Fall from Grace

The morning of Tuesday, January 20, began routinely enough at Health Crisis Network, South Florida's largest AIDS service agency. If anything, the 100 staffers at the main office on Biscayne Boulevard might have been a bit more relaxed than usual, having had Monday off in celebration of Martin Luther King's birthday.

Starting at about ten o'clock, though, fourteen of those staffers were called one by one into the administrative offices. "They told us to gather up our things and leave, and that was it. They said they had financial problems and they had to do it," recalls Mercy Ortiz, a five-year employee who had been director of case management for a year and a half. "It was such a shock. We didn't know what was going on."

Two of Ortiz's case managers were also laid off, as was the director of psychosocial counseling, Dr. Wendy Whitfield, and two of her counselors. "After I got laid off, I went to Wendy about to cry," says Ortiz, who is now trying to get by on a part-time job with Dade County Public Schools. "And then they called her in, and she came back five minutes later saying, 'Me too.' And in the middle of all that I was trying to cheer her up." Ortiz offers a bemused sigh. "This is the oldest AIDS organization in Miami. I don't understand how suddenly there's not enough money."

She isn't the only one asking that question.
Indeed, HCN's financial meltdown has stirred up a slew of concerns about the fifteen-year-old nonprofit, as well as some long-simmering animosities. Murmured accusations of mismanagement, malfeasance, and plain stupidity have run rampant among clients and care providers in Miami, which has the nation's fourth-highest incidence of AIDS. The agency's attitude toward the crisis -- a public posture that there is no crisis but private expressions of nervousness -- has only worsened matters.

"What's happened is over the last two years our client load has doubled but our budget hasn't," says HCN's former development director Keith Cromley. "Federal dollars have started to shrink, and we didn't bring in as much as we'd have liked with our fundraising events. We were hoping to develop some other income either through private foundations or corporations, but the support hasn't been at the level we hoped."

This party line, however, has done little to erase the sense that HCN -- once considered the heartiest of AIDS service agencies -- has been in a freefall over the past two months. A few weeks before the layoffs, executive director Marc Lichtman resigned. After the layoffs, most of the rest of HCN's staff was furloughed for the next two and a half weeks. Although many employees continued to work without pay, the agency's 900 clients were thrown into turmoil. One hundred of them, considered "inactive" or not in acute need of services, were cut from the caseload. The rest have had to contend with unanswered phones, referrals to other agencies, delayed appointments, and canceled therapy sessions.

Curiously, HCN's shortfall coincided with the receipt of two large federal grant payments totalling $146,000, a fact that has raised questions about how the agency was spending federally allocated funds.

"Where does the money go?" demanded John Muhammad, chairman of the county's HIV Health Services Planning Council (an advisory board that makes recommendations on allotment of AIDS funds), at a specially called meeting after the layoffs at HCN. "I've been getting a lot of questions from PWAs [people with AIDS] and the community at large. People have been coming and telling me that services aren't being rendered and HCN is referring people out, and yet it just received money. I'm angry about what I see."

In response to the crisis, Betty Alvarez, president of the 27-member HCN board of directors, announced in early February that she was appointing a task force to recommend new measures that would ensure the organization's survival. But during this period of retrenchment, two top managers, development director Keith Cromley and chief financial officer Alexandria Douglas, announced their resignations. Both had accepted jobs -- Douglas as executive director -- at the Florida AIDS Action Council (FLAAC), a lobbying group. Cromley said he stepped down because his doctor had advised him to get a less stressful position. Regardless of the reasons, their resignations, and those of two lower-ranking staffers, conveyed the sense of a mass flight.

In late February one possible impetus for the exodus emerged. HCN announced plans to merge with a smaller nonprofit, Community Research Initiative of South Florida (CRI), to form a new corporate entity. The new group, as yet unnamed, will be run by CRI's current executive director, Richard Siclari. A week after the merger announcement, four more HCN employees were quietly laid off. A teen education program was canceled, eliminating fifteen part-time employees.

