By Jacqueline L. Salmon
Washington Post Staff Writer
Monday, December 27, 2004; Page B01

Maritza Sanson, a pixyish woman with a cap of soft brown curls, broke into a wide smile on a recent afternoon when a Food & Friends volunteer showed up at her D.C. home with the daily delivery of food.

On today's menu: bagels and cream cheese for Sanson, 42, and her husband, Luis Fernando Hurtado, 47, as well as fruit salad, fish sandwiches, green beans and potatoes.

"This is fantastic," Sanson said, as she unpacked the containers and stowed them in her small refrigerator.

Just a few years ago, Sanson, who is recovering from breast cancer, would not have been able to receive free food delivery from Food & Friends. The District organization had provided daily meals since 1988 only to those incapacitated by HIV/AIDS in the Washington area.

But in 2000, Food & Friends began providing six-day-a-week food delivery and groceries to those with other life-threatening diseases, such as Parkinson's, cancer and Alzheimer's.

Across the country, more and more AIDS organizations that have provided food, housing, legal aid, medical treatment and other help to those infected with HIV/AIDS are diversifying.

But the expansion has drawn concerns from those who note that 40,000 new HIV infections occur annually in the United States and that 18,000 people a year die of AIDS. They say that those afflicted by HIV/AIDS will be shunted aside in the rush to diversify.

"The epidemic is not over," said Michael Petrelis, a San Francisco AIDS activist. By diversifying, "it seems like they're spreading themselves way too thin, especially since [AIDS] funding levels are down."

Kandy Ferree, president of the National AIDS Fund, which helps finance about 400 community AIDS groups, said she is concerned that some AIDS groups may expand into fields where they aren't as qualified just to get more funding.

"It is absolutely critical that organizations . . . not chase dollars for the sake of chasing dollars," Ferree said. "It's very dangerous."

But the AIDS groups that are diversifying say reduced AIDS funding and fading interest in AIDS causes among donors are forcing them to seek other income sources. In addition, AIDS groups say, they have a moral imperative to share expertise developed during two decades of caring for seriously ill AIDS patients.

"If we've created a service that's needed by people who are sick, then we should do what we can to expand to meet their needs," said Stephen Woods, executive director of Project Open Hand in Atlanta. "Just because we responded to a crisis at one point in time [doesn't make it] necessary to focus only on one population."

For Food & Friends, the result has been a dramatic change in one of the largest AIDS organizations in the country. These days, 40 percent of people who receive food from the group suffer from other illnesses.

Food & Friends' leader says the organization had to expand its clientele to remain alive in an era when AIDS funding is shrinking, the AIDS death rate has fallen and those infected with HIV are living longer.

"If one depended solely upon funds that are restricted to persons with AIDS, I think there is a serious question of whether we could survive," said Food & Friends Executive Director Craig Sniderman.

In Texas, AIDS Foundation Houston now offers housing, substance-abuse treatment and other help to people suffering from other infectious diseases and diabetes. The Latino Commission on AIDS in New York is helping Latino immigrants not afflicted with AIDS apply for asylum. Project Open Hand, which formerly delivered food just to AIDS patients, now also manages eight senior centers and delivers food to the elderly.

"It's definitely very much a trend in the field," said Frank Abdale, executive director of the Association of Nutrition Service Agencies, a national organization of 120 AIDS groups. Abdale said that all of his association's large members have expanded beyond AIDS.

AIDS groups have also turned their attention abroad, offering clinics, drug treatment and other services to combat the international AIDS epidemic. For some groups, diversifying has had a dramatic impact.

Miracle House, a 14-year-old charity in New York that started out offering temporary housing to out-of-town caretakers of hospitalized AIDS patients, has had its proportion of AIDS patients fall to just 10 percent of its clientele since it opened to those with other ailments and their caretakers.

Miracle House Executive Director Gilles Mesrobian said the organization broadened its mission after noticing that demand was falling because fewer AIDS patients were being hospitalized for long periods.

"If we had not made this transition, we probably would not have survived," he said. "A lot of smaller [AIDS] organizations have failed because they were unable to keep abreast of change or adapt to the landscape."

AIDS groups say that expansion has helped them shore up sagging fundraising efforts.

"There is an awful lot of donor fatigue on AIDS," said Mike Smith, executive director of the AIDS Emergency Fund in San Francisco, which expanded to include breast cancer patients a few years ago. Since then, it has received tens of thousands of dollars from such groups as the Susan G. Komen Breast Cancer Foundation.

Some groups are looking abroad, where the international AIDS crisis is drawing more attention -- and dollars -- than the domestic AIDS situation.

Next year, for example, the Children Affected by AIDS Foundation in Los Angeles expects that its funds going to international AIDS initiatives will jump from 10 percent to 25 percent of its budget, said Executive Director Catherine Brown.

The group operates programs in Latin America and the Caribbean to work with children affected by AIDS. It plans to expand to up to a dozen countries.

Noting that an estimated 13 million children worldwide have been orphaned by AIDS, Brown said her group couldn't look away.

"You can't be in pediatric HIV/AIDS and have that as your mission and ignore what's going on internationally," Brown said.

At Food & Friends, expanding its mission also caused some strife -- internally and externally.

The local ACT UP chapter has objected to the changeover. Spokesman Wayne Turner said Food & Friends' move is "an embodiment of what is happening with [AIDS] charities around the country. These groups that were formed to meet the specific needs of people with AIDS have become monsters."

Food & Friends' leadership also argued over the changes.

"We had some members who felt that we might be abandoning the gay community," said Suzanne Goldstein, president of Food & Friends' board of directors.

Since the expansion took effect, Food & Friends has prospered. Its budget has climbed about 35 percent since 2000 -- from $4.7 million to an expected $6.3 million in 2005.

In October, it opened an $8.7 million headquarters in Northeast Washington -- twice the size of its leased facilities in Southeast Washington.

The new facility -- with a large commercial kitchen, 10 walk-in freezers and coolers, and a covered loading area -- will allow the group to triple the number of people to whom it delivers food to 3,000 people a day.

It now feeds 1,000 in 14 counties in the Washington area.

The diversification to other illnesses also has enabled the charity to attract funding from organizations that wouldn't have given it a second look before, leaders say.

The Avon Foundation has donated $1.5 million -- half for Food & Friends' headquarters construction and half to help fund its services to breast cancer patients.

Avon Foundation President Kathleen Walas said her organization was impressed that the group had expanded into other illnesses after doing such a good job focusing on HIV/AIDS victims.

Food & Friends is "an organization for others of their type to keep an eye on," Walas said.