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Issue #178: May 24, 1998
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Special Report
$7.8 million in AIDS funds redistributed
TPAC slices funds for minority groups; lawsuit planned
Richman calls for state to rein in TPAC
On the other hand...AACO gives $3.8 million in prevention funds to minority groups
Lawsuit planned by Latino group
TPAC slices funds for minority organizations
After seeking major publicity this spring for what it said would be its first effort to re-distribute federal and state AIDS resources to minority organizations, The Philadelphia AIDS Consortium (TPAC) announced this week that it had severely cut its overall funding for African American community based organizations, allocating most of its funding for case management and HIV prevention programs to organizations operated by organizations traditionally seen as directed by white leadership.Historically African American AIDS organizations received only $120,218, or 7%, of the $1,701,046 set aside by the TPAC board for "African American Allocations," according to a list distributed by TPAC at a meeting of the Title II Ryan White Planning Council, which is comprised of its board of directors.
TPAC disputes this analysis, claiming that some organizations have, through adding board members and staff who are people of color, qualified as "minority" organizations even if they have only recently become more representative in their organizational structure. While most definitions of "minority organization," including that utilized by the city's AIDS Activities Coordinating Office (AACO) and the federal Centers for Disease Control (CDC) require that a majority of staff and board be people of color, TPAC decided instead to use a definition requiring one or the other -- a majority of the staff or a majority of the board, but not necessarily both. According to TPAC, this is the official definition mandated by the state and by the federal Health Resources and Services Administration, which provide TPAC its funding.
Most minority AIDS advocated have rejected this approach, saying that it is only a technical way to protect funding for older groups and prevent new groups which arise directly out of communities of color from building their capacity to serve their own communities.
The inclusion of groups meeting the TPAC characterization as "minority" groups brings the allocation for African-American organizations to 55% across all service categories, according to TPAC.
Other definitions, including that recommended by the Philadelphia HIV Commission for Ryan White funding last year, additionally require that the organization have a history of involvement in the communities of color being served, and that the staff majority be concentrated on management and frontline service staff, rather than be comprised of non-service related staff such as secretaries and housekeeping personnel. TPAC itself has publicly prided itself on meeting this stricter definition, but says it cannot apply it to its allocations process because of state requirements.
The TPAC cutback was most severe for historically African American case management and HIV prevention agencies.
Out of almost $420,000 specifically allocated by the TPAC board for African American case management services, TPAC distributed 94% of the amount to traditionally white organizations, eliminating the funding for drop-in centers at One Day At A Time -- the only walk-in AIDS service sites outside of Center City Philadelphia -- and cutting in half the only early intervention case management program specifically serving African American gay men, at the Colours Organization.
According to TPAC's minority definition, 75% of its African American case management funding was allocated to white groups.
The new allocations reduce TPAC's support of minority community-based case management services by 63% compared to last year's funding level by most definitions.
Despite longtime federal and state priorities which say that HIV prevention funding should be directed to agencies historically based in the communities being targeted, TPAC allocated only $35,000 to African American groups for AIDS education services, giving the remainder -- $273,500 -- to white organizations to conduct African American prevention programs. The action immediately put Colours Magazine, the only minority gay AIDS publication in the nation, out of business, as well as several highly successful workshop and seminar series targeted to sexual minority men of color that have been sponsored annually by Colours since 1994.
The action means that TPAC is funding no HIV prevention programs run by and for sexual minority men of color, the most rapidly growing portion of the population of people with HIV, according to city data.
The result of the cuts is that TPAC's HIV prevention allocations for historically minority community-based organizations next year will be almost 70% lower than they were this year.
Colours cut follows criticism of TPAC
Michael Hinson, executive director of Colours, told fastfax that the funding reductions would probably result in layoffs at the small organization and a significant reduction in its programs, as well as the end of the highly-respected Colours Magazine.Hinson and other minority advocates have been highly critical of TPAC for what they say has been a history of insensitivity to minority communities and a truncated and unrepresentative planning process. When he was a member of the TPAC board, Hinson frequently challenged staff financial reports and policy recommendations, and was part of a failed effort to discharge TPAC executive director Larry Hochendoner from his post.
