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."

As for the central issue -- the perceived undermining of care and services in places where AIDS is on the rise -- Cooper says her hands are tied.

"I can't get into that argument. That's not my job."
Apparently not. Cooper was conspicuously absent from the recent "State of HIV in Houston" forum at City Hall. While the name implies universal participation, the event -- arranged by City Councilmembers Judson Robinson III and Gracie Saenz -- was clearly an opportunity for the Minority Caucus to air the plight of its community-based agencies. Cooper says she wasn't invited to sit on the panel, but planned to attend until "something came up at home."

In fact, the forum has sparked a backlash of sorts among the better-funded care providers, whose presence in the discussion was reduced to a few seats in the audience. Toward evening's end, however, their collective gripe was delivered by Sara Selber, executive director of the AIDS Foundation Houston.

Listening to Selber is itself like a trip in time, back to when early warnings about the HIV virus were widely ignored. The AIDS Foundation is one of the biggest and best at handling the consequences of that ignorance, offering case management services, emergency assistance, scores of volunteers and probably the best food pantry in the city to about 1,500 people a year.

"For the record," Selber says, the foundation will "fight" for the small minority agencies, despite being what she terms "grossly underfunded" itself. But that didn't appear to be her purpose during the City Hall symposium, when, clearly agitated, she wondered aloud how the Minority Caucus rated its own forum. And in a recent interview, Selber showed a less-than-empathetic side that would probably resonate with any gay man who has survived the denial of HIV that existed a decade ago.

"When I didn't get funding for something or another, I looked at my grant to see what I'd done wrong," Selber says. "Sure enough, it wasn't a good grant.

"I lost $75,000 from our food pantry, and no one's screaming about that. We took a $75,000 cut, and we never opened our mouth. I just looked elsewhere for it."

That's easy for her to say, counter Minority Caucus members. Despite the food pantry cuts, the AIDS Foundation's share of the 1996 Ryan White funds will be more than $500,000, 20 percent more than in 1995.

"If the process is flawed, and it's flawed to your benefit," says caucus chair Audrey Gassama, "then naturally you're going to be happy."

Less pleased are people like Lucy Reyna, vice chair of the Minority Caucus, who runs the HIV program at the Association for the Advancement of Mexican-Americans. Before the county attorney's ruling, AAMA had provided case management, outreach and transportation services to more than 500 people a year, 70 percent of whom were Hispanic. But in 1995, the agency's Ryan White funding was slashed by $425,000. This year, AAMA's in deeper straits: including supplemental funds, it will probably receive no more than $110,000.

As a result, Reyna has had to turn most of her HIV case load over to other agencies. Some of her clients were fortunate enough to land at AVES -- the Amigos Volunteers in Education and Services. Reyna can only hope the others will go to the referral agency, never mind being happy about it.

"It's money," Reyna says. "The minority and mainstream agencies are being pitted against each other because the mainstream saw that the minorities were gaining strength and getting more money."

The din has prompted Harris County Judge Robert Eckels to order an examination of how Harris County doles out Ryan White grants. The funding cycle begins each November, when care providers submit proposals outlining their services, projected clientele, experience and costs. An anonymous panel scores the proposals and sends them along to the county purchasing department, where everything that's transpired is inexplicably tossed out the window.

The purchasing department takes the scored proposals and weighs them against the ethnic breakdown of AIDS cases within the entire Ryan White funding area. Those demographics are roughly 40 percent white, 40 percent black and 20 percent Hispanic. No matter how an agency scores, the extent to which it proposes to serve a clientele that meets those exact demographics determines how much Title I funding it receives.

For example, AAMA predicted a clientele that is 69 percent Hispanic, and indeed scored highest in several funding areas. But because the county estimates that only 20 percent of HIV cases are Hispanic, AAMA received only 20 percent of the funds it requested for its Latino clients. Case management and volunteer funding was completely cut, and though its food pantry scored highest of all, AAMA received little more than half the $71,000 it requested to feed its clients.

According to an analysis by AAMA's executive director, Gilbert Moreno, all community-based groups have suffered similarly. On average, minority agencies that scored highest in various funding categories ultimately received just 50 to 75 cents of each dollar they requested. On the other hand, the so-called "mainstream" agencies -- such as the AIDS Foundation and the Family Service Center -- received an average of about 90 percent of what they asked for.

"To score highest and be told that you're serving too many of your population is a slap in the face," Reyna says.

Particularly when Reyna and others in the Minority Caucus suspect that those agencies that have historically served gay men are in fact cooking their client projections to assure themselves more funding. They insist there is no way that, say, the AIDS Foundation -- whose offices are on the northern edge of River Oaks -- can claim to serve a majority of blacks and Hispanics.

Selber reported that just more than half her clients in 1995 were black or Hispanic; 82 percent were men. Yet in 1996, the foundation received funding for seven minority case managers. Meanwhile, there are no community-based case management services available for African-Americans. The NAACP lost its case manager, and the WAM Foundation, whose 1,700 clients are 89 percent black and 63 percent women, was shut out as well.

"The problem is," says Ann Robison, director of the Montrose Counseling Clinic, "a lot of agencies are now saying they are minority agencies. The AIDS Foundation got all the African-American case managers. I would be embarrassed to try and claim to be a minority provider."

Eckels and Cooper say that if there's a better way to distribute the Ryan White grants, they want to hear it. Eckels ordered King Hillier, chair of the Harris County Ryan White Planning Council, which sets funding priorities for HIV services, to form a committee to make recommendations. Hillier, who admits there are inequities in the county process, says he has asked the committee to finish its work by month's end.

But many say the committee's recommendations will be meaningless as long as the Planning Council continues to consist of representatives from the largest, best-funded agencies. The Minority Caucus thrived at a time when the NAACP, AAMA and other community-based groups had seats on the council. Now, none of those groups are represented.

"We were all thrown off," Gassama says. "It seems to me that if you were interested in working with the community, you'd have the NAACP and AAMA involved."

Eckels seems to be losing patience with the Minority Caucus' complaints. He acknowledges that injustices have occurred, but that no one complained until after the funds were allocated. And, as far as he's concerned, Sue Cooper and the HIV Services Division are not the problem. He agrees with his HIV services director that she is being assailed by a few malcontents.

"If they could come up with a way to fund everyone of those organizations totally, to the extent that it complies with the county purchasing laws, we'd do it tomorrow," Eckels says. "It's not about any racial issues. If AAMA can make their case on the criteria established, they will be funded. They told me they could compete.

"The process is flawed? Well, make the process work. But I don't want them coming back to me after the fact complaining that it doesn't work."

To some longtime AIDS activists, the struggle for equality in Harris County has been exhausting. And it'll likely heat up more before it gets better -- in addition to councilmembers Robinson and Saenz, four Texas lawmakers have begun to lobby for more minority funding: Congressman Gene Green, state Senator Mario Gallegos and state Representatives Gerard Torres and Garnet Coleman.

Some wonder if that will be enough clout.
Bob Hergenroeder, director of the very directly named People with Aids Coalition, went toe-to-toe with Cooper for almost two years over the county attorney's ruling on minority funding. Nothing's changed since then, and while he doubtlessly hopes for the best, he sounds far from optimistic.

"The assumption was that the minority agencies would do as well as anyone else," he says. "But it's been proved that they are not on an equal footing. It seems like the county really doesn't care if the minority agencies get any funding.

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