In the space of six weeks, in other words, Miami's premier AIDS organization had lost a quarter of its staff and scaled back its programs. Given the planned merger with CRI, few observers now expect HCN to fold. But it's clear the agency will never be the same.

In 1983, the year HCN was unofficially born, AIDS was a barely understood plague that was killing gay men in grisly ways. The group of about two dozen volunteers that eventually called itself Health Crisis Network did things like visit hospitals and take meals to patients at home. Among those involved were attorneys, social workers, and staffers at Jackson Memorial Hospital, which was then the only local hospital treating AIDS patients. Most had friends or family members with AIDS; most were gay men. "We used to have group meetings at the back of a church," says attorney Samuel Blum, a long-time HCN board member. "We would address psychosocial concerns to try to gain some understanding about how we could help families -- or ourselves. At that time if you were diagnosed with AIDS you probably had 30 weeks to live."

After a few years the group grew into a full-time social service agency with half a dozen workers. "We were incorporated and we started to have a budget and counselors. We got a break on the rent for an office on NW Twentieth Street from the phone company," Blum recalls. Operating funds came from donations and fundraising parties.

"That's how the White Party started," adds Robert Longstreth, Jr., another early member and still a board member, "as a party at somebody's house in the Grove. There were a lot of white balloons there, so it got to be called the White Party. We charged five dollars to come in so we could get some money to hire more people to take care of the office and so forth. I sat outside at a card table and took five dollars from everyone who wanted to come in. It was completely grassroots."

United Way became the group's first major funder in the late Eighties, supporting a program Blum refers to as "educating the educators," in which HCN workers visited other social service agencies to teach counselors about AIDS and how to handle clients with the disease. "We were the only game in town," Blum says. "We had expertise that people in other organizations didn't."

In 1989 Cathy Lynch took over as HCN's executive director. She immediately recognized the need to run the nonprofit as a business. Under Lynch's leadership, HCN steadily expanded its staff and services to meet the growing demands of the AIDS community. Expert grant-writers were brought on to secure federal and state funds for counseling, assistance, and prevention programs. The programs brought in clients and sent staff and volunteers out into the community as speakers and educators.

This community visibility attracted substantial private donations, often from gay-owned or gay-operated firms and foundations. The White Party morphed into an entire high-profile week of gala fundraising shows and dances that became a don't-miss stop on the international gay party circuit. Ten years ago HCN staged its first AIDS Walk on the heels of similar moneymakers in other cities.

As the organization became a powerhouse in both image and earnings, its reputation in some quarters began to dim. A segment of Dade's gay community viewed HCN as a secretive, bureaucratic, and increasingly arrogant clique that didn't care to cooperate with other AIDS agencies, gobbled up media attention, and proved stingy about helping those who weren't clients.

At the same time, the first of what would eventually become a flood of nongay, nonwhite, penniless AIDS victims was beginning to show up at HCN. A huge percentage was also substance abusers. As an organization founded by white middle-class men, HCN was criticized by minority communities as insensitive to their needs.

By most accounts, Lynch and her staff worked to target more programs to the changing HIV population; the Parent-Teen AIDS Prevention (PTAP) program, for example, started three years ago with a private grant, training young black women to educate their peers.

Many within the AIDS service community, however, believe Lynch alienated HCN's leaders by refusing to cater to the gay power structure. By the time she resigned in July 1996, Lynch was under heavy fire from HCN's gay critics for what they perceived to be the agency's uncooperative behavior. Since neither Lynch nor HCN board members will talk about her resignation, it's not clear what role gay politics played in it. Lynch now works for the Florida Department of Children and Families and refuses to say anything about her seven years with HCN. She has no interest in dredging up the past, she says.

