It’s been 52 years since the Haight Ashbury Free Clinic launched in an old Victorian building on the corner of Haight and Clayton streets. The year was 1967, and a massive influx of young people had descended on the neighborhood — many of them sleeping on friends’ sofas, floors, or the street. As people did drugs, had sex, and lived outdoors, there was an immediate need for health services, and when Dr. David Smith opened the doors to the clinic at 558 Clayton St. it served 400 people in its first week.

But this month its tenure as a fully-staffed, drop-in clinic for the neighborhood came to an end. In early July its medical team packed up their supplies and moved to HealthRIGHT 360’s new location on Van Ness Avenue and Mission Streets.

Across town, another clinic is facing the same fate. Tenderloin Health Services, located on the top floor of the six-story social services provider Glide building in the Tenderloin, will close in October.

The decision to shut two long-standing clinics that primarily serve unhoused and low-income populations didn’t come easily to the HealthRIGHT 360 team. Lauren Kahn, managing director of policy and communications at the organization, tells SF Weekly that the organization “never make any decisions that don’t align with our values. But we have to keep the doors open and the lights on, and make decisions that are financially sound.”

Finances are at the heart of both closures, though the story goes deeper than that. In the case of Tenderloin Health Services, a steadily-reducing population of patients means that qualifying for funding has become more challenging.

“There’s a lot of ways that the government supports and props up safety-net health centers like ours, but you have to operate with a certain number of patients to qualify,” Kahn explains. “You can’t always make everything work.”

Demand has dropped. The number of patients currently receiving care has dropped from a high of 4,000 several years ago, to a current average of around 1,500.

Kahn has a few theories why.

“There is competition for high-quality healthcare for low-income people in the Tenderloin. There is a bunch of clinics, and our census has gone down,” she says.

The clinic has also struggled to stay fully staffed. “There’s a real shortage of healthcare providers everywhere in California, and that extends to S.F. We were having trouble making sure we had enough nurse practitioners and physicians.”

Most of the current staff — including the popular Dr. Andrew Desruisseau — will move over to the main HealthRIGHT 360 location at 1563 Mission St. by Oct. 4. The next few weeks will include transitioning clients, too. Some will move to the Mission Street campus. Others, who may want to continue their care in the Tenderloin, will receive a personal handoff from their current caregiver to someone at another nearby clinic. The goal is to make sure no one falls through the cracks.

“We have little concern that we will be able to transfer everyone to care that feels good and meaningful,” Kahn says.

The closure of the Haight Ashbury Free Clinic has similar origins — their patient population has also dropped to around 1,000, half the number it served at its height.

Kahn credits this to a gentrifying neighborhood where low-income health services aren’t as needed as they once were in the 1960s. But there are also structural issues at play: the clinic is located up 26 stairs, with a heavy metal door halfway up. It’s not ADA accessible, and even once you’re inside, the tight doorways can make it difficult for patients to navigate. The building is aging, and the toilet frequently breaks. None of that mattered as much in the past when the population it served was younger, but unhoused seniors have become more prevalent in the Haight, and many can’t physically access the clinic.

“We can’t grow, and we can’t afford to rejigger the space,” Kahn explains. “We couldn’t add a second doctor even if we wanted to. With the decreasing patient volume, and for reimbursement rates, it’s not financially viable.”

But the Haight isn’t being totally left in the lurch: HealthRIGHT 360 was recently gifted a van, which they plan to use for mobile outreach. This way doctors can meet patients where they’re at — on street level. HealthRIGHT 360 is still trying to find a location to park it, but hopes to have it up and running by September.

As for the old clinic, it will still be used, for now. The Homeless Youth Alliance holds drop-in hours on Mondays, Wednesdays, and Fridays from 5:30 to 7:30 p.m. Many of their young people they serve can make it up the stairs easily to access snacks, medical care, and the needle exchange.

A tentative plan is also in place to bring back daytime hours to Haight clinic, with HealthRIGHT 360’s guidance. If this moves forward, it will be run by volunteers — just like 1967.

The closure of both clinics is a blow to the communities they serve, but Kahn hopes that with time they can fill the gaps.

“When we take away one thing we’re always replacing it with others,” she says. “We take this seriously — that marginalized populations get access to care and are treated the way they deserve to be treated.”

But at the same time, keeping low-income clinics alive is hard.

“You can’t take for granted that we’re always going to be here,” she adds.