Hinson would not comment on whether he felt the elimination of Colours programs was retaliation for his open criticism of TPAC in the past.
Larry Hochendoner, executive director of TPAC, told fastfax that part of the funding reduction for Colours was related to poor performance on meeting contract goals for the early intervention case management program, which was only begun with TPAC funding last fall. "Current performance had an impact in cutting this organization in half," Hochendoner told fastfax, noting that the proposal review panels which made the funding recommendations looked at "current and past performance for the same services."
Hochendoner had no comment on the elimination of Colours Magazine and the only black gay HIV prevention programs it had previously funded, or on the elimination of One Day At A Time's neighborhood HIV center.
Hinson countered that implementation of the new project was delayed for weeks because of TPAC's inability to prepare a final contract, which he said Colours had to send back on several occasions because of errors. He said that TPAC also took several months to finalize reporting and data collection requirements, and that TPAC itself has asked that the program's goals be reduced because of the delays. Hinson noted that since the program relied on making agreements with health clinics and other outside agencies to collaborate on the service, TPAC was also aware that it would take time to finalize those arrangements.
"TPAC never funds black groups to serve whites," noted David Fair, who is treasurer of Colours. "But it never seems to have a problem entrusting the lives of people of color to its friends in the white community. And nobody has bothered to notice that this action eliminates almost totally the most effective AIDS care and outreach programs run by and for black gay men. TPAC has, is now, and will probably forever be totally ignorant of the impact of its arrogant decisions on real people, whatever PR spin it tries to twirl."
Fair said that TPAC's decision continues what he called an "historical pattern" of passing over black gay men for "more acceptable" populations of people affected by AIDS. "You know you're an outcast when government agencies force a choice between poor people on drugs and poor people who are gay," Fair said, "and you lose every time."
Several African American AIDS organizations have contacted the Pennsylvania Legislative Black Caucus to ask for their immediate intervention to address the TPAC decisions. They have also contacted local members of the Congressional Black Caucus, which only last week called for a major reinvestment of Ryan White and AIDS prevention funds in minority community organizations.
Hochendoner, the TPAC director, said that the decision not to fund certain minority groups should not be interpreted as saying they are "unnecessary or ineffective." He said these services "might be funded through other sources, such as CDC money, title I, foundations or corporations. While this may not address the issue of scarce resources, it is sadly a fact we all face in HIV/AIDS funding."
Latino groups plan court action
TPAC did only slightly better in its allocations for Latino community AIDS services. In that category, in which $292,687 was available, only 28% went to Latino organizations, with the remainder going to white organizations to serve Latino clients. Asociacion de Puertorriquenos en Marcha, one of only two Latino organizations in the city conducting HIV prevention activities, suffered a 35% cut in its prevention funding, while Congreso de Latinos Unidos received an almost four-fold increase in its food program.Congreso and other Latino AIDS advocates criticized TPAC for prohibiting applications for funding from city Latino groups for case management services, even though Title I and city allocations for these services were reduced earlier this year.
Alba Martinez, executive director of Congreso, said that she and other Latino community groups are preparing to sue TPAC in federal court to gain an injunction against the new allocations.
Martinez and her attorneys believe that restricting AIDS services funded by Title II to only certain racial groups -- for example, funding case management in the African American community but prohibiting funding for case management for Latino people with HIV/AIDS -- is a "racial class" violation that could be overturned in federal court. She said that TPAC's decision to prohibit the funding of some AIDS services for Latinos, whoever the provider would ultimately be could be in violation of Title VI of the federal Civil Rights Act. She noted that TPAC also prohibited any agency from receiving Title II funds to provide primary medical care to Latinos, a major mistake in her opinion, given that rates of symptomatic HIV disease and death rates are significantly higher among Latinos in Philadelphia than in other populations.
Hochendoner said that TPAC restricted the eligibility for different services at the recommendation of a small consumer panel it convened earlier this spring. He said that those consumers earmarked case management funding for the Latino community only to organizations providing services in the suburbs of Philadelphia but not in the city. This recommendation was made prior to a significant cut in city funding for Latino community case management, however, and TPAC declined to change them when this was brought to its attention by various Latino advocates, according to Martinez.