Nevertheless, Lynch's departure didn't mollify the agency's detractors; if anything, the level of criticism has increased. "Last year we busted our ass to help them [with the AIDS Walk] and they wouldn't even return our phone calls. This year -- nah," huffs a man who works for a gay publication and requests anonymity. "At the beginning [HCN] was something totally different." These sentiments echo those expressed by other members of the gay community and by workers for smaller AIDS organizations.

"I'm appalled at [HCN's] behavior with PWAs," says Julia Llorente, a member of the HIV Services Planning Council who works at the People with AIDS Coalition (PWAC), an often-strident advocacy group whose staff has long criticized HCN. "A lot of them have come to me exhausted and frustrated because they can't get anyone [at HCN] to listen to them and they are not treated with respect. Of course, it's worse now; in the last two months alone about 100 clients have come to me saying they cannot receive services from HCN because it's closing down, or they don't have case managers, or whatever."

Paul Devine is one of the HCN clients who came to Llorente because he's starving (on around 200 calories per day), about to have his electricity cut off, and needs transportation to and from a hospital for an operation. His former case manager was laid off, he says, and the one he has now still hasn't connected him with services he should be eligible for. But worse, Devine says, "I just talked to a guy over there, and all he could tell me was I just have to wait. He was so cavalier in tone, and I'm supposed to be entrusting my life to them? HCN has been a closed system for a long time. It's accessed through association. Everybody knows this. I can only add my voice to the rest of the crowd in the hope that HCN will become more conscious of its own clients."

After Lynch's departure, a national search netted Marc Lichtman, the veteran executive director of Douglas Gardens Community Mental Health Center, a large nonprofit social service agency in Miami Beach. He had served on the Florida Commission for the Elderly, on the board of the South Florida Hospital Association, and as chairman of the Board of Nursing Home Administrators. Lichtman, responding to the shift in AIDS treatment away from hospitalization and toward less institutional approaches, wanted to decentralize HCN's services. He managed to open satellite offices in Miami Beach, South Dade, and North Shore Hospital.

Lichtman says he also wanted to lessen the agency's dependence on two huge public fundraisers for more than a third of its budget. He thought HCN should concentrate more on securing government and foundation grants, diversifying fundraising events, and recruiting more volunteers. He had misgivings, too, about some of the elements of the White Party, such as the casual sex and drug use.

Although HCN's current staff and board members are reluctant to discuss their conflicts with Lichtman, his efforts at reform were not embraced in all quarters. What's more, during his tenure, HCN's financial office missed an application deadline for a large federal grant, exacerbating cash-flow problems, and a federally funded clinical program was found to have inadequate staffing and shoddy record-keeping.

Lichtman can't be said to have been directly responsible for those problems, and the financially disappointing 1997 White Party was planned and staged by the same group of staffers, board members, and volunteers that had done it for years. Nevertheless these snafus occurred on his watch. He resigned quietly after the White Party, saying he was frustrated in his attempts to introduce changes at HCN. The layoffs, furloughs, and resignations of other top management soon followed.

Despite its recent cutbacks, HCN, by its own reckoning, provided services of some kind to 920 people during this past March. The agency's heralded Riccardia Child and Family program for HIV-infected children and children who are relatives of AIDS victims allows counselors to visit schools and homes, coordinate summer recreation activities, and work with the children in a special playroom at the HCN main office, 5050 Biscayne Blvd. Funding comes from a private foundation and is channeled through United Way, which currently provides grants to HCN totalling $260,000. This money also funds a telephone hotline whose counselors deal with everything from client referrals to suicide calls. A teen hotline has been discontinued.

Although HCN has no medical staff, its employees provide free clinical services, including counseling, therapy, substance abuse programs, and a confidential HIV testing program. Although the Parent-Teen AIDS Prevention program is no longer operating, HCN continues several other outreach and education programs: Workers go to bars and parks and other locales where young gay men congregate and distribute condoms, AIDS-prevention literature, and advice; and workers and volunteers visit schools, community centers, and offices to speak about AIDS prevention and treatment.

