The crisis forcing deep, painful cuts at the Whitman-Walker Clinic, long the Washington region's leader in the fight against AIDS, stems from financial erosion over the past six years and myriad factors that were within and beyond the organization's control.
Fundraising slowed and then plummeted. Assets were spent down when revenue did not cover expenses. Programs that could have been cut were maintained or expanded.
According to supporters and detractors alike, the board of directors' reluctance to confront those factors reflects an intensely held philosophy that the nationally known clinic should be a one-stop shop for the men and women it serves -- not just those infected with the AIDS virus, but also the entire gay, lesbian, bisexual and transgender community.
As board chairman Billy Cox explained, "We've tried to do everything for everybody."
"Our hearts have, for many years, extended beyond our purse," Cox said after the cuts were announced Wednesday. He said he and his colleagues have worried about the implications "for a long time" and were torn over how to respond. "The board is a very passionate board, and people feel like the programs we offer are sacred."
Everything changed when Whitman-Walker couldn't meet its payroll in mid-May, when its chairman called D.C. council member Jim Graham (D-Ward 1), who headed the clinic for 15 years, and said the organization desperately needed help. Cox and interim Executive Director Roberta Geidner-Antoniotti laid much of the blame on the D.C. Health Department and the Prince George's County housing agency, which together owed the nonprofit more than $700,000 for services provided months earlier.
Although critical of the city's troubled reimbursement system, Graham was sympathetic only to a point. He was floored that a $29 million organization -- one of the largest of its kind in the country, with 7,000 HIV clients and a host of comprehensive medical, legal, housing and social services -- could be threatened so completely by a $475,000 payroll. The clinic's million-dollar line of credit? Maxed out, he was told. Its cash reserves? Drawn down.
The reasons can be traced to the late 1990s, several years after the introduction of powerful drug cocktails that began to stanch the chilling mortality rate among AIDS victims. (By July 1998, as Whitman-Walker marked its 25th anniversary, the country had recorded 665,357 AIDS cases and more than 401,000 deaths.) As the rate of deaths decreased, the sense of urgency about AIDS and the needs of those afflicted seemed to fade among many supporters. Many were ready to turn to other issues.
Said former volunteer Richard Rosendall, now vice president for political affairs at the Gay and Lesbian Activists Alliance: "It created a whole new set of challenges."
So did the changing face of AIDS. Twenty years into the epidemic, no longer did gay, white men predominate among those infected. In Washington in particular, the disease was overtaking the black community, largely through intravenous drug use and heterosexual contact. More recent AIDS patients were increasingly poor and female.
All of that had implications for Whitman-Walker's fundraising juggernaut, which had benefited from such mega-events as the AIDS Ride. "You're not going to fill galas at the Mayflower with people from public housing," D.C. Council member David A. Catania (I-At Large) said wryly.
Contributions plunged. In 2000, they totaled almost $13 million; three years later, they fell to $8.2 million.
Across the country, similar forces buffeted Whitman-Walker's counterparts, large organizations that also were founded as health and support centers for gays and lesbians and which became the first responders when AIDS hit in the early 1980s.
The Gay Men's Health Crisis in Manhattan recorded a $4 million deficit as fundraising faltered in 1998 and government money failed to cover the difference. "We were operating an agency larger than we could maintain," recounted its executive director, Ana Oliveira. The center hired a consultant who recommended an "intensive-care response" -- eliminating departments and programs and one-third of the staff. The action was drastic but successful. After 30 months, all debt was paid. Every budget since has been balanced.
"These financial crises, they're very painful, they're very difficult to get through. . . . They're very humbling," Oliveira said.
For Whitman-Walker, such problems began during a time of protracted internal turmoil. Graham quit as executive director for a D.C. Council seat. His successor, Elliot J. Johnson, was not in place for eight months, and four month later was ousted amid allegations of inappropriate behavior and an undisclosed criminal record.
A. Cornelius Baker then was hired to lead the clinic and reenergize a demoralized and depleted staff. Fiscal 2000 closed with a moderate but telling deficit -- one that would have exceeded six figures if not for $880,000 in line-of-credit borrowing. Less than a year later came the Sept. 11 terrorist attacks and their devastating diversion of money previously counted on for support. The fundraising never rebounded.
"A lot of things out of their control put them where they are, and a lot of things in their control put them where they are, and it's the complicated relationship between the two," said J. Channing Wickham, who leads Washington AIDS Partnership, a philanthropic collaborative. "There's plenty of blame and responsibility to go around here."
Excepting a one-time budget cut right after the Sept. 11 attacks, the board did not substantially target spending or programs. It began selling real estate to cover shortfalls or to buy other property. Those purchases, aimed at consolidating clinic facilities along 14th Street NW, might make sense over time but did not address immediate needs.
Progress was made in reducing long-term debt, to $6.7 million in 2003 from $8.3 million in 1999. But with contributions still dropping and key federal grants flat, there was little margin for maneuvering. The clinic announced it would pull out of the housing assistance business. It established a sliding-fee payment scale and laid off some workers. Still, by last month the delays in local government reimbursements for medical care, rental assistance and other services pushed the operation to the edge.
Baker, who left in December, believes a major business plan approved last fall could have averted the cash-flow emergency had it been implemented. "The long-term solvency for the clinic is great," he said last month.
In parts of the community, Whitman-Walker's image remains tied to its founding by gay, white men -- to its detriment, some activists said. Although two-thirds of the 38-member board is white, the clientele is 56 percent black and 10 percent Hispanic. More than eight in 10 HIV clients make less than $12,000 annually.
The $2.5 million in cuts announced last week has elicited "a great outpouring of community support," Geidner-Antoniotti said Friday. Clients and supporters are sending donations as small as $10 and as large as $10,000. Many are shocked by the scope of the measures: The clinic will pull out of the Northern Virginia and Maryland suburbs by October and lay off nearly one-fourth of its staff of 260. It will close its food bank and residential programs for people who battle substance addiction, and it will reduce dental care, prevention outreach and case management.
"There are so many clients who will be hurt," Cox said. "These cuts have just been enormously emotional and difficult."
In Northern Virginia, local and nonprofit officials are scrambling to spin off and save Whitman-Walker's AIDS services there. "An awful lot of work, years of work . . . is there and shouldn't be lost," said Arlington County Board Chairman Jay Fisette (D), who ran the clinic's Arlington center for almost a decade.
The emergency deadline dismays him. Making that location a standalone entity is not a new idea. Until now, however, the board never chose to pursue it. "Having a regionwide presence was seen as a plus," Fisette said.
Virtually no one questions the region's continuing need for the clinic. Even a diminished Whitman-Walker would play a central role in the care and support of thousands of men and women living with the AIDS virus or struggling with other issues because of their sexuality.
Yet with the universe of providers far more diffuse -- in contrast to two decades ago, there are organizations for HIV-positive minority women, for black gay and bisexual men, a food bank that caters to those with life-threatening illnesses, for instance -- the clinic's primacy might never be the same. "They still have a place in the community," said Patricia Nalls, founder and executive director of The Women's Collective in the District. Its AIDS constituency is infected women and their families.
"But no one agency can serve the entire community," Nalls said. "It's just not going to be like it used to be."