Gina Quattrochi, Executive Director, Bailey House: AIDS at 20

November 5, 2001
Gina Quattrochi, Executive Director, Bailey House: AIDS at 20

The facts are grim. More than 21 million people have died of AIDS since the 1980s, 75 percent of them in sub-Saharan Africa. Some 36 million people are currently affected with the HIV virus — over 25 million of them in Africa. More than 13 million children have been orphaned by AIDS and, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), that figure may reach 30 million before the end of the decade. In the most affected countries, half of all 15-year-olds alive today will eventually die of the disease, even if infection rates drop in the next few years.

In July, two weeks after the United Nations General Assembly convened a special session on HIV/AIDSPhilanthropy News Digest sat down with Gina Quattrochi, executive director of Bailey House, an award-winning community-based organization in New York City that provides housing, services, and technical assistance to persons living with HIV/AIDS, to discuss the state of the epidemic and the challenges she faces as the head of an AIDS organization at a time when the public and funders have moved on to other topics.

Since commencing work in the AIDS field in 1991, Quattrochi has managed Bailey House's programs in step with the changing nature of the HIV/AIDS epidemic. In 1993, she helped establish the National AIDS Housing Coalition (and currently serves as its president), and in the years since has founded a number of advocacy organizations committed to the establishment of a continuum of housing options for homeless people living with HIV/AIDS. She also serves as chairperson of the New York City AIDS Housing Network and on the advisory panel for Vanderbilt University's National AIDS Housing Cost Study.

Quattrochi has been quoted extensively in print and electronic media and has testified before numerous Congressional, New York State, and New York City Council committees on the housing needs of persons living with HIV/AIDS. She received her law degree from Union University-Albany Law School in 1978 and is an adjunct faculty member at New York University's Wagner School of Public Service. Prior to becoming the executive director of Bailey House, she served on its board of directors for five years and held several positions within the legal field.

Quattrochi has two children and holds an advanced brown belt in karate.

Philanthropy News Digest: Earlier this year the United Nations convened a special session on HIV/AIDS at its headquarters here in New York. Did you attend the session?

Gina Quattrochi: Yes, I did. I've been interested in the global epidemic for years, but at the U.S. Conference on AIDS in Denver last year, I attended a session on AIDS in Africa and ended up being very, very moved by the presentation. I decided then that Bailey House and I had an obligation to figure out how we could help people in Africa and other places with what we've learned here since 1983.

And I'm really glad that Sharon [Perkins, Bailey House's deputy executive director] and I were able to attend the session. First of all, just being in a UN setting — it's pretty regal and impressive. Second, to see people from all over the world who were there specifically to talk about the ramifications of the epidemic and to hear the debates about various sub-populations — men who have sex with men, IV drug users, sex workers — to hear the debates about treatment, and about how people in other countries view the evolution of the epidemic through the lens of gender discrimination and human rights — all of that was extremely exciting and really invigorating for me as a New York City AIDS advocate and activist.

I've been an AIDS activist since 1985. And while we've done tremendous things here in New York and across the country in terms of building a care and treatment infrastructure, one of the things that's happened is that, because we've been relatively successful, we have collaborated with the media in creating this perception that AIDS is a chronic, manageable illness, like diabetes. Many of us have done it out of a sense of relief — relief that our clients, friends, and loved ones are not dying in in such great numbers anymore. Unfortunately, our sense of relief has led the general public to believe that the AIDS crisis is over here.

But the minute you go into other communities — communities right here in New York like East New York, East Harlem, Bedford-Stuyvesant, the South Bronx, Far Rockaway — you're forced to realize that for many people, people who lack stable housing, who lack access to care because they're IV drug users or they're sex workers, this is not a manageable, chronic illness. It's an illness that kills people. It's an illness that demands top-notch, high-quality medical care, housing, proper nutrition, etc., if people are to survive.

And the minute you connect that reality to other places in the world, all of a sudden you jump from this notion of a chronic, manageable illness to something more accurately described as a worldwide pandemic. [In June], during the so-called twentieth anniversary of AIDS in the United States, leading scientists, people at the top of the AIDS research and treatment field, were talking about this epidemic in a way that was extremely scary. I mean, they're predicting that this epidemic could assume apocalyptic proportions.

