Everyone hates paperwork. Everyone really hates doing the same paperwork twice. And when you make people do the same grant proposal paperwork twice and at the end of it some of them still don’t get any money, well, that’s when people get really mad.
That’s what happened to the community-based organizations that run education and prevention programs aimed at quelling Alameda County’s raging HIV/AIDS infection rate. Every three years, these organizations apply to the county for money for their outreach programs. It’s a lengthy and complicated process. The application itself is more than 35 pages long, and the county’s HIV Prevention Planning Council spends about a year deciding how to choose the winners.
This year, the paperwork was due in March, with funds to be awarded at the beginning of the new fiscal year in July. But when one community organization learned that its proposal had been tossed out on a technicality, the group’s executive director raised such a ruckus that that the county agreed to give it a second chance — by throwing out everyone’s applications and making them start over.
The news was received poorly by HIV-prevention groups, who said the extra work was untimely and unfair. There were even whispered allegations that the organization in question, the Sexual Minority Alliance of Alameda County, had played the race card, threatening legal action over a perceived bias against organizations that primarily represent African Americans. Whatever the case, starting the process over was a hassle for almost everybody. The new application demanded enough small revisions that groups couldn’t simply resubmit their original proposal, and that delayed the grant money’s arrival until October. Even though the county agreed to give current grant recipients a ninety-day funding extension to cover the cap, the delay is causing plenty of problems for HIV service providers. Without knowing if their funding will resume, they have essentially had to freeze their planning process for the coming season, and they are uncertain of their ability to continue outreach programs, design new ones, hire staff, or reassure their employees that they have jobs past October. Since funding awards won’t be announced until September 4, local HIV-prevention educators are on the edge of their seats.
Alameda County’s decision to throw out everyone’s proposals so upset providers that a half-dozen agencies banded together to draft an angry letter to Ron Person, the director of the county’s Office of AIDS Administration. “This situation is not just inconvenient for providers,” the letter noted. “This delay harms the communities we serve. This is the most important thing. … What will happen if an agency complains again? What considerations can you give the agencies that responded appropriately to avoid putting them in disadvantaged and penalized conditions?”
Their complaint is not entirely theoretical. For example, administrators at La Clinica de la Raza in Oakland’s Fruitvale district may have to lay off two people and scrap two new outreach programs. And as Anna Dorman, the clinic’s health education manager, points out, having to resubmit the funding application ate up time and money, especially for a nonprofit with already limited budget. “To put together two proposals is a considerable amount of work, and that means there’s a cost to the agency — all that people-time,” Dorman says.
Or consider the fate of the Tiburcio Vasquez Health Center in Hayward, which serves the medical needs of about 8,000 South County residents each year. Although the clinic’s proposal had passed muster on the first round and was being considered for award money, on the second round employees who were rushing to resubmit the application failed to include some necessary paperwork, and the application was disqualified. Now the clinic will have to hunt for outside funding sources to support the two new programs it had hoped to staff with county money, one for intravenous drug users and sex workers, and one aimed at creating healthy families.
According to whispers from some prevention groups, the Sexual Minority Alliance, or SMAAC, was assured a second chance at the funding process because executive director Roosevelt Mosby threatened legal action over race discrimination. Person and Arnold Perkins, head of the county public health department, could not be reached for interviews. However, their next-in-command, Maria Aguilar, program director for the county’s Office of HIV Prevention and Education, says she’s never heard a lawsuit mentioned. Mosby himself was mildly evasive when asked if he threatened to sue: “I asked Mr. Perkins to give the whole issue to their attorney, but I don’t remember launching that type of threat. I think it’s the rumor mill.”
Mosby says SMAAC’s first application was screened out inappropriately because the grant instructions had not made it clear that all proposals needed to explain how the group would interact with one particular state program. Nor had it stated that applications could be thrown out for failure to comply. Mosby said that by complaining, he had hoped that SMAAC’s application would be reinstated, not that everyone else would have to reapply. However, Mosby makes no apologies for his request. “I think that the county did what was necessary,” he says. “We articulated a flaw in their process, and they did a corrective action.”
But not everyone feels that way, and there’s some angry talk about backroom deals. “A lot of people are reading this as guaranteeing that the people who complained in the first round get funded the second round,” grumbles one healthcare organizer who wishes to remain anonymous. “The feeling is that the outcomes for funding in this county have already been decided and everything else is kind of token — that the public health department already knows what it wants to happen and everything else is just for show.”
