Doing more with less

Addison Ore, executive director of Greensboro’s Triad Health Project, says it’s something that makes her want to bang her head against the wall.

That something is the seemingly irrational decisions federal officials and other funding sources make when dolling out money to cash-strapped AIDS service organizations (ASOs) in the South. While ASOs in big cities in the northeast and west get plenty, Southern ASOs — where the HIV/AIDS crisis has hit all-time highs — remains low and nowhere near proportional to the services needed here.

“It’s not rocket science,” Ore says. “Just look at the demographics. It is clear where the spikes are and funding is not equitable.”

Throughout spring, qnotes sent requests for 990s (the tax returns non-profit groups submit to the IRS each year) and our first-ever Community Assessment Survey to 22 LGBT organizations, ASOs and Pride festivals across the Carolinas. Of the 21 groups still in operation (one had merged with another survey participant), eight were ASOs. Of the seven based in North Carolina, only one — yes, one — reported operating without a deficit in their 2008 fiscal year.

“It’s just the economy,” says Rodney Tucker, the current executive director of Hickory’s ALFA (AIDS Leadership Foothills-area Alliance). “Money from foundations has shifted from health-focused to job-focused. Secondly, people have decreased their donations.”

Ore says funding problems have always been a trend, especially since the economy first faltered a couple years ago. In 2008, Triad Health Project suffered from a $67,701 deficit — the third largest deficit for North Carolina ASOs that year.

“The last couple years we really have been doing more with less,” she says. “We’ve certainly seen cuts across the board locally, statewide and federally.”

Ore’s Triad Health Project isn’t alone. Across the state, ASOs are having a tough time keeping up with increased demands and limited funds. In 2008, Tucker’s ALFA faced a $39,505 deficit. In Charlotte, the Regional AIDS Interfaith Network (RAIN) saw a deficit of $43,901. Raleigh’s Alliance of AIDS Services-Carolina faced a slight deficit of $5,220. The two highest deficits were Western North Carolina AIDS Project’s $88,307 and AIDS Care Service of Winston-Salem’s $77,177.

Even the state government faced budget problems this year, as need for medication assistance through the AIDS Drug Assistance Program (ADAP) outpaced available funds. In January, new enrollment to the program was capped and hundreds of new applicants have been wait-listed. Gov. Bev Perdue’s 2010 budget proposal — with an additional $14 million in ADAP funding — seeks to provide access for some of the wait-listed patients, but it certainly won’t be a cure-all. ADAP once served clients with incomes up to 300 percent of the poverty level. If legislators in Raleigh approve the governor’s budget as-is the new funds will be available only to those earning less than half the previous income requirements.

Back in Greensboro, Ore says keeping her organization running is a daily challenge. Her one goal is to keep her clients served.

“We’ve had to make tough calls and say no to clients in some ways that we haven’t said no before,” she says, stressing: “But we still and will never have a waiting list.”

Like many ASOs, Triad Health Project provides case managment and operates education and prevention initiatives. Some of their programs are funded by grants and contracts with local, state and federal governments.

“Most of that we have to front the money and we’re waiting two to three weeks for reimbursements,” she says. “That puts quite a strain on us. You can feel my throat close up as payroll comes around. Quite frankly, it’s no secret that we’re always ‘robbing from Peter to pay Paul.’ Talk to folks and you’ll hear that story over and over.”

As with the state’s ADAP funding, Ore says client needs have outpaced the resources they recieve. “There are a lot of unfunded mandates for services we are required to provide — we don’t get sufficient funding for them,” she says. “Triad Health Project has ben flat-funded by Guilford County for eight years running to do our client services program. The percentage of what they pay for the program’s actual costs are funding about less than 20 percent.”

ALFA’s Tucker faces similar obstacles. Despite increased funds for prevention programs — the result of tapping into new granting sources — ALFA still faces strict spending rules.

“The problem with state or federal funds is that they are very directive on how you spend it — the funds are for that and nothing else,” he says. “Overhead costs and expenses, something like the copier breaking down, that’s where we need those unrestricted funds.”

ALFA and Triad Health Project make up the difference by fundraising throughout the year. Ore’s group organized one of their biggest fundraisers, Dining for Friends, this month. Nearly 60 parties had been registered beofore the event. In Hickory, ALFA raised $17,000 through its recent Hike for Hope.

“We raise a great deal of our funds ourselves,” Ore says. “Almost 40 percent of our budget comes through special events and direct mail. That’s a remarkable figure for a non-profit.”

A ‘silver lining’

After news spread of the state’s decision to cap new ADAP enrollment, the HIV/AIDS prevention and advocacy community stepped up its game. A coalition of statewide leaders in the North Carolina AIDS Action Network (NCAAN) met first in Raleigh, then in Charlotte. The meetings brought together HIV-postive clients, LGBT advocates, state House representatives, county health department staffers and ASO directors like Ore, RAIN’s Rev. Debbie Warren and Raleigh’s John Paul Womble. Jacquelyn Clymore, director of the state Department of Health and Human Services’ HIV/STD Prevention and Care branch, also joined in.

At their meeting in Charlotte, Clymore told qnotes that public and elected officials need to start treating the HIV/AIDS epidemic as a real public health crisis. She said some are beginning to grasp the concept, but more education is still needed.

“A lot of education still needs to be done for lots of people, not just the legislature,” she said. “Why does this program matter? How are we going to support it?”

Ore says the state’s ADAP crisis created an opening for increased awareness.

“Just look at the governor’s budget for ADAP,” she says. “That wouldn’t have happened without the steady drum beat NCAAN has been banging on since the whole thing started. That’s the silver lining of this ADAP crisis: It has really galvanized the community. People are angry and aren’t going to stand for it.”

On May 25, the same day as Equality North Carolina’s Day of Action lobbying day, NCAAN will bring HIV-positive community members and their families and friends to Raleigh. They hope their advocacy on HIV/AIDS funding will help convince state legislators to keep Perdue’s budget proposals intact. Perhaps, NCAAN’s advocacy might also result in increased support as well.

These issues can’t be clearer or more important for LGBT community members — especially as HIV infection rates continue to climb among young gay and bisexual men of color. But the stigma that has pervaded HIV advocacy since the 1980s AIDS Crisis continues to take a toll on prevention and education efforts, Ore says.

“Stigma is the number one barrier to everything we do, still today in 2010,” she says. “People are still saying crazy things.”

Education and prevention, she says, must go hand-in-hand with appropriate funding and support.

“It’s unbelievable the misconceptions and things students today do not know, and these are 19- or 20-year-old kids who have never lived in a world without HIV,” Ore says, recounting a recent “HIV 101” presentation at a local college.

With so much time and energy spent on funding concerns, Ore says it’s easy to forget the best way to support the efforts of ASOs like Triad Health Project can so often be the simplest: Get tested, be aware, get involved.

“Know your status,” she says. “Practice safe sex. Take responsibility.” : :