Too Many Nonprofits? Yes - At Least Too Many AIDS Organizations

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.

See also:

Comments (8)

  • I absolutely agree with you that nonprofits should be actively considering and evaluating merger possibilities. There is a tendency to squander valuable limited resources by our own myoptic view of what we do to serve our respective community/constituents. If not by merger, then by collaborative efforts we could stretch those resources and stop some of the duplication we see.

    Apr 01, 2009
  • Great points, Mark! Another strategy would be to take the skills we've learned in the HIV community to serve a broader audience, as the HIV nutrition community has done with an expanded mission to serve other disease groups. Here in Boston, Community Servings ( saw the potential for shrinking HIV funding 7-8 years ago, and realized that in order to continue to serve folks with HIV effectively we needed to expand our focus and our donor market by serving other critically ill clients and attracting donors with interests beyond HIV. Broadening our mission has strengthened the agency and allowed us to continue a robust nutrition program for our HIV clients. Our national nutrition association, ANSA has great resources available on expanded missions at
    David Waters, CEO
    Community Servings,
    Boston, MA

    Apr 02, 2009
  • Hi David. I totally agree with you. You are my role model!! We are launching a new subsidiary soon called the Center for Housing and Health, designed to meet the housing needs of people with chronic medical conditions, including, but not limited to HIV. What you and your sister agencies have done over the past few years is remarkable. Thanks for the inspiration.

    Apr 02, 2009
  • The pressure to consolidate is significant, and will grow. There's a new resource available to some nonprofits to help them figure out their consolidation options, provided by the Taproot Foundation. It's called a Competitor/Collaborator Analysis. Check it out at
    A columnist in the San Francisco Chronicle ran a story on this topic today:
    My POV is that those who see the current situation and think it means the sector as a whole is overbuilt are mistaken. Rather, the sector is dramatically under-capitalized, relative to society's needs and the potential the sector holds to meet those needs, and meet them more efficiently than the private or public sectors can. Imagine what our society would be like if our nonprofit sector was three times its current size!
    Matthew O'Grady
    San Francisco, CA

    Apr 02, 2009
  • A perspective often not heard in the question of whether there are too many nonprofits (in some locales or on some issues) is how best is the target person or household or population served. Look at human services. Are people best lifted out of poverty by, speaking for my city, having a scattering of 20 food pantries, 6 clothing handout sites, 8 utility payment aid offices, 8 credit counseling locations, 4 housing counseling locations, and 11 government benefits counseling groups? Yes, this enables specialization, neighbors connecting with neighbors (sometimes), the education and convenience for many (new) volunteers. But what of the person in need? Think of the bus fare costs alone required for this. Think of the labor swallowed up by grant contract reporting. Think of the inability to have an accurate current picture of the client's needs, eligibility, and engagement. I'm not for centralizing it all. But the truth is nonprofits tend to spring up when desired by motivated individuals and there is an overall lack of planning and coordination. This can be offset by clear headed managers and policies at public agencies that look for a healthy critical massing of services in chosen locations. Soemtimes the bureacrats or politicians pick the venues. Often the n-p community dictates where services or contract or gift dollars go.
    Mike Moran
    Wash., DC

    Apr 03, 2009
  • Well put. Glad someone is speaking up about this.

    Apr 09, 2009
  • Fascinating concept of the uniting of a community to bring forth healing and wholeness to HIV people and beyond. I thinking the conversation is needed and part of the problem is that a lot of the Old School excutive directors, case mangers, and such need to retirier and bring in new folks without so much old negative baggage of fear that keeps the HIV person held in stima, shame and guilt, by forcing the HIV person underground without hopes and long term goals.
    As an HIV positive person that is looking for a job and focusing on my health so disability will not overcome me; I have learned that being included in the community without stima from HIV professionals and others in the local communitiesto is a key of good health and wholness for one to face that fear of stima and push through the many fears spoke of by the professional AIDS person to finding my works. Over coming the stima is much more important to me than to try to figue out the layers and layers of paper work, or to try to understand the overwheming pride and ego of the Non-Profits HIV groups focusing on clients. The first step I believe is for non-profits to see the clients as human beings that have the same potential goals, aspirations and hopes as the professional career AIDS person and for then to help HIV people find their works in the community( more HIV people finding their purpose and works then less money needed for the hand outs or bandaids) and to enspiriter hope, yes hope, long term goals and honest real inclusion within their community, not just another pill, food bank or housing, which to me is a real Charity NON-Profit that focuses on LOVE as the truth meaning of a Charity which will always bring forth wholness to a person and not just another number for an intake form or another study or list put together to meet grant requirierments. The second step I believer would be for NON-Profits employed AIDS professional case mangers to answer the telephone and get rid of the xxxxxxx voice mail.
    The good news is that HIV people are learning to overcome the stima, shame and guilt put on them from local communities and many are finding their purpose and life. I am thankful for the caring people of the past in non profits, however, again I believe it is time for some of them to move on, and let fresh new concepts, ideas and hopes come forward in the community with the goal to end the stima, shame and guilt of AIDS.
    Global Network of Positive People in the USA
    Frederick Wright
    P.S I like to know how many casemanagers that have invitied a HIV/AIDS person over to their house for dinner or to their church for worship or to their happy hour time after work.

    Apr 14, 2009
  • Anonymous

    Seriously? How many have I invited over for dinner, church, etc? Well, that depends. To keep my job I am required to keep professional boundaries, or I would be fired. In my personal life, plenty of friends living with HIV, over for coffee, dinner, and all the rest.

    Nov 17, 2011

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