The Whitman-Walker Clinic, the major AIDS services provider in the Washington, D.C., area and one of the largest in the nation, capped a month0long financial crisis in June by announcing massive reductions in personnel and services.
The action reflects what has been occurring at AIDS services organizations ( ASOs ) across the country for several years, and what is likely to continue unless both government and private funding keeps pace with the increasing demands for services.
The Clinic will close its satellite facilities in the Maryland and Virginia suburbs, each of which serves more than 300 clients; lay off 50 of its 270 employees and not fill 12 existing vacancies; and cut its annual operating budget by $2.5 million.
Interim executive director Roberta Geidner-Antoniotti said that programs had expanded to meet the need rather than the available funding. The reorganization cuts 'back to the cores services that we know are the most sustainable.'
She said closing the suburban facilities 'will save the Clinic approximately $920,000 annually.' They will remain open for a period of months while attempts are made to find other organizations to take on some or all of their responsibilities.
Whitman-Walker will suspend its $60,000 contribution to a needle-exchange program that it spun off as a separate agency several years ago and perhaps lead to its demise. It will close two residential treatment and housing programs for substance abusers, and it will end prevention activities not directly funded by grants or contracts.
The food bank serving more than 300 clients will be closed, the research program will be scaled back, and case management services and administrative overhead pared back.
The Clinic had insufficient funds to meet its mid-May payroll and employees were paid only half their salaries. That was blamed in part upon a cash flow problem exacerbated by delays in payment from the D.C. government, which has since been rectified.
However, the longer term financial picture has been one where flat or declining government funding, coupled with a downturn in private giving, particularly after 9/11, has completely drained the once healthy financial reserves of the organization.
Whitman-Walker was able to delay such dramatic cuts longer than many other ASOs because it also provides medical services and it tapped the equity of its property holdings.
'I credit the board with taking responsible action to save the institution,' David Catania, the openly gay member of the D.C. Council who chairs the Health Committee, told the Washington Post. But, 'In an era where the epidemic is still with us, to see this kind of retreat is disheartening.'
Marsha Martin, executive director of AIDS Action, says, 'The big six agencies [ ASOs ] are all talking about this issue; they have all experienced a reduction in resources. Two years ago the San Francisco AIDS Foundation took a 20% cut.'
'At all of the organizations around the country, people are receiving fewer dollars for more work; you end up having shortfalls at the end of the year.'
'People see waiting lists for ADAP as an indicator that there is a crisis, but what we haven't noticed is a parallel phenomena going on with AIDS services,' says Terje Anderson, executive director of the National Association of People With AIDS ( NAPWA ) . 'They have been getting squeezed, but we haven't been able to quantify it like the waiting list for ADAP, so they haven't gotten as much attention.'
The CDC estimates that 40,000 Americans become infected with HIV and 16,000 die of AIDS each year. 'You do that math,' says Anderson, 'That means in the last four years we've added 100,000 people living with HIV/AIDS in this country.'
'Funding has not kept pace with the caseload. Except for ADAP, everything else has gone up at a rate under that of inflation. You don't absorb that big of an increase without getting squeezed.'
He believes that Whitman-Walker's retrenchment will mean that some people living with HIV will lose essential services while others will become frustrated trying to negotiate the complex system of services and simply drop out.
Anderson also fears the negative impact on the willingness of people to get tested for HIV. 'Part of it is the explicit understanding that services will be available to people if they test positive. That is part of what we tell people—learn your status so you can get into care and treatment.'
But highly visible cut backs in services can create a public perception that services will not be available. He says, 'I'm concerned that it will frighten people away from getting tested.'
Martin says conversations about mergers and downsizing are going on at ASOs all across the country. 'Whitman-Walker is emblematic of what we are going to be seeing over the next five years if we don't get some help from both the public and private sector.'
