About a third of a million dollars in federal funds earmarked to fight AIDS wound up mostly unused and in limbo for the past three months because of local infighting that has even professional politicians shaking their heads.
The money finally was freed up last week, but there still exists a bitter struggle for power among the harried and chronically underfunded private groups in Maricopa County that are battling the disease.
"I think it hurts everybody, including the AIDS patients, to have this kind of ruckus going on," says Randy Gorbette, who runs the Phoenix Shanti Group, the only nursing center and hospice in the state that is devoted entirely to victims of the HIV virus.
But others in what is commonly referred to as "the AIDS community" say the problem is Gorbette. And the federal money has brought to the surface a long-simmering feud within the AIDS community.
When Congress voted in 1990 to spend $220 million on AIDS programs nationally, it named the bill and the money after Ryan White, an Indiana teenager who died of AIDS in April of that year.
The decision on who would get the $300,000 in federal money earmarked for local "case management" was given to a 27-member panel of local people inside and outside the AIDS community, and it centered on bids by two major private agencies, Shanti Group and the Arizona Aids Project (AAP). Overseeing the panel was the Maricopa County Division of Public Health.
The money was to be used for healthcare, volunteer training, counseling and referral, prevention-education programs and to help women and minorities who have AIDS.
The 27-member consortium met from July to November of last year and decided to grant the money to AAP. But Gorbette appealed the decision last November, leaving the money in limbo until last week.
But the conflict spread beyond the panel. Last month, John Bahr, an AIDS victim who operates the HIV-Action Committee, staged a three-block march and candlelight protest outside Shanti's hospice at 13th Street and McDowell, demanding that Gorbette publish Shanti's financial statements or resign. Gorbette obtained an injunction that blocked Bahr from stepping onto Shanti's property.
Another AIDS agency, the Catholic diocese's Malta Center, recently asked the County Attorney's Office to investigate Gorbette's grant application for alleged misrepresentations." (Bill FitzGerald, a spokesman for the County Attorney's Office, tells New Times: "There's nothing to file on. There is no criminal impropriety.")
"Shanti should be doing all the medical stuff-that's what they do best," says Bahr, who last year received an award from the state Department of Health Services for his volunteer work for people with AIDS. The problem, says Bahr, is that Gorbette wants to take over all the programs for people with AIDS.
"The fight is between Randy and the rest of the AIDS community," says Bahr. "Everyone else is working together. He really is the downfall of the community right now. He really wants everything under his jurisdiction. He wants control."
Many people on the panel were opposed to centralizing AIDS programs under one agency's control. AIDS victims need choices of treatment, and some agencies are better off tackling specific parts of the complex problem, say Bahr and others.
"It's egos, there's no question about that," says Kirk Baxter, who chaired the 27-member panel and is founder of Body Positive, an advocacy group for people who have tested positive for the HIV virus. "We end up in a catfight over a very limited amount of funds. And there is a perception in the community that the worst offender is Shanti Group, in terms of a spirit of cooperation."
Cooperation was essential because the panel members included Gorbette, Bahr and Rick Correa, executive director of Arizona AIDS Project. But Maricopa County Supervisor Carole Carpenter says of the infighting: "You can pick any social issue where there are competing agencies and it just doesn't come close to the kind of problems we've had with this issue."
Gorbette says his critics are motivated by "professional and personal jealousy," because Shanti has been able to squeeze some money from government agencies. Last year, the county gave Shanti $50,000 in emergency funds so the hospice wouldn't close.
Bahr says he doesn't think last week's decision to reject Gorbette's appeal and award the money to AAP will end what Bahr calls "back-door politics." Gorbette, says Bahr, is "empire-building."
Gorbette acknowledges that his critics are at least partly right: He does want to offer centralized "diagnosis-to-death" programs for AIDS patients at Shanti. "If this is an empire," Gorbette says, "to me, it's a good empire."
Gorbette says it was "unfortunate" that his appeal caused the money to be tied up for three months. But he says he filed the appeal because he didn't think Shanti got fair consideration. "We believed all along that, politically, the most credible decision they could make was to split the money," he says.
