at gay bars more effective, gay bars themselves are disappearing. And not just in the South; across the country, establishments that have historically served the most marginalized subsets of the LGBTQ community are struggling against gentrification, rising rents, and shifting clienteles.

I spoke to Scott Seitz, CEO of SPI Marketing, a company that specializes in gay and lesbian market research, about this. According to him, even in LGBTQ meccas like Los Angeles and New York, gay bars are “morphing,” with the most successful bars targeting a straighter, less racially diverse, and more affluent clientele. Meanwhile, bars historically welcoming minority customers are disappearing at a rapid clip. “Smaller ones are going, and bigger ones are getting bigger,” says Seitz. “The big shift has been the cost. When the yuppies come in and drive the rental price, the smaller bars go away.”

Seitz also says rising costs have been the biggest factors behind the closure of gay bars in the past decade, far outweighing the influence of hookup apps like Grindr and Scruff. In response to skyrocketing costs, many smaller and more diverse gay bars are closing shop, taking with them a valuable resource for HIV outreach and community building for a portion of the LGBTQ population often denied the comfort of traditional “safe spaces.”

CrescentCare, formally known as the NO/AIDS Task Force, has worked with gay businesses in New Orleans for over 30 years, holding information-sharing events and fundraisers in bars and clubs since the early years of the epidemic. But recent breakthroughs in HIV treatment and prevention have made the group’s long-standing relationship with the bar scene even more fruitful. Since the Food and Drug Administration’s approval of the first at-home rapid HIV tests in 2012, venue-based pop-up HIV testing has become an increasingly common phenomenon. Outreach programs attempt to meet the communities most vulnerable to HIV where they are—whether that be gay bars, pop-up parties, or community centers. Mobile testing has helped turn these hangouts into convenient, stigma-free platforms for reaching those in need of education and treatment, especially to patrons who may not be aware of or acquainted with the group’s clinic.

Because it doesn’t depend on clients making a special trip, on-site testing at bars and pop-ups affords early opportunities to detect HIV. This was the case for a Good Friends patron I spoke to named Aaron, who, despite keeping a regular three-month routine of check-ins at the clinic, first learned he was positive during a regular night out.

“I had been getting tested every three months since I was 16, so I just knew for sure that I was probably fine, but I wanted to set an example,” he told me. With karaoke blaring in the background, Aaron slipped upstairs to the Queen’s Head Pub, where a female representative from CrescentCare laid her equipment and instructed him to sit on a barstool as she took a mouth swab. Still a little buzzed from the bar, Aaron sat upstairs and made small talk as he waited about 20 minutes for the test results. “I felt super positive about getting a negative result,” he recalled, “and then I did not.”

“I felt super positive about getting a negative result, and then I did not.” — Aaron

When the test came back positive, the light atmosphere of Good Friends gave way to a serious sense of dread. The representative held Aaron’s hand and assured him everything would be alright as they waited another 30 minutes for the results of a second, more accurate test, this time using a sample of Aaron’s blood. “I think she knew that it’s very rare that the first test is wrong,” he recalled. “I could tell by the way she was reacting.”

Aaron sat in shock as the second test also came back positive.

“The first thing you think is, ‘I can’t do anything about it right now,’ ” said Aaron. As he gathered his composure, the CrescentCare representatives sprang into action. “They were very, very good about being clear about what was going to happen and saying, ‘We will take care of setting this up for you. You don’t have to worry about making this appointment.’ The last thing I wanted to worry about was having to call and make an appointment.”

By the time Aaron made his way back to his friends, still waiting at the bar downstairs, he was, understandably, ready to call it a night. “I was the horror story of why people wouldn’t want to get tested at a bar,” he told me. “But the other side of that is that I wouldn’t have known.” Two days later, Aaron was in treatment, and his viral load became undetectable (which also means nontransmittable to others) within two months.

“Obviously we now have a lot more tools in our toolbox to help prevent HIV,” Jean Redmann, CrescentCare’s director of prevention, told me. “In the old days, it was condoms and information to get testing. Now it’s all of that, of course, but it’s also ‘Let us get you a PrEP appointment, let’s link you to our PrEP navigator, and if you test positive we can get you into care within 72 hours and you’ll be virally suppressed at a much greater rate much sooner.’ We have been out at these bars for a long time, but being able to offer these additional services can really have an effect on infection rates.”

Unfortunately, this expanded toolbox for HIV intervention has come at a time when gay bars are becoming less accessible for the populations of men who have sex with men most at risk to HIV exposure: gay and bisexual men of color, the economically disadvantaged, the transgender community, and sex workers. Alarm bells have been ringing in the gay community for years about the closing of gay bars (not to mention the disappearance of nearly all lesbian bars), but there are few official sources of data on the subject. A recent study by sociologist Greggor Mattson using listings from the Damron Guide, an LGBTQ travel guide published annually from 1977 to 2017, found that in the U.S., listings for bars oriented toward gay men declined by 26 percent between 2007 and 2017, falling from 1611 listed establishments to 1190.

Growing up in New Orleans, I’ve personally witnessed the loss of not just gay bars, but gay spaces writ large. I am still mourning the loss of the Ninth Circle, a small, goth, locals-oriented dive situated at the outer fringe of the French Quarter across the street from Armstrong Park—where sex workers used to materialize like clockwork after a certain hour. It was replaced by a straighter, markedly more upscale place. Another sore spot is the disappearance of Lucky Pierre’s, a bar that lovingly fostered a workforce of African American, Asian, and Latino transgender and drag performers, and was improbably located on the tourist superhighway of Bourbon Street.