HCN's staff now numbers about 65, including 13 administrative staffers and 3 in the development department, which handles fundraising and public relations. According to the most recent independent financial audit, covering June 1996 through June 1997, salaries and benefits accounted for more than two-thirds of the organization's $3.2 million annual budget. That's not surprising, because most of the staff works directly with clients in case management, counseling, and education.

Individual salaries, including those of top administrators, will remain unknown to the public until after HCN files its annual report to the IRS. Even then, nonprofits are required to report only the salaries of the five highest-paid employees. The agency's most recent filing is for fiscal year 1995, and lists only Cathy Lynch's $77,000 salary. HCN's interim chief executive officer Glenda Hicks won't reveal anyone's current wages, although she says two people earn more than $50,000.

Critics of HCN, as well as some gay business people interested in offering donations, say they've been frustrated in attempts to inspect financial statements or to simply learn how the agency spends the millions it takes in. HCN is not required to itemize most of its expenditures and doesn't have to reveal what proceeds of fundraisers are used for either. Private contributors don't have to be identified.

The general belief within the AIDS community is that HCN spends more than anyone else on salaries and benefits, while other organizations have to depend on volunteer services. "They're top-heavy," contends Gene Suarez, a seasoned AIDS activist who sits on two AIDS services advisory boards and is one of the few people willing to speak on the record about HCN. "I understand the need to be business-oriented, but now it's gotten to be that the only time they're in contact with the community is for fundraising. They have all these people they pay good salaries to do fundraising. They're into money."

HCN managers respond that of course they emphasize fundraising -- not out of obsession with money but because the agency can't do what it's supposed to without paying for salaries, equipment, and facilities. HCN also needs to be able to put up matching funds for big government grants.

Currently a little more than a third of HCN's annual budget comes from the federal government and the State of Florida; more than half a million dollars come from federal Ryan White Title I grant money. Revenue from the agency's annual special events accounts for another third, although the portion was greater in past years. The rest of HCN's financial support comes from United Way, private foundations, revenue from a thrift shop, and other minor sources.

The White Party, held in November, and February's AIDS Walk Miami largely define HCN in the eyes of the public and are covered lavishly by the Miami Herald and other local media. Months of planning and hundreds of thousands of dollars go into staging the events. The most recent editions were promoted more heavily than usual.

Just before the 1997 White Party, an article in the Herald described the travails of AIDS fundraising nationwide. Organizations all over the country were cutting back, and some were going under. Even the Gay Men's Health Crisis of New York, with a budget about ten times bigger than HCN's, recently laid off 20 of its 280 employees, according to spokesman Stephen Soba, and is considering reducing services. Yet in November 1997, HCN was described in the Herald as being "one of the few AIDS groups in the nation not reporting a decline in gifts." The White Party organizers were expecting to clear $815,000, the story added.

That Thanksgiving week of bashes produced only $500,000, about the same as the year before. More events were held but fewer people were allowed into the main party at Vizcaya, and many big contributors were nonplussed by no-shows by Madonna and Patti LaBelle at a special Delano Hotel dinner, at which they were the headlined attractions. (The disappointing take was one of the factors that led to Lichtman's resignation in early January 1998. He has since decried the White Party Week as an out-of-control drug-and-sex fest that "only creates more clients for HCN.")

Planning for the 1998 AIDS Walk began a full nine months in advance. HCN's board paid $15,000 for the services of Miller Zeichik and Associates, a Los Angeles-based firm that has organized successful AIDS Walks in other cities. Six to ten employees, most specially hired for the walk, worked full-time for more than six months; the budget, according to Lichtman, was $100,000. Organizers hoped the 1998 walk could raise one million dollars, twice what it earned in 1997, but the February 22 event grossed just $500,000.

