Us Helping Us, People Into Living Inc.'s name speaks volumes about its mission: The organization was founded in 1985 to help African-American bisexual and gay men in Washington, D.C., grapple with HIV and AIDS at a time when the disease's support system was perceived as being primarily for white gay men.

Fifteen years later, the organization has come far from its impromptu beginnings in a D.C. juice bar to become an established agency with a $1 million budget and ten employees. This growth, according to Ron Simmons, Us Helping Us's executive director, reflects the continuing need for bisexual and gay men of color to have an AIDS service organization to call their own.

"In D.C. the black gay community is quite separate from the white gay community," Simmons says. "We have five or six bars that are solely black-run, and 99% of the people who go there are black. Having that, black gay men are accustomed to being in a black gay environment. Us Helping Us provides that."

Us Helping Us, which offers prevention programs, holistic health services, case management, and an information hot line, is among dozens of organizations nationwide that have been formed to address the needs of specific demographic groups—among them women, Asians, Latinos, and African-Americans—affected by HIV and AIDS.

At the epidemic's outset, members of these groups say, the major AIDS service providers did not offer programs that took into account their specific cultural issues and concerns. Even though at many large AIDS service organizations—such as Gay Men's Health Crisis in New York City and AIDS Project Los Angeles—the majority of clients today are not white and programs have evolved to address the changing face of the epidemic, many people still prefer the comfort zone of a smaller, minority-run agency.

"Research has shown that black folks will change not only the way they speak but what they say when they're in an interracial environment," Simmons says. "It becomes a problem in a support group if people aren't going to be real."

Indeed, if communication is key to a successful client relationship, then obviously the people who work with the clients have to speak the same language. That was not so obvious in 1991 in San Diego, when a lack of bilingual services led to the formation of PACTO Latino AIDS Organization. "A lot of the Latino community would go to…agencies, and they didn't have Spanish-speaking personnel," says Cesar Enriquez, PACTO's executive director. "Even the clients that did speak English said they weren't treated right. They said they were discriminated against because they were Latino."

Today, PACTO continues to fill a service gap by offering bilingual case management and prevention-outreach programs, and it runs two transitional shelters—including the only one for the transgendered in San Diego. Still, balancing its $200,000 annual budget is a struggle, according to Enriquez, who relies on federal Ryan White Act funds the county distributes. "If I could find other funding sources, I would drop [the Ryan White funding] completely," Enriquez says. "There is a lot of politics involved."

In Philadelphia, cultural—and language—barriers led to the founding of AIDS Services in Asian Communities in 1995. Formed in response to the influx of numerous refugees from Vietnam, Cambodia, and Laos, ASIAC offers case management, interpretation services, and culturally sensitive prevention programs. "In the [Asian-Pacific Islander] community, they don't really talk about subjects like homosexuality and drug abuse," says Ronald Sy, ASIAC's executive director. "The general perception is that this doesn't happen in our community—it happens elsewhere."

ASIAC has carved out a broad role as an AIDS service organization through its official designation as the regional provider for interpreters and translation services for all languages spoken in the area. The interpreters accompany clients when they meet with case managers, visit doctors, and pick up medication at pharmacies. "We feel this is our most important function," Sy notes, "to be a bridge between consumers and providers."

Language and culture are not the only barriers to attaining the most appropriate services. Even women with HIV who speak English as their first language often feel like their situation is not understood. That is where agencies such as Women Alive, a Los Angeles-based treatment, education, and advocacy organization for women with HIV, come in. Started in 1991 as a program of the AIDS service organization Being Alive, West Hollywood, the women's group went out on its own in 1997.

"The issues are different for women," explains Women Alive program director Tammy Vitrano. "The stigma is still so strong—the shame and the fear. We just needed a private place for them to come."

Women Alive offers a range of support programs, including counseling services and a telephone hot line, led by peer educators. Just as important as the organization's services is its ambience, according to Vitrano. "I think our members feel that their needs are met when they come here," she says. "It's more of a personal touch. They're not just another client number. We're on a first-name basis. They know they can come anytime and hang out."

Still, organizations like Women Alive—with only half a dozen or so staff members and an annual budget typically well under $1 million—cannot provide every service to clients.

For example, Us Helping Us offers case management but does not have medical services, while Women Alive does not offer case management. ASIAC has a lengthy waiting list for its small case management program, and PACTO Latino must refer clients who need counseling to another agency.

That is where older, more established organizations can fill gaps in services. How do these much larger entities view their smaller counterparts? Do they see them as competitors or partners in the fight?

"We don't see it as a we-versus-they opposition," says Ronald Johnson, associate executive director at Gay Men's Health Crisis. "We see it as we're all serving the needs of people who are affected by this epidemic. There is unfortunately more than enough need for all of us to be in there fighting." G