It was not politics that led to a major shake-up at Nashville CARES earlier this week.

The nearly $1 million reduction in government funding that forced Tennessee's largest HIV/AIDS services non-profit into a major restructuring was the result of market economics. CARES' five-year contract with the state to administer its Insurance Assistance Program came up for renewal this year, and a firm that manages similar programs in about twenty states entered a bidding war for the contract.

According to Patrick Hamilton, CARES' chief development officer, “CARES fought to keep the contract because we viewed it as an essential part of our mission to end the HIV/AIDS epidemic in Middle Tennessee. In order to do so, CARES had to bid a much lower rate that we were previously receiving. This meant a significant deficit to our upcoming fiscal year budget.”

"At the end of the day we are a mission driven agency," Hamilton added. If it was important to the agency's mission to retain this contract, therefore, it was equally important for the organization to remain solvent without cutting services to those in need of them.

The organization thus made every effort to maximize savings in management and operations. Echoing the statement issued yesterday by CARES CEO Joseph Interrante, the organization's director of communications, Dana Schroering, explained, "Most of this restructuring occurred in management and in back-office operations, creating no reduction in most agency programs and services. While some restructuring involved vacant positions, it did involve layoffs of eight employees, which the agency deeply regrets." In addition, four vacant positions were eliminated.

Two positions that were cut will have an impact on services, however: the staff members who ran the agency's prevention programs for women (SISTA2SISTA) and non-gay adolescents (Survivor Club) were cut, along with their programs. These programs were originally funded externally, but in 2014 the CDC eliminated funding for prevention education for women and non-gay adolescents, and United Way ceased funding Survivor club. Since then CARES has been sustaining them out of its operating budget.

"It's important to note," said Hamilton, the elimination of SISTA2SISTA and Survivor Club, not only involved the personnel costs, but the total program costs (supplies, training materials, etc.). By eliminating these two programs, there was a significant impact on the budget." However, it's equally important to note that CARES' restructuring ensures that these populations continue to be served. "Youth programming will continue through Young Brothers United, whose target population accounts for the majority of new HIV diagnoses in young people under age 25. CARES services for HIV-positive women and their partners will also continue."

In addition to personnel cuts, other budgetary items were reduced. "There were also additional cuts to the budget," explained Schroering, "including supplies, professional development training and changes to employee benefits, among others."

If CARES is able to sustain the loss of twelve back office positions without compromising service, it raises the important question of how? According to Hamilton, "We are asking people to take on additional responsibilities in order to keep front line staff and programs and services in place. We have to absorb the reduction, restructure, and ask people to do more. The last thing we want to do is see services cut. At CARES 90% of every dollar is going directly to programs."

The cuts cannot have been easy: some of those who lost their jobs had been with the organization for nearly twenty years, according to sources who prefer to remain anonymous. However, CARES' top priority remains its mission. "Just last year our Board of Directors outlined a new strategic plan," said Hamilton. "This meant we really knew what our priorities were and that's what the Board used to lay out how we would absorb the shortfall. Guided by the priorities in our strategic plan, it leaves the agency leaner, but still fully committed to our goal of ending HIV/AIDS in Middle Tennessee."

Local HIV/AIDS activist Josh Robbins noted that, "Any time someone is laid off it raises emotional issues, and worries, but funding was lost and from there the best thing any management or board can do is see how they can keep services the same while reducing budget. I think the most important thing this highlights is that government funding sources are volatile, and that it's very important to always be expanding the local and corporate donor base. I have every confidence in the board and management of Nashville CARES to move forward."

"These were tough decisions," Hamilton said, "but if it wasn't for the generous support of the local community, the cuts would have been much deeper and worse and could have impacted services. We are appreciative of the continued support of the Nashville community for our mission."

There are currently still three open positions listed on CARES' website - positions deemed essential to maintaining and providing services - and everyone who lost their job in the restructuring is potentially eligible to apply for those positions, depending on job requirements.

CARES CEO Joseph Interrante photo via O&AN files