In an email to fastfax after the TPAC appropriations were announced, Hochendoner criticized AACO for making the Latino cuts even though TPAC had already announced its priorities.
Fair, who also serves on the Congreso board, said that he believed that TPAC's inability to conduct a responsible planning process and various procedural violations may also be in violation of the Title II Ryan White Act provisions that require that TPAC's board, as the Title II planning council, play a meaningful role.
AIDS Services in Asian Communities and the Southeast Asian Mutual Assistance Association Coalition shared almost evenly the $146,343 allocated to Asian and Pacific Islander services. Sources said that no non-Asian organizations applied for funding in this category.
We The People also fared well in the TPAC funding competition, receiving increased funding ($27,286) for its food programs and small addition grants in the areas of information and referral and support groups.
Racial tension long a part of TPAC history
Racially-tinged disputes, along with charges of conflict of interest and bias against people with HIV/AIDS, have played a major role at TPAC since its founding in 1990.On several occasions, entire allocations processes have had to be re-done because of complaints, and almost every major decision made at TPAC over the last eight years has generated heated opposition from minority AIDS advocates.
In part to address this history, TPAC's board of directors has undergone wholesale transformations on two occasions, both with the aim of increasing minority and "consumer" participation. The latest changes, which occurred last year after the state health department threatened to take away all of TPAC's funds, resulted in a board which has a majority of people of color and people with HIV/AIDS, although many have complained that the new group -- which excludes the staff of minority providers of AIDS services -- is so inexperienced that it has been easily manipulated by TPAC staff and outside political figures.
Unlike other AIDS funding sources in Philadelphia, TPAC has never made a formal priority for funding AIDS organizations which are historically based in the minority communities being targeted for services. The AIDS Activities Coordinating Office, acting on direction from the Philadelphia HIV Commission, has adopted a definition of "minority organization" and assured that a proportion of the funding available will go to those organizations, based on HIV/AIDS prevalence data. For example, with over 60% of the HIV cases in Philadelphia occurring among African Americans, AACO seeks to allocated at least that proportion of the funding to organizations which meet the Commission definition of a minority organization.
TPAC, on the other hand, has typically focused its funding on the demographics of the client population that an organization serves, rather than on the organization's cultural competence to serve the community. Most minority AIDS advocates have condemned this approach, claiming that it results in an institutional bias in favor of more established white organizations, and that the unrestrained spread of HIV disease means that any organization, no matter how unable it is to serve minority people, will necessarily have a large minority clientele.
City health commissioner Estelle Richman has joined the chorus of complaint about TPAC. On May 1st, she wrote to state AIDS director Janice Kopelman to complain that TPAC's "willingness to move toward real consumer empowerment and collaborative processes seems no longer to be a Title II priority." She criticized TPAC for failing to meaningfully involve consumers in its priority setting for this year's allocations, and for failing to adequately train those who did participate so they could play a useful role. [See related story.]
The African American and Latino Caucuses of the Philadelphia HIV Commission, which oversees almost $20 million of city, Title I and AIDS housing funding, formally condemned the TPAC priority process, according to Richman. She said they had contacted the Health Department to complain that, after a year-long TPAC planning process, they were called in "at the last minute" to lend credibility to a process they had no role in designing.
TPAC's funding for minority AIDS organizations, which had always lagged behind funding from the Philadelphia Health Department and Ryan White Title I sources, had already been weakened when it was forced to cancel contracts with three minority organizations -- Unity, Inc., the Ecumenical Information AIDS Resource Center, and the Holistic AIDS Project of One Day At A Time -- because they were not meeting their performance goals or had fiscal management problems.
TPAC did not announce what African American groups had applied for funding but were turned down, but Hochendoner told fastfax that 11 of the 39 proposals which were rejected were from "known minority providers." Hochendoner said that the amount of funding requested by all of the groups which applied totaled over 8 times the amount of money available.