PND: Give us an idea of the magnitude of the global AIDS epidemic....

GQ: Well, it's estimated that right now there are forty to sixty million people infected with the HIV virus. That's probably an underestimate. Testing in most places in the world, and even in some places in this country, is not widely available, so we don't really know how many people are infected. Here in the United States, where mandatory testing has not been the rule, we don't know how many people are infected. The CDC [Centers for Disease Control] estimates that there are approximately a million Americans living with the HIV virus. But again, that's just an estimate.

"...it's estimated that in the next ten years, there will be forty million AIDS orphans in Africa alone...."

So worldwide, we could be talking about forty to sixty million, maybe more. And the number of new infections is growing rapidly. In the United States there are forty thousand new infections every year. And the number worldwide, in 1999, was five-point-six million. If globally we have five million new infections every year, and you add that to the forty to sixty million who are already infected, we're looking at an epidemic of unprecedented proportions — one that will be complicated by other factors. For instance, it's estimated that in the next ten years, there will be forty million AIDS orphans in Africa alone. That's about equal to the number of children in this country who attend public school. And that's just in Africa.

PND: Let's focus on the developing world for a moment. What could happen if the global community doesn't mount a concerted, coordinated campaign to stop the spread of the disease in developing countries?

GQ: Well, it's my sense, based on my experience here, that without concerted, intentional action by nations around the world, we're looking at something that could reach apocalyptic proportions. In some countries in Africa, the infection rate is already at ten to fifteen, even twenty percent of the adult population. So we could be looking at the whole-scale elimination of entire cultural and ethnic groups around the world — in Africa, in Southeast Asia, in India.

PND: And because infection rates are highest among younger cohorts, we could be looking at profoundly negative demographic changes in these societies over the next twenty to thirty years?

GQ: Right. Take South Africa. The apartheid government has been out of power since 1994. And so for the first time in what, a hundred years, South Africans — people of color in South Africa — are finally able to participate as citizens of their country. But what they're looking at now is the almost total elimination of several generations of their fellow citizens. And that threatens, both in South Africa and almost every other country in Africa, the economic and social stability that has been established at great cost over the last ten years.

That's why it's now viewed as a national security issue — one that has repercussions for the entire world. Because if the fragile economies of Africa and Southeast Asia collapse under the weight of this epidemic, we're all in trouble.

PND: Earlier this year, United Nations Secretary-General Kofi Annan called for the creation of a global AIDS fund with an endowment of seven to ten billion dollars. To date, how would you rate the response to his appeal?

GQ: Well, there has been a lot of discussion about the global AIDS fund, both in the diplomatic community and the activist community. What I've learned from activists in this area is that there are really three areas that need to be addressed. One is the global fund, which will provide funding for infrastructure and treatment. The second is cancellation of Third World debt. That was something started during the Jubilee 2000 effort and which is now being continued in the context of the AIDS epidemic. And the third is drug pricing. There's been a lot of movement on that front, with the price of various HIV/AIDS treatments coming down over the last three or four months. But that's just a half-step in what is probably a ten-step process needed to really develop effective care. Because the simple fact remains that, although the drugs are cheaper, they're still priced out of reach of most Africans. So those three things — debt cancellation, drug pricing, and the global fund — really need to be addressed simultaneously.

One of the positive aspects of the UN conference was the sense that others realize the United States is not going to take a leadership role in this fight. Others will have to step forward, and many already have. Leaders of the various African nations have stepped forward, as have folks from other countries and continents. And that's a positive turn of events.

PND: Let's talk about AIDS in the United States. According to AIDS at 20, a survey by the Henry J. Kaiser Kaiser Family Foundation, the number of Americans who view AIDS as the country's number-one health problem declined from 44 percent in 1995 to 26 percent in 2000. What are the implications of that finding?

