In Denial

As HIV spreads among blacks and Hispanics, agencies that serve those communities say they're being shortchanged

A few years back, a handful of grassroots agencies that provide care and services

to people with AIDS undertook a bittersweet mission. Known collectively as the Minority Caucus, the group was thrilled to receive more than $1 million in federal funds to distribute among African-American and Latino neighborhoods. But with the money, much of which was used to pay for case management and outreach services, the caucus confirmed an awful truth: the HIV virus had exploded in Houston's minority community, particularly among heterosexuals and women.

And it seemed the influx of resources to care for people of color only begot the need for more.

"They were beginning to break down the barriers," says AIDS activist Joe Fuentes, an HIV-positive Latino. "They were overcoming the denial in the minority communities about HIV."

But that's only led to the emergence of another form of denial, say black and Hispanic AIDS care providers, who, in the last two years, have been forced to eliminate programs and cut services in the very communities where AIDS is flourishing. As a result, the Minority Caucus and its allies have been engaged, as one caucus member put it, in "an ongoing war" with the Harris County Health Department's HIV Services Division and its director, Sue Cooper.

Cooper's office distributes the roughly $10 million the county receives annually through the federal Ryan White CARE Act. AIDS has steadily migrated toward minority communities, according to the Center for Disease Control, so the feds suggest a good deal of that money be funneled to groups that serve blacks, Hispanics and women.

That began to happen in Harris County with the Ryan White Title I grants in February 1992. By any standard, the $4 million or so the Minority Caucus received and distributed over the next three years was money well spent. By 1995, 44 percent of the reported HIV cases in the Harris County area were African-American, 20 percent were Latino, and 27 percent were women, a solid majority of whom contracted the virus through sexual contact.

As the epidemic spread beyond gay white males, so, naturally, did the money. The percentage of Ryan White grants awarded to Houston's minority-based agencies rose from the low teens to 27 percent in 1994. As a director in the National Minority AIDS Council described in a February 1995 letter to the White House, "[t]he Houston experience is indeed a laudable example of successful community empowerment and ownership of the disease."

That experience, however, has become anything but admirable. In August 1994, the county attorney ruled that funds targeted for the Minority Caucus constituted an illegal set-aside. When the 1995 Ryan White grants were distributed six months later, minority-based groups found themselves in a time warp, circa 1990, when agencies that serve gay men reaped the lion's share of the grants.

The 1996 Title I appropriations take them back even further. Of the $6.6 million Harris County received in February (supplemental allocations this month will bring the total to about $11 million), $5 million has gone to a handful of so-called "mainstream" agencies, most of which have seen more minorities come through their doors, but nonetheless have historically served a largely white clientele.

Meanwhile, only $1.4 million was disbursed among 17 HIV-care agencies in predominantly black and Hispanic neighborhoods. The most troubling cuts have come from areas such as case management and transportation, which are critical to reaching those who are reluctant or unable to seek help.

"If you're a person who could look at the overall picture, you could see this was helping," says Audrey Gassama, chairperson of the Minority Caucus and founder of the Loving Arms Foundation, a daycare center for HIV-positive children. "We have made such good progress, and to me, it was just sabotage to the minority community, what Sue Cooper did."

Cooper has been director of the county's HIV services -- and chief administrator of the Ryan White grants -- since the division was formed in 1992. Until then, the federal funds were handled by the Greater Houston AIDS Alliance, which Cooper ran before taking the county job.

Soon after Cooper's departure, the AIDS Alliance collapsed following an independent audit ordered by her successor, Michael Stringer. The audit found that there were no records of millions of dollars in Ryan White grants allocated on Cooper's watch. Theft and fraud were ruled out, Stringer says, but the AIDS Alliance was ordered to pay more than $100,000 in state and federal fines.

No one's accusing the HIV Services Division of mismanaging Ryan White grants. But Cooper's critics -- not all of them are black and Hispanic -- say she has skewed the funding process to favor a few large groups while making it difficult for minority clients to get care. Cooper is deeply mistrusted by minority AIDS activists, and wafting around the vociferous complaint that she's a poor administrator is the fear that she is hoarding power or, worse, a racist.

Cooper dismisses her critics as too few to be of any consequence. Those who do complain, she adds, take "great delight" in it.

"We cannot base funding on the ethnicity of the agency," Cooper insists. "The county attorney said it was illegal. The bottom line for this office is to obey the law and do our job. The issues are much broader for some of these groups."

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