“We Weren’t a Scrappy Little Agency Anymore”: Professionalization and Exponential Organizational Growth within Early HIV/AIDS Service Organizations

Background and Purpose: AIDS service organizations (ASOs) of the 1980s and 1990s provided an indispensable source of support for people living with HIV and dying of AIDS. These early services were performed primarily by a volunteer workforce of LGBTQ community members, most often without formal training in social work. Within the first decade of the epidemic, however, many of these organizations faced internal and external pressures to professionalize their models of service delivery, driven in part by exponential growth in AIDS diagnoses and ASOs’ increased reliance on governmental and philanthropic support. The present study sought to investigate the ways in which early ASOs professionalized in response to these pressures, the profound organizational implications of doing so, and what it meant for the volunteer community members who delivered important services during this period of professionalization. To examine these questions, this paper uses Gay Men's Health Crisis (GMHC), the world's first ASO, as a case study.

Methods: This paper calls on data from oral history interviews (N ≈ 100) with former members of GMHC. Semi-structured interviews elicited participants’ narratives of the crisis, including their motivations for joining GMHC, the challenges of developing and delivering services in this context, and the meaning they make of those experiences 40 years later. Interviews were conducted virtually via Zoom and analyzed using an inductive thematic approach.

Qualitative interview data is complemented by archival research, conducted in an existing collection of GMHC documents currently archived in the New York Public Library, as well as a new collection of documents donated by interview participants.

Findings: Data from interviews and archival documents reveal the tensions caused by merging a grassroots past with the needs of a rapidly growing organization. With an increase in numbers of clients needing services, an outpouring of philanthropic support, and unprecedented governmental funding streams, interview participants note that the professionalization of service delivery was often necessary to sustain and expand organizational capacity during the height of the epidemic. Yet, as the organization adapted in these ways (i.e: instituting best-practices, clear guidelines, and prioritizing the hiring of credentialed professionals), many former members of GMHC — particularly those who joined the organization as volunteer paraprofessionals in their early-twenties — noted feeling isolated from the movement-centered mission that brought them to this work in the first place. These tensions came to a head when volunteers organized to create a Team Leader Caucus in 1990, insisting that their voices be represented on the Board.

Conclusions and Implications: This history demonstrates how effective service provision and crisis response requires not only the application of established models, but the inclusion of community members in the highest levels of organizational decision-making. This history will be put in conversation with recent changes in the professional degree classification of social workers, investigating how historic conversations around professional service delivery can be re-engaged to bolster community-based social work practice in the current landscape.