HCN's leadership blames much of its current financial woes on these disappointing results. HCN's problems have not been solely financial, however. In the fall of 1997, an annual evaluation by the Florida Agency for Health Care Administration, which funds a counseling and assistance program at HCN, found case managers had much higher caseloads than allowable under the agency's guidelines, and that several cases weren't being properly documented. "The case ratio is a new problem," says Judy Rosenbaum, regional Medicaid program administrator at the Agency for Health Care Administration. "We've had conversations [recently] that alerted us to some major problems they were having in other areas. We're looking forward to better documentation, and we'll be back out to monitor them."

An independent audit for fiscal year 1995-96 -- required by HCN's government funders and conducted by the Miami accounting firm Kaufman Rossin Co. -- found sparse or nonexistent documentation of services in some clients' case files. The agency maintains that the problems were remedied with the firing of the responsible case workers. Progress reports and requests for reimbursement, however, were "chronically delinquent," the audit noted. This tendency for tardiness was not limited to case files.

In May 1997, after six years of receiving more than half a million dollars annually from the Ryan White Title I program, HCN submitted its 1997 grant application five minutes late and was disqualified from the competitive process. The agency was allowed to reapply in August 1997 and won the twelve-month grant, worth more than $500,000. For three months, though, HCN was providing services without billing the government for reimbursement.

But the staff, according to several former employees, wasn't worried about money. They'd never worried before, and they were getting their paychecks. The board apparently saw no cause for alarm either. "We were hoping we'd make up for those three months with what we raised from the White Party and the AIDS Walk," says board member Alberto Arias. "We thought we were going to make more money."

In January HCN's interim director and chief financial officer Glenda Hicks called Dan Wall at the Dade County Office of Audit and Management Services, through which all Ryan White Title I funds are disbursed. Despite having finally been awarded the grant in October, HCN wasn't expecting to receive the money for several more weeks. Hicks asked Wall if he could speed up payments. Wall issued a check for almost $86,000 on January 14. A week later -- the day after the fourteen layoffs but before the news was made public -- he sent HCN another $60,000. "Because of their cash flow situation, they placed a call to me and said we need to make payroll, so I did what I could," Wall says. "The first news of those layoffs was from the Miami Herald. We'd just made two expedited payments to them, rather large ones. The whole thing about furloughing employees, the leaving of the executive director [Lichtman], was all news to me."

According to the Herald article, the reason for the layoffs was the missed deadline and the White Party shortfall. These explanations were met with widespread skepticism. "A lot of us thought there must be something more to it," says Gene Suarez. "They had a big reserve two years ago and here they were begging and turning people away. They raised money in December; how can you be out in January? All we're asking for is accountability."

Predictably, the crisis has spurred the gay community's rumor mill into overdrive. The latest talk has HCN preparing to file charges against someone for embezzlement, or a group of clients preparing to sue HCN for misspending government funds, or both. There is no evidence to back either claim, which HCN officials deny.

Dan Wall's office is preparing to scrutinize HCN's fiscal year-end budget, submitted April 14, in which the agency must account for all Ryan White Title I funds it awarded. These funds must be spent according to an itemized contract. Wall says he wants to see where the expedited payments went after the layoffs and furloughs. "In their year-end actual accounting of funds, I expect to see changes in expenditures based on the furloughs, and if any of the Title I people were laid off. If they haven't spent it on allowable items, they'll have to return it."

In the meantime, the most recent independent financial audit of HCN was completed earlier this month. It covers June 1996-97, and thus is already outdated. Several problems with documentation and supervision of case files were noted, as well as the recurring "chronically delinquent" reports. These could endanger HCN's Ryan White Title I funding, although the agency has filed a plan to correct the problems. Wall's staff will be monitoring its progress.

The most up-to-date look at HCN's financial state will come from audits now being performed in preparation for its merger with Community Research Initiative. Neither agency claims to know when those audits will be completed and made public.