GQ: The implications are devastating. They're devastating in terms of funding, they're devastating in terms of public policy, and they're devastating in terms of prevention and treatment. This is an insidious virus. It's spread through sex and drugs, and those are very personal behaviors that are difficult to manage and change. For example, we have a whole generation of adolescents who were infected perinatally and who are now becoming sexually active, and yet we still don't have a comprehensive HIV/AIDS prevention curriculum in city schools. We're not talking to our kids about how this disease is transmitted.

"....In communities of color across the country...we're looking at infection rates that rival those of developing countries...."

You know, I was on a plane recently to D.C. and was sitting next to a gentleman and we began to talk about what we did. And when I said I ran an AIDS organization, his comment was, "Oh, AIDS, we don't hear much about that anymore, except for Africa." For me, he was John Q. Public. It's that concept again of, Well, since we don't really hear much about it, it's probably not so much of a problem, when in fact, we're looking at forty thousand new infections domestically every year. In communities of color across the country, but particularly in places like the rural South and among young gay African-American men, we're looking at infection rates that rival those of developing countries.

So the sense that the AIDS epidemic is not a serious health or public health issue anymore denies the basic reality that in many communities throughout America we are going to see the wholesale elimination of lots of people.

PND: Is there a disparity in HIV/AIDS funding for the white gay population as opposed to communities of color?

GQ: I think what's happened is that over the years, as the epidemic became more of an epidemic of communities of color and as more organizations came into the AIDS service arena — I'm talking about New York — some funders readily and gladily went on to less "controversial" diseases like breast cancer, where the question of who is or isn't a victim isn't an issue. I won't name names, but I think some funders got cold feet when they were faced with putting money — or not putting money — into small grassroots organizations that sprang up as the disease spread into poorer and more disenfranchsied communities. So you heard a lot of, "We can't put money into these grassroots organizations anymore because they don't know how to manage their finances." Or, "They're not compliant with funding requirements, so we can't fund them anymore; we need to move on." Rather than offer these organizations the technical assistance and funding they needed to develop reliable infrastructures, some funders walked away at a time that was crucial for the survival of many of those smaller organizations as well as the folks who needed the services the most. Others, like the Robin Hood Foundation, did not walk away, but instead incorporated management assistance into the very fabric of their grantmaking.

That's one thing that has happened. Communities of color, particularly newer, smaller organizations within those communities, have had an increasingly difficult time accessing foundation and corporate grants. And many of them don't have the ability to mount big direct-mail campaigns or put on big gala special events, which is the way a lot of us raise our private money.

The other thing that's happened is that there's been a move by organizations serving communities of color to force government funders to look at the percentage of money that goes to those organizations as opposed to organizations whose boards or staff or clients are not significantly comprised of people of color. Some of these efforts, like the establishment of Congressional Black Caucus HIV/AIDS funding from the federal government, have been successful. However, it's complicated by the fact that many AIDS organizations — Bailey House, for instance — do not qualify for Congressional Black Caucus money, even though our mission has always been to serve homeless persons living with HIV/AIDS. Our client base is ninety percent people of color. Our senior staff is about sixty-five percent women and men of color. The only area in which we're deficient is at our board level. And yet our services — our housing services, our case management services, our vocational and education services — are provided to a client base that is ninety percent people of color. I'm not sure how to make funding more equitable, but the debate is certainly healthy and has already led to some positive changes, such as the decision by the New York City Council earlier this year to address funding for HIV/AIDS in communities of color.

I think the issue really is to help organizations run by people of color to get more funding and to ensure that those organizations receive appropriate levels of operational support so that they can build a strong infrastructure and provide great services to their clients. One of the things that's evolved in the AIDS movement here in New York is to have many different kinds of organizations provide services in ways that are culturally and linguistically appropriate, as opposed to a cookie-cutter approach. We've learned over the years that certain organizations know how to serve a particular sub-population better than others. And that's one of the things, I think, that has made the care here in the United States so effective.

