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Maloney admits that poor treatment of donors and word-of-mouth stories spread by clients could be partly responsible for the drop in CAP's fundraising. "That wouldn't be surprising," she concedes. "Again, we've made mistakes -- and then there are the people who are unhappy no matter what. Our history has been a tough one, and sometimes people will look to the past rather than to our hopes for the future."
Everyone seems to agree that working together with other organizations is the key to successfully evolving with the epidemic. "Because of the new leadership at CAP, for the first time, we may have a staff and a board that works together for the clients," says the PWA Coalition's McKittrick. "The board is very strong at CAP. There were different goals and directions between the board and staff for a long time, and they weren't collaborating with different agencies because they weren't collaborating among themselves."
Maloney seems to understand that. "It's probably up for debate whether we've bitten off more than we can chew," she says. "Collaboration is the wave of the future. There's this perception out there that CAP has this big ego -- that we're the big guy in town. Well, I'm here to tell you we're not about ego. We need to get together with other AIDS agencies to collaborate. This is definitely a turning point. We need a dialogue about how to be more cost-effective."
Board president Shea agrees. "When you look at the number of women, black people, immigrants and homeless people we're serving now, it changes everything we do and how we do it," he says. "That raises a lot of questions: How does one organization do everything? Can we do everything for everybody? How do we focus on what we do best?"
While CAP's challenges include healing old wounds with donors and clients, coming up with new and creative ways to raise money, responding to changes in the epidemic without spreading itself too thin and collaborating with other agencies, the nonprofit's critics are also facing a challenge: to learn how to adapt along with the organization. Some understand that CAP simply can no longer operate as the grassroots agency it once was, but others continue to resist change.
"In the 1980s, the PWA Coalition was totally volunteer-based. We've had to become more professional, and that's been a struggle," McKittrick says. "All AIDS service agencies have struggled with going from grassroots groups to professional human-services case-management organizations."
The Cascade AIDS Project has also recognized the need to be more professional as the needs of its clients have changed. Bruner, Cascade's executive director, says complaints about agencies not offering compassionate services, such as grocery-store coupons and meals in the waiting room, are ridiculous. "I would never do that here. That's crazy. No health and human-services nonprofit operates as a drop-in day center. Some people feel that once an organization does something, it has to do it forever more, and that's crazy, too," he says. "Ten years ago, people who had AIDS were usually dead within a year. Look at the dramatic increases in life expectancy and life quality in the last few years. If people are only living for a few months and need a place to hang out, my God, let's do all those feel-good things, but why should the agency be a drop-in lunch place for people who are doing better? Get your own lunch!"
Agencies like CAP, Bruner continues, "can't consist of the same ten people who hug everyone who walks through the door; they have to become more businesslike. To bemoan the loss of the touchy-feely grassroots response of the past is outdated. We've fast-forwarded twenty years, and it's not just about HIV now; it's about homelessness and drug addictions and mental-health problems and on and on, and it's probably not going to feel like it did in 1984 anymore.
"The role of places like CAP is different now. They're about how to help people live with this disease and be self-sufficient," he says. "I'm more focused on those things than on the feel-good stuff of years ago. Back then, we did lots of things that were small, immediate gestures to ease people's pain, but we can't operate like we used to."