SINCE THEIR CREATION in the 1980’s as a parallel social service system to serve HIV-positive gay men, AIDS service organizations (ASOs) have wrestled with questions of what they are and who they serve. But never in their five distinct “identity crises” have ASOs been less certain than they are today of their very survival as freestanding community-based agencies. Beginning with the advent of highly active antiretroviral therapy (haart, better known as “combination treatment” or “the cocktail”), ASOs have struggled to stay relevant as single-disease entities. As the HIV epidemic in America continues to shift from middle-class gay men to lower-income people of color—largely gay and bisexual men—it has become harder to justify the need for agencies focused only on those with HIV when clients’ needs have more to do with their income than with their HIV status.

REMEMBER the “good old days” of AIDS service delivery, back when AIDS itself was still a terrifying epidemic? Not knowing how long we could keep our friends alive, wondering who would be next to fall ill-the tension kept us on edge. In the beginning, those of us touched by the virus, whether ourselves, our friends, or our lovers-we were alive back then, even amid the terror, anger, and death.

We held meetings, founded nonprofit service agencies, and started free clinics. We formed support groups, held auctions, dances, and AIDS walks, and sponsored bike rides. We scraped for money any way we could. We demonstrated, lobbied, wrote letters, organized. We wept, grieved and then wept some more. We found ourselves so far past grief that all we could do some days was laugh at the lunacy of death’s intrusion upon our young lives. We fought with those who feared and hated us. We fought with each other, our allies, among ourselves. We felt immersed in the moment and the times. We experienced a deep connection to each other-and to those who had died. We struggled together to make sense of it all, to bring some meaning into the sadness and sorrow.

By the late 1990’s, it appeared that we were succeeding, too. …

NINETY-SEVEN THOUSAND, five hundred seventy-seven gay men-that’s how many “men who have sex with men” were newly diagnosed with HIV in the U.S. from 2001 to 2006. … More than 100,000 gay and bisexual men. The AIDS crisis never ended. In fact, it’s getting worse again.

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