So we need to fight for more funding for those organizations, and for recognition from both the community at large and from funders. It's like what our clients say to us when we tell them they have to go to budgeting classes. "We don't have enough money to budget," they'll say. In a sense, it's the same for many of these smaller, grassroots organizations — it's not that they don't know how to manage their money, it's that they don't have enough money to manage. Even Bailey House. We passed our fiscal 2002 budget last night and the ratio of admin to program is eighteen percent admin and eighty-two percent to direct service. I challenge any CEO of a Fortune 500 company to succeed with that kind of operating ratio. Because what it means is that our back-office operations, our development, our administrative, our support staff is very lean. We actually do a very good job with it, but again, we're probably one of the better-funded mid-sized organizations in the city.

You know, it's difficult to run programs on three percent admin, which is what most government contracts give you — between three percent and seven percent. It's very difficult to run programs with that level of operational support. And all of us are now expected to be technologically "up to speed." We're expected to track all kinds of client outcomes. We're expected to use e-mail, because funders are getting into using e-mail and having access to the Internet. But that costs money. Office space in New York costs money.

PND: On a scale of one to five, how would you rate the federal government's response to the AIDS epidemic in this country?

GQ: I 'd give it a two and a half.

PND: Two and a half?

GQ: Yes.

PND: Same question for the media.

GQ: I'd give the media about a one and a half. Except for these last two weeks [following the UN special session], which have been great. If we could extend the last two weeks over the next fifty, we'd be doing okay.

PND: Same question for corporate America, on a scale of one to five.

GQ: I'd probably give it the same two and a half.

PND: And the private philanthropic sector?

GQ: I'd put it right there, with a couple of exceptions.

PND: ...two and a half?

GQ: Right.

PND: What kind of impact has the sudden attention on the global epidemic had on local and community-based initiatives?

GQ: Well, it's a little too early to tell, because, again, while there's been a focus on the global epidemic over the last year, it wasn't there prior to that. I think what needs to happen now is that those of us who are doing AIDS work in this country really need to strategize about how we can capitalize on the energy that was created during the UN special session to bring attention back to the epidemic here.

"...The United States does not exist in isolation. For us to think of ourselves as isolated from this epidemic is ludicrous...."

One of the concerns that folks have is that if we focus on Africa, then what about New York? what about Atlanta? what about Los Angeles? But after having spent time with activists from other countries, I realize that we have a lot to gain by joining in the global campaign against AIDS. For starters, the passion — the desperation, really — that activists in other countries have is inspiring. And I think it can help ignite, or re-ignite, the sense that there's a crisis in this country. The United States does not exist in isolation; while some folks may want it to, it doesn't. We're part of a global economy. New York is one of the international capitals of the world; people from all over the world come here for care. And for us to think of ourselves as isolated from this epidemic is absolutely ludicrous.

So I feel there's a lot for us to gain by recognizing that we're part of this and by getting all those groups you mentioned before — the federal government, corporate funders, the foundation and philanthropic world — back to the table to begin to talk about what those connections are and what work we need to do here and what the funding needs are and how can we both sustain and expand the capacity of organizations to serve the forty thousand new cases in this country every year. You know, as people with HIV/AIDS live longer, they need more services. The turnover in our housing programs is much lower than it used to be, which means that rather than having housing for twenty thousand people living with AIDS in New York City for a year or two and then turning that number over, we need to keep growing these programs because more people need them and they're living longer in that housing.

PND: Let's talk about your organization for a moment. What is Bailey House?

GQ: Bailey House started in 1983 as the AIDS Resource Center. Back then, we had a dual mission: to address the issue of homelessness among young men who were being diagnosed with GRID — Gay-Related Immune Deficiency — and to counter the notion that this illness — this so-called gay cancer — was God's punishment for homosexuality.

So the organization started out by providing housing and pastoral care referral. Since 1983, we have developed a vast array of comprehensive services, which include direct housing, both through our congregate residences in Greenwich Village, which is now called Bailey-Holt House, and through a scatter-site apartment program, which is now in four of the five boroughs of New York City, where we actually rent apartments in the open market for our clients to live in.

We also have a city-wide vocational education program that serves people living with AIDS from all five boroughs. We have a program in East Harlem that accepts walk-ins from all over the city and helps people with HIV/AIDS establish their government entitlements, helps them find housing, and refers them to primary and other types of care. We're opening up a new residence this fall for women and children in East Harlem. And we'll be adding an additional thirty-five units for single adults from that community as well.

