Our Q&A with new AIDS United CEO

Advocacy, funding organizations merge in 2011

AIDS Alert asked Mark Ishaug, president and chief executive officer of the newly-formed AIDS United of Washington, DC, to discuss why the National AIDS Fund and the national policy advocacy group AIDS Action merged and what this will mean for people living with HIV/AIDS and the clinicians providing their care. His answers are presented below in a question-and-answer (Q&A) format.

AIDS Alert: What will the new merger of the National AIDS Fund and AIDS Action to become AIDS United mean with regard to advocacy, clinical care and research funding and grants, and services to people living with HIV/AIDS?

Ishaug: We're marrying the three things I think are key to stemming the epidemic: public policy advocacy, community mobilization, grassroots network development. So we're bringing those together with our historical focus on strategic grant making and organizational capacity building. I think the programs we're going to fund and develop will be made stronger by having a policy grounding, and all of our program work throughout the country and in Puerto Rico will inform our policy efforts in Washington, DC, and throughout the country. I don't see any division between policy and program building and capacity building. For me they complement each other and make each other stronger because the policy work is rooted in the real life experiences of people living with HIV and the people who serve them. And the work we do at the local level becomes stronger. The grants programs we fund at the local level become stronger if they have a policy and advocacy component to them.

AIDS Alert: Why did the National AIDS Fund and AIDS Action begin efforts to merge into one organization?

Ishaug: We wanted to combine the two strengths of the organizations into one stronger organization. We have a firm belief that being united and more efficient will make us more effective and bring us closer to our goal of ending AIDS in America. Now more than ever there is a need to be merged in this battle because the economic challenges are greater than they ever have been in fighting AIDS. Hopefully we'll save resources by having one stronger organization, and we can invest those resources in program and policy work.

AIDS Alert: In your tenure as president and CEO of the AIDS Foundation of Chicago, what was the accomplishment you are most satisfied with and how might you translate that work to the new organization of AIDS United?

Ishaug: Twenty years is a long time. With our team at the AIDS Foundation of Chicago, we've done so many amazing things. The one I think is the most important is we launched recently a subsidiary called the Center for Housing and Health. It will focus on the housing and health needs of people with chronic medical conditions, including but not limited to people living with HIV. This is exciting to me and how I think about the future of HIV care. HIV cannot be dealt with in a silo. The care and prevention and wellness programs need to be based in and grounded in a comprehensive health care and chronic disease management model. People living with HIV are people with mental health issues and substance abuse issues and diabetes and liver disease and a panoply of chronic medical conditions. We need to make sure our services meet the multiple needs of people living with HIV.

To me, even the challenge at AIDS United will be how we fight. What's important is we make sure people living at risk for AIDS get the services they need to be healthy, stay HIV negative. And for those living with HIV, we want them to get the most affordable and accessible care. It means we cannot operate in a silo, as if there's the AIDS world and then the whole other health care world. They cannot be separate. While we have a focus on HIV and we bring our expertise on HIV to all our program and advocacy work, it has to be done in the partnership with a much wider community of advocacy providers, including housing organizations and those working on job training and employment programs. So it's a really challenging and exciting time, and it's also a huge opportunity for us.

AIDS Alert: How do you see the mission of AIDS advocacy groups evolving in the decade beginning in 2011?

Ishaug: We're going to need to respond in a comprehensive and coordinated way to health care reform. A significant part of our activities will be focused on coordinating with other health advocacy groups and disease organizations beyond HIV. We have to advocate together as a broad, non-disease-specific community for universal health care. That's what in health care reform is the biggest determinant of our ability to bring us closer to being a country without AIDS: health care reform is the principle answer. It acts as a fundamental base that will change the story.

AIDS Alert: What about the new Republican Congress' efforts to repeal or underfund health care reform?

Ishaug: We're still trying to determine what the Republican agenda is toward health care reform. We understand there's a huge deficit and push-back, but we have to push-back harder and we will. We have to make sure people affected by HIV, their friends, lovers, Congressmen know the cost to the country if we don't implement health care reform for low income people, especially for those with chronic illnesses. It would be disastrous. We can save money and save lives. There is a movement to underfund programs that will save money and save lives. We need to bring back a focus on prevention, including treatment as prevention. There is a lot of talk these days about the value of antiretroviral therapy (ART) in preventing HIV infection, and we will talk about this more and get people to understand the implications of this.

We've committed as a world to ending smallpox, reducing other diseases like cholera. We have a track record of disease eradication, and we can do this and we can do this in America. AIDS is a winnable battle, and we are in it to win.

AIDS Alert: The past decade was notable for AIDS/HIV prevention, care, and treatment budget cuts or flat-funding many years. Then there was a little good news in the last year. Do you see the political changes of 2010 as a sign that we are returning to lean years? And, if so, how will your organization deal with this reality?

Ishaug: For the past decade funding for AIDS care and the AIDS Drug Assistance Program (ADAP) has maintained and in some years increased because of our strong advocacy. The notable exception was HIV prevention. That has been a battle, a frustrating battle that we have not been able to win. It's true the new House Republican majority wants to cut $1 billion from nondiscretionary funds including money for health care. Paul Ryan from Wisconsin proposes to move that budget back to the 2008 funding level which would be disastrous for people with AIDS and other diseases as well. We don't want to get pitted into a match, a fight pitting different funding streams against each other. That's regarding the categorical funding.

The AIDS community really has to do a better job of finding ways to increase access to other mainstream funds or entitlement programs such as Medicaid and Medicare and make sure those important programs provide a safety net for our clients. And finally we have to stimulate private philanthropy. It's really important federal and state governments don't do this alone. We have to maintain private philanthropic support and ask more corporations and foundations to come to the table. One of the big parts of the strategy is calling on the private sector to assist with its implementation. So at AIDS United we'll work very hard to get the private sector to step up. We were very proud last year to receive a $3.6 million grant from the Social Innovations fund, which is a federal grant run out of the Corporation for National & Community Service, which is the same body that supports the AmeriCorps Program. The grant was made to the National AIDS Fund, but it's now operating under AIDS United. We'll use the funding to make grants to local communities to receive access to care. The grant requires a two to one match. This is a call to arms for the private sector to meet us in meeting this challenge. We cannot fail. If we don't raise $3.6 million we can't continue the program next year. We'll do everything we can, but we have to ask the private sector to step up to the plate.

AIDS Alert: Is there anything else about AIDS United that you would like to explain to clinicians and others on the front-lines of HIV care and treatment?

Ishaug: This is a wonderful opportunity for clinicians and the experts in the field to help us figure out how we're going to transform our sector into one that is soundly based in medical care while emphasizing the importance of a continuum of social services, including housing, mental health services, medical care and access to drug therapy. It's all part of a comprehensive package. It's a really exciting time. I do believe we're in a transformational moment here and we need to work with all of our allies to figure out how we provide the most sustainable services for our clients in this new environment. And I do believe it's going to be about not doing business as normal, as usual, and integration will be key to our success.