Who Is Being Served? Looking at HIV Service Organizations through the Lens of the Nonprofit Industrial Complex and As a Racialized Organization

HIV service organizations (HSOs) are crucial to HIV prevention and treatment services in the U.S. However, a complicated nexus of nonprofit-government, philanthropic and corporate relationships influence HSOs. Referred to as the Nonprofit Industrial Complex (NPIC) (Incite, 2007), this nexus breeds inequitable practices within HSO networks, fueling the priority of resources toward white-cis-led organizations (Robillard et al., 2022). Given the health disparities impacting Black, Latinx, gender and sexuality diverse communities, its’ imperative to better understand NPIC from the lens of structural racism. Thus, the aims of this roundtable are to: A) Discuss the research on HSOs; B) Pose a practical framework that incorporates both NPIC and racialized organizations theory; C) Apply this framework to HSOs as an example and D) Create a critical dialogue around the utility of this framework.

This roundtable uses NPIC frameworks and Ray’s (2019) Racialized Organizational Theory to analyze the history of HSOs and its resultant impact on health equity for individuals living with HIV/AIDS. Through an NPIC lens, HSOs are prey to systemic relationships of power and money, between donors, foundations and government entities. The Racialized Organization Theory (ROT) brings a racialized analysis, one that is missed in NPIC. ROT has four tenets: enhance or diminish the agency of racial groups; legitimate the unequal distribution of resources; treat Whiteness as credential; and racialize the decoupling of formal rules from organizational practice.

In utilizing these frameworks, we found that three key themes highlight HSOs as Racialized Organizations as part of NPIC:

• Mission Control focuses on mission inclusion exclusion, and prioritization of communities and services. Organizations may shift their missions to appease funding sources (e.g. donors, foundations). The result is often a type of mission drift that stifles marginalized voices to become palatable to potential funders.

• Professionalization highlights that whiteness aligns with professional demeanor—allowing funders to claim race neutrality when they promote and fund ‘professional’ organizations. Consequently, organizations have a racialized split between their ‘leadership team’, who have decision-making authority and ‘direct service workers’ who are more likely to represent marginalized communities, are the stewards of client experience and no decision-making authority. This creates racial inequity within staff and a disconnect between client needs and organizational direction.

• Dollars Trumps Service highlights, Neoliberal prioritization of free market strategies over public health programming. This need for money seeking endeavors created a tension within nonprofits to balance resources between providing direct services and fundraising. The urgency to funnel resources to engage funders leads organizations to prioritize their ‘marketable’ services. When funding dollars are prioritized based on courting donors and their passion, already underserved communities bare the threat of being erased.

Our findings reveal how HSOs are influenced by NPIC and structural racism. This roundtable has implications for wider social work research, policy, and practice given that many social workers work within non-profits. Our aim is to engage in critical discourse about nonprofit services, and how to engage in justice-oriented practice, research, and policymaking.