We also have a very extensive technical assistance program, which since 1987 has provided technical assistance to community-based organizations, both here and throughout the U.S. We've even helped some international organizations. The program now has a menu of services that includes program development, program evaluation, training on HIV/AIDS program and clinical issues, and help with fiscal infrastructure. In addition, we operate a small academy for leaders of organizations of communities of color to help them develop infrastructure and capacity. And we just launched our technical assistance clearinghouse Web site (www.taclearinghouse.org), which will be a tool for AIDS organizations in New York City to access better, more comprehensive technical assistance for their various organizational development needs.

Last but not least, we operate a conflict mediation program, which works with individuals — people living with HIV and AIDS — and organizations to develop and improve their conflict resolution skills in things like landlord/tenant disputes.

PND: Sounds like a full plate. How big is your staff?

GQ: We have a hundred and twenty people on staff right now.

PND: And your budget?

GQ: Nine-point-six million dollars, as of July 1, 2001.

PND: Can you give us an example of how your organization works with state and/or federal agencies?

GQ: Well, we work with them in a number of ways. Eighty-one percent of our funding comes from the public sector, including the City of New York, which helps fund our congregate residences in the Village and our scatter-site program through its Division of AIDS Services and Income Support.

We also receive federal money, both directly from HUD [the Department of Housing and Urban Development] through the Housing Opportunities for Persons with AIDS Act funding program, as well as from McKinney-Vento funds, which fund some of the services in our program. And we receive some federal money through the City of New York and some state money through the New York State AIDS Institute and the state's Office of Alcohol and Substance Abuse Services. And that pretty much covers our public-sector funding, which amounts to about seven — well, closer to eight — million dollars.

PND: Have you had to make changes in your work or mission over the last few years as a result of government cutbacks at the federal or state level?

GQ: No, we really haven't. In fact, the percentage of our government funding has actually grown a bit. We were at roughly seventy-five percent government funding about two years ago and now it's up to eighty-one percent. So, our government funding has increased, particularly as we've expanded our technical assistance services.

PND: At a Foundation Center workshop this summer, Sharon Perkins, your deputy executive director, made the point that there's been more of an emphasis by public-sector funders on performance-based programming. What did she mean?

GQ: Basically, it means that many funders, and not just public-sector funders, are looking at funding programs in terms of outcome measurement. In other words, they reimburse you not as you do the work but as you achieve certain kinds of outcomes. If you don't achieve those outcomes, you don't get reimbursed. It's a whole new system — although one that was already in place in a number of different social service areas, such as services to the elderly and some of the housing services funded here in the city by the Department of Homeless Services. It's just a different contracting and reimbursement methodology.

PND: Are volunteers important to your organization?

GQ: Yes, very important. We've worked with volunteers since the beginning. In fact, it was largely a volunteer organization in the beginning. Today we have a volunteer coordinator on staff and volunteers support us in a number of ways. They work directly in some cases with our clients, they support us through their participation in our special events, they make it possible for us to be present at street fairs in the summer, where they help raise our visibility and the visibility of our mission.

PND: Are there special problems that arise in working with volunteers?

GQ: No, we've been very fortunate over the years to enjoy a great relationship with our volunteers. We treat them as we treat staff. We have guidelines for them, we do an orientation, we do training, we have an intake and assessment process. Not just anybody can come volunteer.

PND: How will Bailey House be affected if the Bush Administration's faith-based legislation makes it through Congress in something like its original form?

GQ: Well, it depends. I don't know all the details of the legislation, but to me what's ironic about the whole faith-based thing is that, first of all, in the social service arena, faith-based organizations have always been active. It's nothing new.

In AIDS, on the other hand, there has been a lot of controversy because of the unwillingness of many faith-based organizations to provide condoms, to provide safer sex education that includes condom use, to counsel HIV-infected women or women with AIDS on pregnancy termination and abortion.