As for HCN's clients, the past few months have been a period of readjustment. Debilitated by effects of the disease or medications or both, and living on scanty resources, many have had to get used to the extra bus ride or two to another agency for food vouchers or assistance with utility bills. Others are learning that HCN has begun to charge a sliding-scale fee for services. "They've set it up so you pay a part of the costs of counseling and therapy," says Nelson Avila, a client with full-blown AIDS who requires intensive courses of medication and assistance to pay for food, utilities, and other basic necessities.

For the past several months Avila has been chairman of HCN's client advisory committee, which means he also sits on the board of directors. "HCN has incredible counselors and therapists, and it's really sad if we can't get these services. They're telling me my [fee] is four dollars. I don't have four dollars. Other clients are not too happy about this either."

Hicks says the fee scale was implemented to comply with Medicare regulations so the agency could apply for Medicare reimbursement for some of its programs. Most of HCN's clients are so poor anyway, she adds, they won't be required to pay.

Even as a board member, Alvia Palmer Michel was taken aback when HCN management informed the board in January there wasn't enough money to pay salaries and that layoffs would be necessary. "It was a big shock, and it was sudden," says Michel, a well-known activist who is also a client and former employee of the agency. She worried about the continuity of services, particularly the Riccardia program, which is named for her daughter, who in 1987 was born HIV-positive and died five years later. "Emotionally I was affected. I was afraid of people's needs not being met. But I think they're doing the best they can with what they have. Now they refer me out for food vouchers. Just like you have to get on the bus and go to HCN, you have to get on the bus and go somewhere else. It's not like they've abandoned you."

But the belt-tightening has required a reduction in caseloads, Hicks says. The number of AIDS patients in need of support services, meanwhile, has been skyrocketing. And not just because of an increase in new cases.

The rise is also a function of a new battery of medications called protease inhibitors, which have caused a statistical sensation. Recent studies confirm that AIDS patients on the drugs are surviving longer and in many cases regaining much of their strength and health. But they have to follow complicated regimens of pill-taking -- dozens per day, in intricate combinations referred to as cocktails. Some patients never respond to protease inhibitors, some develop secondary diseases or debilitating side effects. For many, the drug cocktails simply stop working after a time, as was the case several years ago with AZT, the first AIDS wonder drug.

In the meantime, though, agencies like HCN not only have more living AIDS patients to serve, but some services have become more important than in the past -- access to extremely expensive medications, for example, and supervision to ensure they're being taken correctly. Then there's the problem of perception. Most people who work in the AIDS community agree that raising money for any project connected with the disease is harder now than a few years ago because the public feels less urgency.

"AIDS has lost its popularity," observes Chip Clawson, a Miami insurance executive and former HCN board member who raises corporate donations for the organization. "It's not fashionable to give to AIDS any more because it has supposedly been cured. The truth is we're on the verge of a rebirth of the epidemic with a whole new generation of cases."

The support infrastructure created since the early Eighties by predominantly white, middle-class gay men -- HCN being a major component of that infrastructure in South Florida -- is being challenged to accommodate a poorer, less politically active population. New AIDS sufferers are overwhelmingly people of color and heterosexual. Non-Hispanic blacks currently have the highest incidence of infection of any ethnic group in the county, accounting for more than 48 percent of all adult cases, according to Dade County Department of Health statistics. Another chilling indicator: There are 393 black non-Hispanic babies with AIDS in the county, compared to 39 Hispanic babies and 20 white non-Hispanic babies.

That's one of the reasons Alvia Palmer Michel, who is black, was appointed to the board of directors of HCN. She first became a client in 1988, worked there as a receptionist for three years, and still does volunteer work. She became one of three black members of the board, which is about half female. "I've been one of the ones wondering what was going on -- just a bunch of white gay men sitting on the board," Michel says. "They are caring people, but in the past they couldn't grasp what our needs were, I guess because our communities' paths didn't cross. We are remedying that. We are communicating better than we were."

