March 6, 2015
Many AIDS service organizations (ASOs) and community-based organizations (CBOs) that deliver HIV services in the U.S. are struggling financially and some are on the brink of closure, according to a national assessment undertaken by the Asian and Pacific Islander American Health Forum (APIAHF).
The researchers surveyed 129 organizations across the U.S. and found most were considering initiating or expanding current medical services, either directly or through a partnership, in order to strengthen their financial situation and improve services for people living with HIV.
Speaking at a National Center for Innovation in HIV Care (NCIHC) webinar, Jacob Smith Yang, senior capacity building director of APIAHF's Capacity for Health project, said a review of Internal Revenue Service Form 990s revealed 75% of organizations reported an operating loss for at least one of the three years under review, while 38% of organizations reported a loss for at least two of the three years and 15% reported losses for three consecutive years.
"Financially, many, but certainly not all, organizations have struggled," Yang said. "While some report a relatively robust financial picture, a handful may be on the brink of closing. Many organizations in the middle are highly vulnerable to shifts of funding."
To cover normal operating expenses, some organizations reported tapping into financial reserves, borrowing funds or accessing lines of credit, seeking advances on grants or contacts, delaying payment of bills, initiating "emergency fundraising" and delaying or reducing payroll (which sometimes meant cutting staff hours or salaries, or letting staff go).
"We're currently in the midst of five main game changers that significantly shift how we think about HIV prevention and care, and the continued role of organizations in the HIV/AIDS and broader health movement," explained Nickie Bazell, M.P.H., capacity building director of APIAHF's Capacity for Health project. "The key purpose of this assessment was to better understand the impact of these changes on organizational stability and sustainability."
According to Bazell, these "game changers" include the impact of a relatively weak economy on organizational funding, implementation of the National HIV/AIDS Strategy and the Affordable Care Act, the Center for Disease Control and Prevention's high-impact HIV prevention approach, and the increasing role of antiretroviral therapy in HIV prevention.
"HIV prevention programs are now directed to focus most of their efforts and 75% of their money on reducing the gaps shown in the so-called HIV treatment cascade which highlights where people living with HIV fail to get tested, get treatment, stay in treatment, and enjoy decreased and undetectable viral loads," Bazell said. "Now this paradigm shift leaves 25% or less of resources to focus on prevention with HIV negative [individuals]. It constitutes a really big shift in how prevention programs are to approach their work."
Accordingly, 92% of organizations reported the desire to initiate or expand medical services, either directly or by linking with another agency, in order to access funding for HIV treatment and care, and improve client outcomes.
"Nearly all organizations believe that community-based services should be better integrated with medical services," Bazell said. "Many are taking steps in that direction, but despite obstacles and confusion about how to proceed sometimes."
The assessment concluded with a series of recommendations, including strengthening of provider education on the Ryan White Treatment Extension Act and the Affordable Care Act; dissemination of case studies featuring organizations that have been successful in changing, adapting and growing with evolving realities; initiation of a national conversation about social enterprise development within the HIV service community; and provision of targeted capacity building assistance to organizations facing acute and serious financial crisis.
The NCIHC is currently holding a series of webinars for Ryan White-funded ASOs and CBOs. Further information is available on the center's website.
Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.
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