But we've been able, as a community, to manage those issues along with the faith-based organizations. My only concern about full-scale, faith-based service delivery would be if funding for service delivery was taken away from other types of organizations. And I suppose I would be concerned if those organizations weren't limited in the way or extent to which they proselytize their clients, or if they were allowed to discriminate in their hiring by only hiring folks of their faith. That would concern me.

PND: There's been a lot of talk about the need to build more capacity in the nonprofit sector. From your perspective, what does that mean?

GQ: It means a couple of things. One, to build capacity means to strengthen the workings of organizations in the sense of managing. For example, Bailey House has gone from a budget of zero in 1983 to a budget of ten million today — actually, in the last two years we've gone from six million to ten million.

However, we were only able to do that because we had a highly committed and competent board of directors and staff. And through the generosity of some early funders, we've had a fundraising department since 1987, which has allowed us to develop the capacity to mount a strong development effort over the years and to tap individual as well as foundation and corporate donors to supplement the public money we receive and to continue to strengthen our infrastructure and programs when that public money wasn't enough. Through the hard work of a lot of people, we have all the things you need to run a business. We have a human resources department. We have a fiscal department. We have a fundraising department. We have seasoned, experienced, knowledgeable managers not only running programs on the client level but overseeing those programs on a macro policy and structural level. And that's what it takes to be able to provide services and manage the funds you get.

But you also need other things, other tools, in this day and age. You need cutting-edge technology. You need to be able to communicate with funders and other providers, both locally and nationally. You need to be able to send your staff out to meetings and trainings and conferences. You need to keep your organization up to date with changes in treatment, changes in the epidemic, changes in just about every aspect of your work. And that all costs money. It goes back to my earlier statement about the demands placed on grassroots and community-based organizations to achieve certain standards of care and standards of business operation, without there being adequate funding for all that.

I mentioned outcome-based management. Well, in order to do outcome-based management, you need certain tools, you need certain kinds of technology. You need training for staff. You have to transition the organization from a line-item budget-based system to an outcome-based system. And that takes time and money.

For ten years I've heard funders, both private and public, say, We want to know what your outcomes are, we want outcome measurement, outcome measurement. And to date, none of them has been willing to put enough money out there to actually help us achieve that. Bailey House is now working with AIDS community-based organizations through our program evaluation department. We're working with a select group of providers who receive HOPWA [Housing Opportunities for Persons with AIDS] funds — it's federal housing money provided through the city — to help them develop outcome measures for their work. And it's really a very complex and time-consuming process. It means changing the culture of organizations. It means getting them the technology they need to be able to track all the various encounters with clients and to measure where their clients are at many different points in time. It means paying for staff whose job it is to do that. When you're doing outcome measurement, you can't assume that people who are already doing direct client service work and supervising programs are going to have the additional time to do all the things that that kind of measurement requires.

So to expand, to develop capacity, means to help organizations identify what their structural and operational needs are and then to find the funding to pay for those needs. And, again, it's frustrating, because most corporate and foundation grants are annual grants. A lot of corporations and foundations, after they've funded you for three years, tell you not to come back. Or they tell you, "You need a hiatus with us, but you're welcome to come back two years from now."

"...The ability of any executive director to run a business is dependent on consistent support that grows as the organization's programs grow...."

Well, I can't run a business if you're only going to give me a year of funding and you tell me to come back in two years. My ability, the ability of any executive director, to run a business — which is really what we're doing — is dependent on consistent support that grows as our programs grow.

PND: Are certain funding partners more sensitive to these kinds of capacity-building issues?

GQ: Well, for me, there is one funder that stands out, and that's the Robin Hood Foundation here in the city. They really are one of the few foundations that has made a commitment to us and other agencies to grow their support as we grow. They provide everything from grant funding to management assistance. Maybe it's because of the way they started or who they are, but I think they understand from a corporate perspective what it means to run a business. Bailey House has received funding from them since 1987. They've stayed with us. They've never said to us, "We've been funding you for five years, now we need a break; come back in three or four years." They're just the best.

PND: These days, that kind of long-term commitment to "engage" with an organization seems to fall under the rubric of venture philanthropy. Are there other venture philanthropy models out there that might serve your organization?

