Bay Area Reporter - December 15, 2005
Zak Szymanski, z.szymanski@ebar.com

Recently, the Tenderloin AIDS Resource Center and Continuum did just that, passing resolutions to assess the feasibility of merging into a single organization.

"We are currently engaged in an exploration of the most strategic way to work together to improve our services while becoming more efficient," said a joint statement released by the organizations following a meeting in October. "We are very good colleagues and neighbors and our premise in coming to this exploration is that it has to make sense to each of us in every way before we move forward."

Overall, HIV/AIDS funding has been declining steadily for years, and San Francisco in particular has been hard hit, with many of its programs competing for limited resources and cutting staff and services to compensate. Since 1995, federal Ryan White CARE funding to the city has decreased $13.3 million, or 32 percent. An additional 21 percent cut in Ryan White CARE funding is expected over the next five years, as are cuts in other government funding sources.

Faced with reductions in Medi-Cal reimbursements, CARE funds, and city money, Continuum had to suspend its groundbreaking Adult Day Health Program earlier this year and consolidate its multiple service sites into one Tenderloin location. Both TARC and Continuum also are facing the end of their two-year prevention contracts from the Centers for Disease Control and Prevention, according to a statement from TARC, which added that both groups also have recently won new prevention contracts from the San Francisco Department of Public Health. Currently, Continuum's budget is $2.3 million and TARC's is $4.7 million for 2005-06. A consolidation of the two would create a larger agency dedicated to providing health and housing services to lower-income residents living with and at great risk for HIV/AIDS.

"We're one of probably many agencies looking to merge," said Tracy Brown, executive director of TARC, who pointed to organizations such as Asian and Pacific Islander Wellness Center and New Leaf: Services for Our Community as models for the process. API Wellness was formed out of the merger of Asian AIDS Project and Living Well Project in 1996 to become the largest and most comprehensive API HIV/AIDS organization in North America. And New Leaf is the product of Operation Concern and 18th Street Services, which merged in 1995 to form the country's leading outpatient LGBT mental health center.

"I've always wondered why we weren't the same agency to begin with," said Brown of Continuum and TARC. "We're one block away from each other. We share some clients but we do different things."

Similar interests

Continuum seeks "to empower and dignify the lives of underserved people with HIV/AIDS by providing innovative health and human services that establish community, improve health and reduce the rate of HIV infection in the community," according to its mission statement. Continuum provides primary care, nursing, case management, and mental health services to a variety of lower-income populations. TARC estimates that it gets more clients who are victims of multiple issues including homelessness, HIV/AIDS, substance abuse, and mental illness, and its programs include a drop-in center and housing for a primarily indigent population. Both groups provide their clients with HIV prevention and testing.

One goal of the possible merger would be to reopen Continuum's ADHC, which for 15 years provided case management, skilled nursing, emotional support, a therapeutic community, meals, and a variety of rehabilitative services, including art therapy and physical and occupational therapy, to lower-income people with HIV/AIDS.

"Our goal has always been to reopen that program in some form, and we've always talked about it as being in suspension. There's not another program like it in the country," said Chiquita Tuttle, Continuum's interim executive director.

Tuttle, who took over for Mark Cloutier in May when he became executive director of San Francisco AIDS Foundation, makes her living as an interim director specifically to help organizations through transitional periods. Because she enters situations without an intent to be permanently hired means she can work "unbiased, with a clear set of goals," she said, adding that Continuum officials presented her with the idea of a merger after she had been hired. Because a final vision for the groups has not been agreed upon, said Tuttle, Continuum has not yet actively sought a permanent replacement for Cloutier as executive director.

Complex

Nonprofit mergers are complex, requiring agreements on everything from a mission and operating specifics to who will serve on the board and as executive director. For that reason, said Brown and Tuttle, specific negotiations are private and the process will take some time.

"If indeed it does happen it's going to be a lot work. At this point all we can say is that the public might want to start being aware that this is a possibility. We can't say this is definitely going to happen û we're not at that point yet," said Brown.

The organizations still need to determine if the merger is financially feasible, given that the groups may have some funding source overlaps that would be collectively lost û rather than gained û by coming together, said Brown.

"If we have too many funding overlaps we could actually wind up being in worse shape. If there are private institutions, for instance, that give no more than $20,000 to an agency then we'd still only get $20,000," Brown explained, adding that on the other hand, identifying duplicate funding that one group could be in jeopardy of losing would be beneficial to both groups. "If we can become more efficient by reducing that redundancy we won't have to feel the impact as much in our client services, which is what we're both concerned about in the face of funding cuts."

Helping the groups determine the feasibility of a merger are several city groups and agencies, said Brown, with the San Francisco Foundation, State Office of AIDS, and the health department all contributing funds to the process. Compass Point, the organization that assists nonprofits, is working with both groups to facilitate negotiations. Negotiation committees are comprised of board members and executive staff from both agencies.

"We're all concerned about the HIV/AIDS needs of Tenderloin residents. If Continuum has residents who are hurting then we're not doing our job either," said Brown. "It would be nice not to have to compete with them anymore, and to say, 'Let's do this together.' Hopefully we can be an example to others that it can work."

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