June 25, 2016; San Francisco Chronicle

The landscape of the AIDS epidemic has changed drastically over the last 15 years—so much so that “organizational Darwinism” has set in for the nonprofits that were born of the crisis in the 1980s and ’90s, according to Craig Miller, the founder of AIDS Walk.

The San Francisco Chronicle told the story of the rapidly changing outlook for AIDS nonprofits. Agencies serving clients with AIDS and HIV have had to address a number of factors:

Both the public perception and the reality of AIDS and related illnesses moved from a “death sentence” to a chronic, managed disease. This has impacted what services need to be delivered to clients.

Clients have gone from young men who were dying at 25 to older patients who, at 55, are still living. Currently, more than half of the people with HIV in San Francisco are 50 or older.

The agencies providing food service have, over time, had a redefinition in what constitutes a healthy meal. In their infancy, these organizations provided menus of high-carb, high-calorie comfort foods for clients who were experiencing great weight loss; now, they’re serving healthier food to those living with diabetes and heart disease.

Technology and online services have replaced the need for phone lines offering information. San Francisco AIDS Foundation, founded in 1982, shut down its phone lines, which had become irrelevant to patients who could search out needed knowledge on the Internet.

Another shift for some agencies: expanding the focus beyond AIDS. Several nonprofits now provide service to cancer patients and those with heart disease.

Improved safer sex practices and advances in drug therapies and medical treatments have shrunk the client base dramatically; some agencies serve half the number they did in the mid-1990s.

Federal funding peaked in the early 1990s, and today’s donors are increasingly interested in more urgent charitable causes.

Miller expands on his “organizational Darwinism” comment by saying, “The process isn’t any prettier than it is in the animal kingdom, but it is necessary.”

Another outcome is the increasing number of nonprofit mergers. The Positive Resource Center, one of the original nonprofits focused on AIDS, will be merging with two other nonprofits: Baker Place, a 52-year-old agency offering housing and treatment for substance abuse and mental health issues; and AIDS Emergency Fund, an agency created by gay men and their friends and family to deal with the AIDS crisis. Last November, Shanti, a nonprofit providing peer support since the mid-1980s, merged with PAWS (Pets Are Wonderful Support).

“We went from Shanti helping people die well to Shanti helping people live well,” said Kaushik Roy, Executive Director.—Jeanne Allen