The selection process set up by the Maricopa County Division of Public Health was "unprofessional, unfocused and flawed," says Gorbette. His appeal listed 16 complaints, including charges that providers and county employees had "conflicts of interest."
Gorbette says he's not happy about last week's decision in favor of AAP, but that he doesn't plan to continue fighting for the money.
Since December, the county has doled out about $39,000 to AAP while Gorbette's appeal was being heard. Now that the $300,000 is coming, says Rick Correa, AAP will finally be able to hire five more employees. Correa says he also plans to start new programs, such as offering training sessions for volunteers in rural areas of the county and programs to serve women and children with AIDS.
The three-month delay didn't cause his agency to turn any AIDS patients away, Correa says, but it caused "stress" for the AAP staff, because the $300,000 represents half of his agency's annual budget. The "Ryan White" money was not a windfall for AAP; it merely replaced the $300,000 in federal money that AAP already had received annually for the previous three years.
"Our people have been putting in 14 to 20 hours a week of overtime,
working sometimes six and seven days a week," he says. "Clients have asked me, `What's going to happen to AAP? Are you going to shut down?'"
The $300,000 chunk of money is "infinitesimal" compared with the needs of the more than 8,000 people in Maricopa County who are estimated to have AIDS or be infected with the HIV virus, says Jack Englander, an official at the state Department of Health Services. Since 1981, 682 people in Maricopa County have died of AIDS, state officials say.
Doug Hirano, chief of the office of HIV-AIDS at the state health department, says about $4 million in state and federal money is spent on AIDS programs, with the majority of that money going to education, surveillance and intervention programs. Only about $1 million of that, which includes the $300,000 in Ryan White money, is spent on actual health services.
In addition, Maricopa County last year spent $1.2 million on AIDS programs: $50,000 in an emergency grant to Shanti, $20,000 to Shanti to pay for volunteer training, $1 million for emergency care and $140,000 to pay physicians at McDowell Clinic.
The state doesn't spend any money on direct healthcare services for people with AIDS-outside of the $127,000 it spends on healthcare for state prisoners with AIDS, Hirano says. When money is so tight, says County Supervisor Carpenter, all the infighting just hurts the cause of AIDS patients.
"The county doesn't fund well at all," says Carpenter. "That's been a problem from the start. But resources are just so scarce at this point that we can't afford this kind of fighting between groups. It puts [the county officials] in the middle, and we've increasingly tried to make the message clear that it can't continue."
It's not just county officials that complain, says Kirk Baxter, who chaired the Ryan White consortium.
"We hear that from every level of government-from the county Board of Supervisors, legislators, as well as the congressional delegation," says Baxter. "Our efforts are thwarted because of a very convenient excuse: `Why should we fund you when all the organizations can't agree?' What they're saying is they are disgusted with the lack of cohesion between the groups."
That lack of cohesion showed at the November 5 meeting of the Ryan White consortium. Gorbette angrily resigned and stormed out of the room after his agency didn't receive the money, recalls Bill Tye of the Catholic Church's Malta Center. "It was a very hostile walking-out," says Tye. "It was a temper tantrum."
Gorbette says he didn't throw a tantrum, but left "calmly" after announcing he was resigning. He says he had complained earlier about the selection process, but no one had listened. He has said that Tye, whose agency provides counseling for AIDS victims, wasn't qualified to help judge the grant applications.
Tye, himself an AIDS patient, blames Gorbette for causing the fighting on the local panel.
"It always goes back to one personality: Mr. Gorbette's," Tye says. "Since he filed the appeal, it's been real clear what he's trying to pull. He has an objective-for Shanti to provide AIDS services from diagnosis to death. Any other provider he sees as competition."
Gorbette says it's not that he's trying to take money from other agencies, but Shanti already provides counseling services for many AIDS patients. "We should be paid for what we're already doing," he says.
Critics who complain that centralized programs for AIDS patients won't work just don't understand them, he says.
"I've always been out front," Gorbette says, "I've always been on the cutting edge."
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