November 26, 2004

A view to the horizon

Difficult times for AIDS service organizations will require new thinking

by Bill Hardy

As the dust and numbness lift from this November�s election, it�s time to seek clarity of vision and purpose about what may now be on the horizon.

There are many indications that the next four years and beyond are going to be difficult. Difficult for the LGBT community. Difficult for the marginalized and less fortunate in the country. And certainly challenging, at profoundly deep levels, for those who do not share the conservative, often destructive world views that are frequently clothed in values-laden jargon.

The current political and economic climates are affecting the entire not-for-profit, health care, and human services sectors. But these challenges will perhaps be nowhere more obvious and potentially catastrophic than among HIV and AIDS programs.

For people living with HIV in the U.S. and those who serve them, there is a growing consensus that the �writing is on the wall.� The messages coming from federal and state departments overseeing key AIDS programs are consistent and foreboding: There are ever-increasing needs among an ever-growing number of people living with HIV/AIDS, but no additional resources.

Coupled with that less-than-cheery forecast are the unambiguous agendas being promulgated by conservative ideologues. These include strident insistence on (and funding for) abstinence-only sex education programs, tighter scrutiny of NIH research and the CDC�s HIV prevention activities, and President Bush�s stated desire to move to the White House�s jurisdiction the $2 billion Ryan White CARE Act program, which is up for congressional reauthorization in 2005.

Closer to home, there is a looming possibility of a 10 to 25 percent cut in Ohio�s Ryan White CARE Act Title II budget. This program provides key services�including case management, emergency financial aid, and the AIDS Drug Assistance Program (including medical care)�for thousands of Ohio�s people living with HIV and AIDS. There is growing concern that Ohio may join the ranks of other states where people are put on waiting lists for services, including life-sustaining medications.

Declining funding, increasing accountability, and escalating financial pressures will continue to be crucial factors impacting AIDS programs. Already, AIDS service organizations�in Ohio as elsewhere�are competing more and more with each other (and with other public health concerns) for funding, advocacy and access to political influence.

If this sounds too unsavory or Darwinian for service organizations--dedicated, after all, to doing good--what are the options to help ensure that Ohio�s HIV/AIDS needs will continue to be addressed?

First, we could continue to proceed with the �survival of the fittest� dynamics that are already well underway. However, unless resources are expanded, pursuing this path will likely produce disastrous outcomes. As we vie for survival, HIV/AIDS programs and AIDS service organizations�especially those with smaller budgets and limited diversity of revenue streams�will shrink and disappear, and with increasing frequency.

Or, we can work together to rethink strategies and infrastructures to ensure the continuation of the most-needed HIV/AIDS services.

�Doing the math� is the easy part. But if we are truly committed to meeting the needs of people living with HIV/AIDS and preventing the spread of this still-deadly disease�which are all that really matter�we�re going to have to move beyond the paradigms, structures and mindsets of the past twenty years.

Otherwise, the coming years may make the last two decades of AIDS support look like �the good old days,� in much the same way we now look back on Ronald Reagan as a moderate. This is nostalgia we cannot afford.

Bill Hardy is the executive director of AIDS Resource Center Ohio.