Mark Ishaug has been the CEO of the AIDS Foundation of Chicago for 11 years, and serves on the board of the National AIDS Fund as one of the two elected partner representatives. He has worked and taught in Zimbabwe and Mozambique, and is on the national board of Funders Concerned About AIDS. The AIDS Foundation of Chicago is both a grantmaker/funder as well as a grantseeker.
There are more people living with HIV and AIDS than at any time in our history. As just one example, the statistics recently released for Washington, DC, are in the same league of infection rates as in sub-Saharan Africa. The need is greater than it has ever been.
But at the same time, resources are not only failing to match the increased need, they are actually declining. Congress failed to appropriate any new funds for HIV prevention in fiscal 2009, while federal support for AIDS care and housing is basically level.A Most states have reduced funding for AIDS, and we anticipate lower levels of government funding, foundation funding and even individual donations, given the economic situation.
Something's going to give; the HIV/AIDS community of nonprofits is at a tipping point.
An impossible situation?
In the midst of this perfect storm, there are just so many AIDS organizations competing for such few and limited resources. How in the next couple of years can we sustain all these organizations, each with its own executive director, its own finance director, and so on?
More of us should have the conversation about mergers and strategic alliances. At the AIDS Foundation of Chicago, one of our key strategic objectives is to facilitate, encourage and support mergers and collaborations in our sector. We're not afraid to have conversations with agencies that are two or three or four times larger than us. We have to think about the client and about services. Most of us have a lot invested in our work, in our organizations, in our brands, in the belief that we know best how to do what we do. And if we have the conversation and it doesn't seem that a merger is the right way to go, then at least we've had the conversation.
There are several reasons why I am attracted to the idea of mergers in our sector:
- In the AIDS sector, primary care is key. And the organizations that don't provide primary care -- which are typically the smaller ones - will need to figure out how to provide it. That might need to be through mergers or strategic alliances.
- I'm fearful that some organizations that provide unique and crucial services and have built trust within the communities they serve will go out of business. And instead of being planful about doing so, after struggling and struggling, on some Friday an agency might just say, "we can't do it anymore." Rather than see this happening, we should be talking more about mergers and other ways to make sure that we keep all the services we can. A proactive approach can help ensure we sustain and grow service capacity in geographic areas where programs are most urgently needed. It can also ensure that populations heavily impacted by HIV/AIDS continue to rely on projects and organizations established to meet their unique needs, with culturally and linguistically appropriate services.
- There are some small organizations that, if they had more capacity in administration, in finance and in fundraising, could continue to do what they do well, and serve even more clients. If instead of being an independent 501c3, they could be a project within a larger organization that has those capacities, they would be able to focus on the services to which they bring an important, committed perspective.
- State reimbursement funds make it especially hard for smaller organizations. If you have to wait four or six months to get paid, if an agency doesn't have cash reserves or a line of credit, you just can't make it. Larger agencies have more of an ability to manage these kinds of difficult cash flows.
- Our clients aren't just living with HIV. Many of them are challenged with long-term unemployment, mental illness, experience with incarceration, lack of housing, and other issues. We can't help someone only with HIV/AIDS. We need to learn to be AIDS-focused organizations without being AIDS-exclusive organizations. One way for us to do this is through economies of scale, collaborations, and other structures. By expanding the portfolio we can provide many more services to people with HIV, not just HIV-related services.
A history of responding to unmet needs
I fully appreciate that the whole issue of mergers is especially complicated for the AIDS sector. After all, many of our organizations started because the big agencies wouldn't do AIDS work. The local specific responses to the epidemic have been incredible efforts to meet the needs of people in communities that are often neglected or under-served. And given how much unmet need there is, I don't think the often cited argument that we should have fewer groups because there is of "duplication of services" really applies.
We can still beat AIDS. This is a winnable fight. Our clients deserve a deeper community conversation about how best to do our work.