To many people of color working in AIDS services, though, HCN's recruitment of a few black minority board members and employees (Glenda Hicks is also black) does not constitute a remedy. They point to the cancellation of the Parent-Teen AIDS Prevention program -- which targeted young black women, the segment of Dade's population most in danger of contracting AIDS and passing it on to their children -- as indicative of a continued disregard for minorities. "It's like they're regressing [in efforts to target people of color]," says Juliette Love, an experienced worker in the AIDS community and former director of HIV programs for Economic Opportunity Family Health Center. "You cannot let those programs go. It says to me that it's not important to them."

To date, no HCN spokesperson has set forth any concrete plans for dealing with the changing face of the AIDS population. At the moment staffers are more focused on the planned merger with CRI.

Richard Siclari, CRI's first employee, set up shop in 1989 on NW 36th Street in one room with a broken desk and a Princess phone. The mission of the new company was to conduct clinical trials of new AIDS medications. Because monetary support for alternative approaches, such as nutrition and herbal therapies, was hard to come by, CRI concentrated on securing funding from pharmaceutical companies to coordinate trials of new drugs, which require several phases of testing before they can be approved by the Food and Drug Administration. Many of the subjects were referred from HCN's vast client base.

By 1996 CRI had an annual budget of more than a million dollars, twenty employees, and new offices in Coral Gables. It was one of about 40 agencies in the nation to test two of the four most widely used protease inhibitors. "We watched one patient after another who were basically at the end, turn around," Siclari says. "The change was absolutely amazing." Assuming the merger happens, more HCN clients should have early access to the latest medical treatments without having to pay the prohibitive costs.

Discussions had been going on between the boards of both agencies for at least a month, according to Siclari, before merger plans were announced in February. The idea of approaching HCN occurred to Siclari long before that, he says, "not to merge, but to collaborate in some way." After Lichtman resigned from HCN, Siclari called attorney Samuel Blum, who sits on both boards, and Betty Alvarez. HCN's financial troubles didn't deter Siclari, who says his organization has also faced the funding struggles endemic to nonprofits.

"This really wasn't just about seeking financial stability," Siclari insists. "I really hoped it wouldn't have that slant. If it was financially driven in any way, it was that we recognize we could become more efficient and think about new service possibilities for our clients."

Instead of provoking the incessant low-grade sniping directed at HCN over the years, the merger idea is receiving a more positive reaction from other service providers. "The truth is I haven't really seen this happening elsewhere," says Kevin Frost, director of clinical research for the American Foundation for AIDS Research (AMFAR) in Washington, D.C., and one of CRI's funders. "And the truth is I wish it would. I think most community organizations have no choice but to cut back on services or to merge with other organizations so they can combine fundraising and grant-making opportunities. In that regard at least, CRI and HCN are way out in front of the curve."

The task force tapped by board president Betty Alvarez to come up with new and better ways of serving AIDS patients is on hold until the merger is accomplished. "The task force may be a part of that further feasibility negotiation as we proceed," Alvarez says. At the moment, the task force doesn't exist.

Representatives of both agencies are awaiting the results of the financial audits and are meeting to work out details such as benefits, job descriptions, and -- one assumes -- a company name and location. If Siclari's current $60,000 salary or the $43,000 for the next-highest-paid CRI employee are any indication, some HCN staffers may have to take a cut in wages. And then there is always the possibility that the merger will lead to more layoffs -- a nonprofit version of corporate downsizing.

"It's going to be a struggle," concedes Michel, who recently got home from a ten-day hospitalization for a blood infection related to AIDS. When she's feeling better, Michel says, she'll resume her appearances before community groups and schoolchildren, in which she relates her own story as a lesson in AIDS prevention, life, death, and perseverance.

She's not too interested in the questions about HCN's management; she just wants its work to continue: "I do know the people at HCN will fight to keep the agency above water. I don't know if they'll win the fight or if it will just die of


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