Paul Champion works in the nonprofit sector at a grassroots HIV/AIDS program in the Bay Area. As with many such organizations, this small nonprofit struggled with funding and had to reorganize its programs.
"Given the limited resources, there were often debates amongst leaders under financial pressure in the HIV/AIDS nonprofit world about what resources should be given priority: prevention or treatment," says Paul. Supporting prevention would mean devoting funds to educational efforts and condom distribution. Supporting treatment would mean devoting funds to medical care for the already infected. With limited funds, the organization couldn't support both approaches. As a lobbyist for the organization, Paul had a heavy hand in the process. He advocated for a small advancement in both the prevention and treatment sector of the organization, instead of a large change to favor one or the other. Paul felt this would best serve the community they were charged with helping because it would put funds toward two segments that surround the issue of HIV/AIDS-those who are at risk and those who have been diagnosed.
But those above Paul felt differently. "We play a more beneficial role by focusing on treatment," said Paul's boss. The upper management reasoned that money and services would have a greater impact if it focused on the treatment option. Those needing treatment were a defined population, whereas those in prevention were hard to define or narrow as an area to serve. With so little money to work with, the upper management felt that it would be better to devote significant funds to one faction, with the possibility of making a difference, rather than splitting their time and money, thereby reducing the effectiveness and possible impact on the community. Their reasoning was sharply questioned by others who felt favoring prevention was a better option, even if the long-term result would reduce the number of infections.
"HIV infections are more likely to continue absent strong prevention programs," says Paul. "But a focus on treatment comes at the expense of the prevention programs-even at the national level."
Paul's job changed with the decision. He no longer was able to advocate for both treatment and prevention. Instead, his grant writing and petitions for government funding were focused on treatment. The organization still supported prevention, but only in theory.
After fighting a losing battle for six months, Paul left the non-profit. "Even guys in white hats-organizations designed to do good-face ethical challenges created by financial pressures," said Paul.
Discussion Questions:
- What should the goal of a nonprofit HIV/AIDS organization be?
- Once the upper management made its decision to favor treatment, should Paul have resigned?
- Do you think Paul's decision was fair to the community served?
- Should Paul have gone to the newspaper or other media outlets?
Jessica Silliman was a 2006-07 Hackworth Fellow at The Markkula Center for Applied Ethics.