mail. Newer groups that are starting up in minority communities must compete for a slice of what is often too small a pie. In addition, experience in fund-raising and technical skills are critical, and such experience may not always be readily shared with others. A description in a report on the adequacy of the response to AIDS in Philadelphia contains a passage that would apply in many localities (Philadelphia Commission on AIDS, 1988:26):
A … problem hampering the growth of community-based organizations in Philadelphia has been the existence of conflicts among the groups. The lack of adequate and stable funding has served to intensify their history of philosophical and personal conflicts …. Fragmentation within CBOs has led to some reluctance among some foundations, health care organizations, and others to become involved in what they see as squabbles.
With the number of persons with AIDS on the rise, and with greater opportunities for therapies to delay the onset of symptoms in otherwise healthy HIV-infected individuals, CBOs and local AIDS-specific volunteer organizations need more volunteers and broader sources of funding. AIDS advocates have pressed governments at all levels to increase funding for health care and social support services provided at home. Reimbursing individuals for services provided in the home, however, will depend on the development of uniform standards and quality control mechanisms.
Community-based organizations active in the HIV/AIDS epidemic face some special problems not shared by other organizations that depend on volunteer labor. These problems range from burnout and sickness and death to difficulties in finding rental space for offices or clinics due to unfounded fears of HIV transmission and neighborhood resistance to having gay men or intravenous drug users congregating nearby. Flexible work schedules may be needed for staff and volunteers who are themselves suffering from HIV-related illnesses (Carbine and Lee, 1988). A number of AIDS organizations have experienced problems in obtaining or maintaining health insurance benefits for their employees as a result of the insurance underwriting practices for small groups.
Community-based organizations formed to respond to AIDS among middle-class, white, gay men have recently been forced to reexamine their roles. As the proportion of AIDS cases grows among minorities in poor urban areas and among intravenous drug users and their sexual partners, the need has grown for organizations that reflect and can respond sensitively to these people's needs. This is of critical importance because minorities make up a disproportionate number of persons with AIDS: African Americans account for 12 percent of the U.S. population, yet 29 percent of AIDS cases; Hispanics account for 9 percent of the population, but 16 percent of AIDS cases (Centers for Disease Control, 1992). There have been significant limitations in the ability of AIDS service organizations to respond to their needs, however. Particular problems have been the lack of minority input