In a letter responding to the criticism by the health service groups, Person conceded that the original application had indeed been vaguely worded, and that SMAAC had a legitimate complaint. “It was only fair to the community that the agency serves to reopen the process,” he wrote. And what about complaints that reopening the process doubled agencies’ workloads and threatened their staffs’ job security? “That’s a valid concern; I can definitely see that from their perspective,” Person’s colleague Aguilar concedes. “Unfortunately, we’re charged to look at the overall picture and not at each agency’s individual concern. The bigger picture is putting everything on a level playing field so that everyone is expected to address the same timelines and the same requirements.”
Officials at a handful of HIV prevention groups say the funding flap is the result of a nasty, ages-old competition for money between groups representing different ethnic communities — one that many hoped the HIV prevention community had outgrown. Part of the reason for this perception is that the bidding process is a zero-sum game, in which each agency comes to the table prepared to defend its client population. “If an extra dollar goes to someone, a dollar has to come from someone else,” one such administrator says. “Every time you move resources, it has to be taken out of one place and given to another. You can look at it not as what’s benefiting another community, but as what’s harming yours.”
Although African Americans have historically had the county’s highest AIDS case rate, and an ongoing federal state of emergency was declared on behalf of that population in 1998, new high-risk populations are emerging, most notably Latinos. Although the AIDS case rate has declined for whites and African Americans, the Latino case rate has fluctuated without apparent trend since 1995. More alarmingly, AIDS is turning up in higher percentages in women and youth. Selena Ortiz, director of planning and development at Tiburcio Vasquez Health Center, says 41 percent of the county’s AIDS cases are in South County, home to the heaviest Latino population, and she suspects that this is a 20 to 25 percent underestimation due to low reporting. In fact, Latinos have historically underutilized HIV care and prevention services for several reasons, including language barriers, cultural stigmas against drug use and homosexuality, and fear of being nabbed by immigration officials when they try to get social services. The Latino community’s soaring infection rate has caused organizers to rally around the cause of HIV prevention. Salva SIDA, a group that advocates HIV treatment for Latinos, recently received nonprofit status after many years of smaller-scale operation. Others point to Aguilar’s lead role in the mostly African-American-led public health department as a sign that the county also is recognizing changing demographics.
Many community organizers say they wish the different agencies would see one another as role models, rather than competition. “The African-American community has done an amazing job in this county of accessing the dollars they need,” says Ortiz. “It’s on their shoulders that the Latino community wants to stand. We want to learn from them.” Such officials stress that all the organizations should work together to address the common needs of high-risk groups who are united not by race, but by behaviors such as intravenous drug use and survival sex work. “It’s a sad story when all of us are racing to become number one and not looking to put ourselves out of a job,” says Mosby. “That’s really what we should be looking to do.”
The competition stems largely from the dearth of available funding. The county only has about $1.2 million to divide among all twenty agencies, of which only seven to ten typically walk away with money. To make matters worse, legislators have cut the cash pool in recent years. Last year after California’s energy crisis drained the treasury, the state cut ten percent, or about $4 million, from the statewide HIV/AIDS prevention budget. Last year in Alameda County the losses were offset by a $500,000 grant from the Board of Supervisors. But no one expects to be so fortunate this year.
On a larger scale, many complain that Alameda County routinely loses out to more metropolitan areas when it comes to state funds. “We’re totally ignored,” grouses one member of the HIV Prevention Planning Commission, who asked not to be identified because of the politics involved. “They always take care of San Francisco and Los Angeles and here we are with two states of emergency, we have some of the highest rates of infection in the whole Bay Area, and yet we still come in sort of second with the state.”
Organizers have another gripe: prevention and education are funded at far lower levels than HIV treatment, which gets $6 million to $7 million per year from the county. They argue that spending more money on prevention would eventually head off the need for more treatment. “The shame of the situation is that it shouldn’t be some kind of struggle between care and treatment and prevention, just the same way that agencies shouldn’t be competing, or certain communities not being served so that others can,” Dorman says.
It will be three years before the county’s HIV prevention groups get their next shot at this kind of funding. In the meantime, groups like the Tiburcio Vasquez Health Center will have to find a way to keep their coffers full and programs open. “We’re not going to let politics or the lack of resources stop us from our mission, which is to ensure the human right of access to quality healthcare,” Ortiz vows. “We’re going to do that with or without county dollars.”
But the application debacle has frayed plenty of nerves and convinced some people that the funding system is too arbitrary and easily derailed, even if some of the groups don’t have to eliminate jobs or cut programs come September 4.
“The larger issue is confidence in the process,” says Dorman. “I think that was damaged. It really undermined faith in the system.”