TPAC was required this year to hold a competitive bidding process for the funding by the state health department, which contracts with TPAC to distribute almost $2.7 million in funding provided through Title II of the federal Ryan White CARE Act and the state HIV prevention program. State officials and community advocates had condemned what they called intensive conflicts of interest in TPAC's funding decisions in the past, resulting in the appointment of a new board of directors, most of whom are people of color, last year.
Richman asks state to rein in TPAC
Philadelphia Health Commissioner Estelle Richman has called for the "immediate intervention" of the state health department to address what she calls the abandonment by The Philadelphia AIDS Consortium (TPAC) of its commitment to "real consumer empowerment and collaborative processes."Richman's action comes after a recent decision by TPAC executive director Larry Hochendoner to pull out of a "joint planning" process initiated last year, which was aimed at integrating planning and priority-setting for almost $25 million in federal, state and local AIDS funds. She also complained that Hochendoner had refused to attend a meeting convened by Joseph Pease, a state AIDS official, for the purpose of fostering a cooperative relationship with the city on AIDS planning.
TPAC oversees over $3 million of funding awarded by the state from Title II of the Ryan White CARE Act and the state's HIV prevention budget. The city's AIDS Activities Coordinating Office allocates over $20 million of city and Title I funding, based on planning and priorities developed by the Philadelphia HIV Commission.
TPAC has criticized the Commission for failing to better coordinate the joint planning process, and for failing to keep what it claims are funding commitments to the planning process made by the Commission. The Commission has itself been hampered by the resignation of two of its lead managers over the past year, and other staff changes.
TPAC, on the other hand, has been criticized by Commission members for developing planning documents and processes without consulting with the state Title II planning council, which is its board of directors, for ignoring the results of formal consumer surveys it has conducted jointly with the Commission, and for not fulfilling its pledge to work closely with the Commission on joint planning procedures.
Earlier this year, TPAC convened a one-day meeting for HIV+ African American people to help it set priorities for $2.7 million which is was putting out for bid to city and suburban AIDS organizations. While over 150 people attended the meeting, less than 20 were actually people living with HIV/AIDS.
Richman was especially critical of this planning process.
"Consumers were given literally just a few hours to be trained about the entire system and then make priorities for allocations for all of the Title II dollars," she said. "The process and the results (which gave very little priority attention to primary medical care at a time when protease inhibitors are moving HIV toward the status of a chronic but manageable disease) was met by almost universal criticism reports to our Health Department by members of the Commission's African American and Latino Caucuses and community members who were asked at the last minute to assist in these TPAC processes."
Richman said she heard expressions of "disbelief and extreme concern" from "many of this region's major African American and Latino service providers and consumers, who, after working with [the city health department] in planning, service gap analysis, and priority setting through our planing process which spans the entire year [her emphasis], knew that the priorities of TPAC which were set in a few hours did not come close to meeting the needs of the community."
Richman also reported that TPAC had pulled out of a joint project to set quality assurance standards for AIDS services in the region, and has undermined a joint case management coordination project that was actually initiated by TPAC several years ago. She also noted that Hochendoner, TPAC's director, refused to meet last month with city and state officials to discuss improving collaboration between the Title I and Title II processes.
In her letter, which was addressed to Janice Kopelman, director of the Bureau of Communicable Diseases of the Pennsylvania Department of Health, Richman reminded the state that she was forced to withdraw responsibility for overseeing Title I funding from TPAC in 1995 "after a log period of severe consumer and community-based criticism of TPAC's ability to plan without conflict of interest to meet the needs of consumers in this region."
While Richman stopped short of asking the state to relieve TPAC of the Title II funding responsibility as well, state sources told fastfax that state health secretary Daniel Hoffman is considering shifting responsibility for Title II and state prevention funding to AACO and the HIV Commission as early as next year. Both TPAC and AACO have publicly denied that they are in discussion with the state on this issue.
On the other hand...
