Toward integration: Organizational and fund development ISSUES Almost everyone involved in developing this Good Practices Guide had a story to tell about how painful the process was to undertake an integrated approach to HIV and hepatitis C. This was particularly true for people working in ASOs. Many of these organizations were started by and for gay men, responding to the unique stigma and barriers gay men faced early in the HIV/AIDS crisis. In the late 1990s and early 2000s, even if some organizational leaders (including management and Board of Directors members) saw the crucial needs for organizations to more fully address HIV and related health issues (including poverty mitigation work and gender justice) for people who use drugs and women living with HIV, to many, it felt like their needs were being erased. However difficult these conversations and organizational changes were, undertaking an integrated approach to HIV and hepatitis C has already become the norm for many organizations today, despite the extent to which organizational missions, visions and mandates actually reflect a truly integrated approach (see below). A similar fear, often termed “the end of HIV/AIDS exceptionalism,” underpins resistance to undertaking an integrated approach to HIV and hepatitis C today (see the chapter “But HIV and hepatitis C aren’t the same!”)— which, in turn, reflects a broader anxiety about the future of our sector. Many people we surveyed or interviewed spoke about tensions that occurred when their organizations embarked on an integrated approach to HIV and hepatitis C. Many of these tensions were related to gay men in staff or Board leadership roles worrying that gay men’s health issues would take a backseat to health issues for people who use drugs—and, in some cases, also women, indigenous peoples, and newcomers to Canada. As mentioned above, many organizations that weathered these challenges did so by recognizing and committing to an intersectional approach—identifying how issues like stigma, housing insecurity, health system barriers and others disadvantage gay men, people who use
drugs, indigenous peoples newcomers, and women alike (although often with differentially oppressive impacts), and that we all must intervene against these structures (and/or provide programs and services that ameliorate their negative impacts) to improve health for all. Have we gotten to where we want to be? That’s for each organization across the country to assess, although with the current state of the war on people who use drugs, on harm-reduction, extremist federal policy targeting newcomers and refugees, receding support for indigenous peoples, and the current state of HIV criminalization, we have a long way to go in Canada—and figuring out how and where our organizations fit in this struggle is a challenging and ongoing task. The best strategy to weather these pressures and ensure our organizations can continue to do the work we do best is to ensure our organizations’ health, strength and capacity. In addition to ensuring our services are relevant to our populations (see “We do what makes sense” above), and that our programs reflect good practices that have been verified by demonstrated successes and evaluation across the sector (see “Promising programs” below), we also need to ensure our organizations are strong and viable—that we have exceptional human
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