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HIV/AIDS Blog Central

Are You Ready? More Musings by Paul Kawata

By Paul A. Kawata

May 6, 2011

This article was provided by the National Minority AIDS Council; Paul Kawata is the organization's executive director.

Are You Ready?
Between today and 2014 there will be a total transformation of how HIV/AIDS prevention and care is provided in America. Are You Ready?

These changes include:

  1. Affordable Care Act (ACA)
  2. National HIV/AIDS Strategy (NHAS)
  3. 12 Cities Project
  4. Enhanced Comprehensive HIV Prevention Plans (ECHPP)
  5. Update of Funding Formula for Housing Opportunities For Persons With AIDS (HOPWA)
  6. Ryan White Reauthorization in 2013 (RWCA)
  7. HHS Action Plan for the Prevention and Treatment of Viral Hepatitis
  8. HHS Action Plan to Reduce Racial and Ethnic Health Disparities

The challenges include:

  1. Federal Budget Cuts
  2. State Budget Cuts
  3. Potential Cuts To Medicaid
  4. AIDS Drug Assistance Program (ADAP) Waiting Lists

To survive, organizations must innovate, adapt and change. Are You Ready?

Is "the Field" Caught Up With These Important Federal Initiatives?

The HIV/AIDS community supports the larger visions espoused in these changes, but the implementation plans may also pose challenges. For example, as jurisdictions roll out the specifics of their 12 City and ECHPP programs, it is quite possible that minority-serving community based organizations (CBOs) will face cuts in funding as resources are reallocated or redirected elsewhere. This could exacerbate already tough budgetary times. Is this an outcome we can or should support? What if it's necessary for the implementation of the NHAS/12 City Project/ECHPP?

As part of the ACA, Health Resources and Services Administration (HRSA) will build capacity in community health centers (CHC) and Ryan White grantees to implement HIV/AIDS medical homes. Are you ready to move your clients to HIV/AIDS medical homes? When they move, will you still be funded to provide services?

In other words, are you ready?

CBOs need to consider the following:

  1. Educate Yourself
  2. Ask Questions & Challenge Assumptions
  3. Inventory of Your Agency's Services
  4. Review Your Economic Model
  5. Change & Grow

Educate Yourself

To know if your agency is on the right track, you need to understand these federal initiatives and how they will be implemented. You need to educate yourself, your staff, your clients and your board. Staff, clients and boards were added because they will also need to adapt and change. This can be very difficult, especially when folks think everything is fine.

Basic Resources

Affordable Care Act (ACA)

National HIV/AIDS Strategy (NHAS)

12 Cities Project

Enhanced Comprehensive HIV Prevention Plans (ECHPP)

Update of Funding Formula for Housing Opportunities For Persons With AIDS (HOPWA)

Ryan White Reauthorization in 2013 (RWCA)

HHS Action Plan for the Prevention and Treatment of Viral Hepatitis (The plan will be released May 12.)

HHS Action Plan to Reduce Racial and Ethnic Health Disparities

The above resources will give you a basic primer; they do not provide any critical analysis.

It can be overwhelming to stay on top of all this information. So many vital issues are being implemented simultaneously, what's a Queen to do? Keep your sense of humor and prioritize those issues that have the biggest impact on your agency and your clients. If your staff is large enough, you may want to identify different point persons who will monitor each initiative in depth.

Ask Questions & Challenge Assumptions

What do these federal initiatives mean for your agency, staff, clients and board?

As a federal official recently said "we are building the plane at the same time that we have to fly it." Because there isn't a clear blueprint, this is a good time to ask questions, challenge assumptions and clarify priorities.

Some Important Questions to Ask

  • What is the role of DEBIs (Diffusion of Effective Behavioral Interventions)? What is the role of community planning? How will they integrate into ECHPP?
  • What is the role of directly funded CBOs vis-à-vis NHAS, 12 City Project and/or ECHPP? How will they be integrated into these important initiatives?
  • If you don't live in one of the 12 Cities, how will this program impact other cities and states? Is there any new funding for cities/states who reside outside of this initiative?
  • Will the Ryan White Care Act be reauthorized in 2013? Will services provided to PWAs under the RWCA be integrated into healthcare reform? Will they be reimbursable?
  • Will all HIV medications be covered under AFA? Does this mean the end of ADAP and ADAP waiting lists?
  • How will success be measured? What are the metrics? What if this doesn't work?

The community wants these initiatives to succeed, but even the word "success" can mean different things to different people.

Inventory of Your Agency's Services

Does your agency provide services that will be funded as these new initiatives are implemented?

First step: Take an inventory of your agency's services.

Then ask hard questions:

  • What services are essential to our mission and our clients?
  • What services will be funded under these new initiatives?
  • Can you modify any of your existing services to fit within the new funding priorities?
  • If you can't modify your services, how will your agency finance them?
  • What are the expectations of your board, staff and clients?

This is the hardest part of the equation. You need to be really honest because your agency's survival depends on these answers.

Review Economic Model

Does your economic model sustain your agency? What is your economic model?

Second step: Identify all your sources of revenue.

Then ask hard questions:

  • Who supports your agency?
  • Is this funding at risk?
  • What does your balance sheet say about your organization?
  • Are you carrying debt? How much?
  • Can you sustain your agency until new revenue streams are identified?
  • Are you fundable under any of these new initiatives?
  • What other funding options should you consider?

You are a business. Like any business, your revenue needs to match your expenses (unless you're the federal government).

Change & Grow

Change can be scary. Adapting to change is an essential life skill.

The community will play an important part in the success of the NHAS, 12 Cities Project, ACA implementation, RWCA reauthorization and other important administration initiatives. However, only the strong will survive.

NMAC will always be there for you. You can always count on me, my Deputy Director Daniel Montoya (, my staff and my board. Thanks for everything you do to fight HIV/AIDS.

Yours in the struggle,

Paul Kawata
Executive Director

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See Also
More on U.S. HIV/AIDS Policy

Reader Comments:

Comment by: John-Manuel Andriote (Norwich, CT) Thu., May. 12, 2011 at 2:36 pm UTC
Many thanks to Paul Kawata and the National Minority AIDS Council for the ongoing series of frank, important discussions of the state and future of HIV/AIDS services in the U.S. I drew from Paul's observations, as well as those of many folks "in the trenches" of service delivery across the country whom I interviewed for the forthcoming new edition of my book Victory Deferred, to examine the history, current state and future of ASOs in a just-published article ("Five Crises: A Brief History of ASOs") here:
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