AACO gives $3.8 million in prevention funds to minority groups
Ironically, in the same week that the Philadelphia AIDS Consortium was coming under fire for distributing funding targeted to minority communities to white-led organizations, Philadelphia's AIDS Activities Coordinating Office did almost the opposite -- distributing over 73% of a $5.1 million pool of city, state and federal HIV prevention funds to organizations in communities of color.AACO's funding decisions were based on a year-long planning process conducted by the Philadelphia Community HIV Prevention Planning Group (CPG), a panel of the Philadelphia HIV Commission. The CPG set aside specific amounts of money for different population groups, and AACO was required, under the mandate of the federal Centers for Disease Control (CDC), to follow those guidelines in allocating the funds.
Some minority AIDS advocates had been concerned that a particularly complex Request for Proposals (RFP) issued by AACO to direct competition for the prevention funding might result in fewer neighborhood minority groups from qualifying for the funds. In the end, however, over $3.8 million went to minority organizations, the highest-ever investment of AIDS dollars in organizations led by people of color since the epidemic began.
The AACO allocations also bring in a wider range of organizations providing HIV prevention services. Among the new groups receiving prevention funding are Anti-Drug and Alcohol Crusaders, MATER Family Center, the People's Emergency Center, Positive Influence, WISDOM, and the Women's Christian Alliance.
The new grants represent the first major funding for WISDOM, which stands for Women with Immune Systems Disorders Organizing and Meeting. WISDOM was founded by Pam Ladds and a number of women living with HIV/AIDS in 1992 as a partner program to We The People, and has since been able to establish an independent organizations.
While comparisons to current funding levels were not available at press time, the funding allocations report issued by AACO this week indicates significant funding increases for One Day At A Time, which conducts extensive outreach and prevention programs in the areas of the city hardest hit by the epidemic in North Philadelphia, West Philadelphia, Germantown and Kensington, as well as for AIDS Services in Asian Communities and the SafeGuards Project of the AIDS Information Network, which has traditionally concentrated its educational activities on white gay men. Most other organizations received level funding or small increases in their budgets.
Both minority and non-minority groups were also among big losers in the funding competition.
The Philadelphia Health Management Corporation and the Family Planning Council of Southeastern Pennsylvania both lost funding, as did BEBASHI (Blacks Educating Blacks About Sexual Health Issues), which lost funding for its HIV counseling and testing program.
Programa Esfuerzo of Congreso de Latinos Unidos, the city's oldest Latino AIDS service organization, received the largest grant of any group in the city -- $583,689 -- but still suffered a $100,000 cut that will require the second layoff of staff in the organization's AIDS programs this year. The earlier layoff resulted from a major cut in Congreso's AIDS case management program.
Asociacion de Puertorriquenos en Marcha, another Latino organization included among those funded, also received a funding cut. The Gay and Lesbian Latino AIDS Education Initiative received an increase in its funding.
Alba Martinez, executive director of Congreso, said that she and her clients were "tired of being an afterthought in the AIDS funding process." She told fastfax that she believes that Latino AIDS services suffer because Latino people with HIV/AIDS have a harder time participating in the complicated and controversial AIDS planning process, and that the city and TPAC are often swayed more by the political pressure from high-pressure advocates than by "doing the right thing."
"An already stretched-to-the-limit AIDS system for the city's poorest -- and most rapidly growing -- population of people affected by AIDS has been decimated by one cutback after another," Martinez said. "We are being penalized because we don't spend all our time at meetings or making political deals, and instead are out doing the job. We're old-fashioned -- we thought if you did the job you'd get the resources. Apparently, that's not always true."
Joe Ribiero, a Congreso client, said that his Congreso case manager, who used to have 40 clients, is now trying to help over 80 because of the cutbacks. He said that "the only way anybody who speaks Spanish in this city even knows anything about AIDS is because of Congreso. I hope the people who make this decision understand that as more Puerto Ricans get infected, it will be because of them it happened. And I thought they were supposed to be trying to keep us alive."
Martinez said that she intends to appeal to higher sources in the city administration and to federal officials to get the funding cuts restored.
The AACO announcement also noted that the city is holding back about $290,000 of available funding to support specialized initiatives targeting older adults and people with mental illness or developmental disabilities. These organizations will be identified through a "small bidders conference" to be announced soon, AACO said.
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