New Orleans has also lost its bathhouse and dark rooms: places that, while potentially dangerous in their own right, played an essential role in discovering my own sexual identity. Other spaces that used to be mainstays for the LGBTQ community, like the Country Club (formerly a clothing-optional spa, swimming pool, and bar) and Laffite’s in Exile, the oldest gay bar in the city, have become more and more popular destinations for straight customers—bachelorette parties in particular. Frank Perez, a historian of the city’s gay bar scene, echoes this point: “[The scene] is becoming more assimilated into mainstream culture,” Perez told me. “You can go into any gay bar in the city, and there’s just as many straight people.”

This “straightening” of gay bars is part of a national trend as many gay bars become more frequent destinations for an emergent generation of well-off, tolerant heterosexuals with an affinity for vodka-cran and heart-thumping house remixes. But as gentrification continues to drive up the costs of business, gay bars that succeed tend to cater not only to a straighter, more affluent base of clientele, but also one that is more homogenous. The findings of Mattson’s Damron study showed that listings of bars targeting gay men of color have fallen 45 percent since 2007.

The decline of queer spaces for communities of color is particularly troubling in New Orleans, which, despite boasting a majority Black population, currently has only one full-time bar catering to the Black gay community. Club Fusions, the city’s biggest and most popular gay bar for the Black and Latino population, burned down in 2015 and was never rebuilt. Though other establishments have attracted a modest following from communities of color since then, neither has managed to inherit Club Fusions’ mantle as the destination for young gay men of color, statistically the population most vulnerable to HIV infection.

Growing up in New Orleans, I’ve personally witnessed the loss of gay spaces writ large.

The loss of bars like Fusions has created serious roadblocks for CrescentCare’s remote outreach efforts. “There really aren’t as many places for Black men who have sex with men,” said Narquis Barak, a researcher and project coordinator for CrescentCare. “We definitely recognize at the agency that venue-based outreach and education has been more challenging with the changes in the gay bars and clubs by virtue of bars disappearing,” she told me. But in other Southern cities, the problem is even worse. there’s only one gay bar at all in Jackson, Mississippi’s most populous city; Memphis, which boasted 14 gay establishments in 1997, today only has two. Both cities are home to majority–African American populations, and both cracked the top 10 for new HIV infection rates in 2017.

At this year’s State of the Union address, President Donald Trump set a goal to end America’s HIV epidemic by 2030, allocating $291 million in new resources to intervention and treatment efforts in 48 HIV “hotspot” counties across the country, plus Washington, D.C.; San Juan, Puerto Rico; and seven states with “substantial rural HIV burden.” According to the government’s official website on HIV, intervention efforts would also combat social challenges that often complicate HIV treatment like racial discrimination, poverty, homophobia, and stigma. These goals may be the right ones on paper, but in the context of the rest of a 2020 budget that proposes draconian cuts to Medicaid, Medicare, Health and Human Services, and the CDC, the administration’s plans to allow health care providers to refuse care for transgender patients, and the fact that the proposed annual funding of $291 million is barely a drop in the bucket toward the $25 billion a year experts estimate the program would need, it’s hard to take Trump’s 10-year plan in good faith.

As the current federal government continues to fumble the task of producing a comprehensive plan to address, well, anything, the onus of the HIV epidemic remains with local legislatures and community organizations. The encouraging results coming from the CDC and community-funded operations like CrescentCare speaks to the potential of tapping LGBTQ establishments as public health resources in the fight against HIV. In turn, in regions and neighborhoods with few resources and smaller networks of gay-friendly spaces, the preservation of gay establishments against gentrification and social stigma should be a key feature of any comprehensive plan to combat HIV.

Aaron Lander of Golden Gate Business Association, the country’s oldest LGTBQ chamber of commerce, thinks this idea isn’t such of a stretch. “Many local and state governments allocate funding for these issues and grant monies to nonprofits and public agencies to carry out these endeavors,” he explained. “Reallocating some of these funds to smaller gay bars to provide these services can help offset some of the operating costs of an establishment.” Lander also suggested that local governments could offer tax incentives to establishments for providing intervention services, providing literature, or hosting “clinic” hours as well as a suite of other proposals that would combat the broader impacts of gentrification. “Providing access to capital and other business resources, especially to minority-owned and those in low-income areas, can help tremendously,” he suggested, adding that “because of gentrification, local governments should set policies to protect businesses with rent control.”

Regardless of policy specifics, it’s clear that one key to overcoming hurdles of America’s HIV epidemic will be identifying and providing care to members of the population most vulnerable to the virus. The easiest way to do this would be to preserve and bolster existing safe spaces for men who have sex with men to congregate without the threat of stigma, persecution, or alienation. The fight against HIV and AIDS, especially in the South, is necessarily a fight against racism, poverty, and homophobia. Enacting a plan to publicly support gay spaces for some of the country’s most marginalized members, in concert with passing anti-discrimination legislation and expanding access to clinics through outreach programs, would be a major step in the right direction.

Since the riots at Stonewall, gay bars have been associated with LGBTQ activism, public policy, and cultural identity. Now, as federal agencies stutter in their response to the HIV/AIDS epidemic it’s time to take them seriously as public health resources as well. In a time when HIV testing can be done virtually anywhere, knowing your status and accessing treatment should be no more difficult than ordering another round at the bar.