GQ: Well, there's the whole social entrepreneurial venture philanthropy model, where businesses like Ben & Jerry's and others are working with not-for-profit organizations to develop income-producing ventures. That's something that Bailey House has looked at over the years. But again, it's a tremendous undertaking. We actually ran a thrift store out in Southampton on Long Island for many years and learned that running a retail operation is an extremely challenging endeavor. We actually closed it two years ago because of declining profit on sales. But the thought — the notion of running a business, particularly because we have a vocational education program — is always in the background.

PND: Where do you see Bailey House in three years? Other than in new offices....

GQ: [Laughs.] Yeah, I can't tell you what a nightmare it is. The biggest barrier to expansion for us has been finding affordable office space. It's terrible.

PND: The fact that your client base is concentrated in one of the higher-priced real estate markets in the country doesn't help....

GQ: Right. Even in East Harlem. We looked at East Harlem three years ago, and space was running between twenty-five to forty dollars a square foot. We were fortunate enough to find space in the United Methodist Church up on Madison Avenue. It's not ideal, but it works and it's in the community, so it's great. But in this building [in Midtown South, on Seventh Avenue]...I guess rents are coming down a bit because of the dot.com bust. But this is considered a Class A building and, again, we have issues. There are issues of security — staff is here late at night, so we need to be in a building that's well-managed and secure. And to try to expand within a Class A building in any part of the city at this point is a tremendous challenge. We're all looking for affordable office space.

But where do I see Bailey House in three years? I see us expanding our direct housing programs. And I see us expanding our whole research and public policy area. One of the things we've learned over the last ten years is that there's huge interest in outcome-based measurement. I believe in outcome-based measurement. I absolutely do. But I also know that it costs money, that it's time consuming, and that it's something you have to have dedicated staff and resources in order to do.

But that's beside the point. We need — the field needs — more documented research on the outcomes of our work and its cost-effectiveness. Last year, we were able to get funding from a combination of foundations to work with the Columbia School of Public Health to look at the role of supportive housing, particularly our two models, scatter site and Bailey-Holt House, in helping clients access comprehensive medical care and adhere to an HIV/AIDS treatment regimen. And what it shows is that once people with HIV and AIDS who fall into the hardest-to-serve category — people who are very low income or were either current or past IV drug users — once those people are provided with stable housing and supportive services, a high percentage of them go on to enjoy a comprehensive, primary-care relationship with their physician and maintain a very high rate of adherence to HIV/AIDS medication regimens. In other words, once you provide stable housing to those people, their ability to access comprehensive care rises exponentially.

We need more of those studies. That study has been used by so many people and has been quoted in so many position papers at this point — I mean, the AIDS community is hungry for documentation of the work that's being done. And we need it now. We need it to defend our funding. And we're going to need it, I think, to defend our existence if this perception of AIDS as a chronic, manageable illness persists.

PND: One last question: What advice do you have for a new or young organization looking to get into the field?

GQ: Build your infrastructure along with your program. The mistake that so many organizations make is that they want to do everything. They want to serve as many people as possible, because they see the need and they see the consequences of inadequate services. It's perfectly understandable. So they get a couple of people together, they form an organization, and they start applying for and getting government grants. And before they know it, they've gone from zero to two hundred thousand to a million to two million to five million dollars. But you can't do that without having an infrastructure in place.

So I guess my advice is to grow the infrastructure along with the program. You have to be disciplined about it. There will be times when making the decision about whether or not you're going to hire a full-time bookkeeper or add another half-time educator is going to be very painful. But sometimes hiring that full-time bookkeeper to manage your books, to help you comply with your grant requirements, will put you in a position in the long run to be able to hire double the amount of staff you wanted to hire in the first place.

Again, these are difficult decisions to make, but if you don't grow the infrastructure along with the program, you'll fail. There are lots of failure stories out there. And we can't afford to fail. We have too much work to do and there's too much need.

PND: Well, Gina, thanks very much for taking the time to talk with us this morning. Best of luck and continued success with your efforts.

GQ: Thanks.

 For more information on the Newsmakers series, contact Mitch Nauffts at mfn@foundationcenter.org.