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.

AS WE ENTER the fourth decade of AIDS, the crisis continues largely unabated. About 1.1 million Americans live with hiv/aids, as do 33 million people around the world. Every year, about 56,000 more Americans are newly infected; roughly half are gay men and half are African American. While the overall HIV incidence in the U.S. remains flat, infections among gay and bisexual men are increasing-the only risk group for which this is the case. Infections are increasing especially among young black gay men.

Globally, 2.7 million people were newly infected in 2008, down from a peak of 3.5 million in 1997. Despite this progress, for every two HIV-positive people who get into treatment globally, another five are newly infected. Most of the 33 million people living with HIV around the world don’t have access to anti-retrovirals (ARVs), the HIV medications that revolutionized treatment in the mid-1990’s, and are not likely to any time soon. In sub-Saharan Africa, where most of these people live, access to something as basic as palliative care (pain medication) is often beyond reach.

On a more positive note …

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. …