Retooling Black AIDS Organizations in the Face of Change

The first in a three-part series about the need for AIDS service organizations that serve Black communities to adapt to the changing landscape.

The AIDS landscape is rapidly changing. Over the last several years, new biomedical tools have emerged that have quickly transformed the AIDS response. Today we are no longer talking about managing AIDS but instead about how to end it. The U.S. response to AIDS is also being transformed. In 2013 and 2014, the country will take a major step toward the ultimate goal of universal health-care access, offering a historic new opportunity to close gaps in the HIV-treatment continuum. As the Affordable Care Act is fully implemented, however, traditional funding streams for HIV programs are likely to change dramatically or, in some cases, go away entirely.

These changes have momentous consequences for community-based organizations that provide HIV-related services to predominantly Black communities. Unless community organizations adapt to the many changes that are taking place, many will not survive. And the closure of those organizations serving Blacks will weaken the capacity of Black America to respond to AIDS at the very time that genuine success against the epidemic is achievable.

Although some AIDS service organizations in Black communities have grown to become prominent pillars of their neighborhoods, the AIDS response in Black America primarily relies on organizations that are much smaller than the large service organizations created in White gay communities in the epidemic's early years. Smaller organizations, with a limited funding base, are most vulnerable in the current environment.

Many Black AIDS organizations have primarily focused on HIV-prevention outreach and education. In large part, these organizations have looked to the Centers for Disease Control and Prevention (CDC) for funding to implement the CDC's DEBI (Diffusion of Evidence-Based Interventions) programs. Yet in launching its approach to high-impact prevention, the CDC has signaled that funding for DEBIs will inevitably decline, potentially imperiling agencies that have focused almost exclusively on DEBI-related funding in the past.

With biomedical prevention tools now taking center stage in the AIDS response, the CDC and other federal agencies will need community-based partners with the skills and expertise to integrate behavioral and biomedical approaches. Yet many AIDS organizations, especially smaller ones that have traditionally focused on delivery of DEBIs, lack in-house medical expertise. At a moment when closing the HIV-treatment cascade has arguably become the central challenge for the AIDS response, many AIDS organizations lack the ability to influence the health-care services that their clients receive. Often, smaller organizations have few, if any, strong programmatic links to local HIV clinics.

At the same time that biomedical advances are transforming the AIDS response, the Affordable Care Act (ACA) is poised to dramatically alter the way that health care is financed and delivered. Whereas prevention services have long been financed through discretionary federal programs, the ACA aims to fold many prevention services into mainstream health-care delivery. And the future of the Ryan White CARE Act, on which many AIDS organizations have long depended for funding, is uncertain, with Congress due to take up reauthorization this year amid a sense of crisis over the federal budget.

These and other changes are not theoretical; nor are they coming down the road. They are real and imminent. To survive, AIDS organizations will need to change as the environment itself changes.

Some AIDS organizations are already moving to adapt to an evolving environment. Empower "U", Inc., a Black community-based organization in Miami, serves as an example, Founded in 1999 by two women living with HIV, Empower "U" has provided a range of services, including outreach, prevention services, housing support, HIV testing and counseling and case management. Today the organization is determined to couple its social service programs with health-care delivery, seeking to obtain certification to become a federally qualified health center.

For other agencies, beginning to deliver health services may not necessarily be the answer. Rather, for them, linking with a clinical program and entering into a multiagency alliance may be the best way to integrate behavioral and biomedical approaches.

Next week: How the Community Education Group in Washington, D.C., demonstrates nimbleness in the face of change.

Excerpted from the Black AIDS Institute's State of AIDS Report, "Light at the End of the Tunnel: Ending AIDS In Black America."