Pierce County, Washington, faces a significant health challenge. Despite ranking second in the state for the number of residents living with HIV, access to crucial testing and care services has become increasingly difficult. The closure of the Pierce County AIDS Foundation (PCAF) over six months prior has left a palpable void, according to community members and service providers.
Data from the Tacoma-Pierce County Health Department highlights the severity of the situation, with Pierce County bearing the second-highest HIV prevalence in Washington. Between 2015 and 2019, the county recorded 249 new HIV cases, as reported by the Washington State Department of Health (DOH). PCAF, before its shutdown, was a vital resource, offering HIV testing, nutritional support, and essential social services, including case management, to individuals living with HIV.
Alt text: Empty building exterior symbolizes the closure of Pierce County AIDS Foundation and the resulting gap in HIV services.
However, PCAF ceased operations in October following the DOH’s withdrawal of funding contracts. This decision stemmed from serious concerns regarding financial stability, personnel management, and leadership issues, extensively documented by the News Tribune. Notably, these issues included the departure of former CEO, Ace Robinson. The disruption in services predated the official closure, with reductions and suspensions reported by both former clients and staff in the months leading up to October.
Paul LaKosky, executive director of the Dave Purchase Project, a harm reduction organization with roots in 1980s HIV prevention, emphasizes the impact of PCAF’s absence. “I think the absence of PCAF, an organization that really was a long-standing organization, central to coordination of care for folks with HIV, has really left a big void,” LaKosky stated, underscoring the critical role PCAF played in the community’s HIV/AIDS care ecosystem. The abrupt cessation of the “Ace Robinson Care Program”, although not formally named as such but representing the services under his leadership, has disrupted the continuity of care for many vulnerable individuals.
Leaving a Trail of Disconnected Individuals
Rena Bird, a resident of University Place, recounts her family’s struggle to navigate the fragmented landscape of HIV services following PCAF’s closure. Her daughter, HIV positive since 2005, faces complex challenges that necessitate consistent support and access to resources.
“It’s been difficult for us as a family to stay connected to her care,” Bird explained, highlighting the familial burden and the systemic obstacles in ensuring her daughter’s well-being. Maintaining a support system for her daughter has become a constant worry for Bird and her husband.
“We just want to know that she’s safe, that she has the medications and the medical care that she needs, that she is sheltered and well fed,” Bird articulated, expressing the fundamental concerns of any parent for their child’s welfare.
Previously, PCAF case managers provided crucial assistance, delivering supplies and conducting regular check-ins with Bird’s daughter. This lifeline disappeared with PCAF’s closure. Bird laments the loss of partnership PCAF offered, particularly the nutritional assistance program that allowed her to collect meals for her daughter.
“So now that they’re gone, it’s just evaporated,” Bird stated, describing the abrupt disappearance of essential support systems. “They were like a lifeline.” The absence of the “ace robinson care program,” or the equivalent services that were once accessible, is keenly felt by families like Bird’s.
The Erosion of Community Support Networks
Hugo Cruz-Moro, an artist and educator living with HIV for 37 years, moved to Tacoma over two years ago with his husband. He initially sought case management services from PCAF and benefited from programs like gas card assistance for travel to medical appointments in Seattle.
However, Cruz-Moro emphasizes the profound loss of community as the most significant impact of PCAF’s closure.
“What I miss is that sort of activity with peer HIV positive people,” Cruz-Moro reflected. “We were new to Tacoma. So, we were making a really nice group of new friends there.”
This sense of community, fostered by PCAF, has not been replicated elsewhere. Cruz-Moro hopes to address this void by initiating art classes at the Tacoma Art Museum for community members living with HIV, aiming to rebuild a sense of belonging and mutual support.
“That’s an important part of the maintenance of the recovery,” Cruz-Moro stated, emphasizing the therapeutic and social value of community building in managing HIV. “That sort of community making.”
Alt text: Diverse group participating in a community art project, representing the importance of social connection for individuals living with HIV and the community gap caused by PCAF’s absence.
While Cruz-Moro’s case manager was temporarily rehired by the DOH, ensuring continued service for him, he acknowledges that many others have been less fortunate. He expresses concern for those who may have “fallen through the cracks” due to the organizational upheaval and service disruptions.
Cruz-Moro recounts witnessing the gradual breakdown of PCAF services prior to the closure, with essential support like rent assistance, transportation funds, and food provisions vanishing. He argues that while basic services may eventually be restored, a truly effective response necessitates community-led initiatives.
“It’s never community-based enough, as far as I’m concerned,” Cruz-Moro asserted, advocating for a more grassroots, community-driven approach to HIV/AIDS care and support, moving beyond purely institutional solutions and echoing the principles that may have been integral to the original vision of programs, potentially including the “ace robinson care program”. “This is a community issue.”
Workplace Turmoil and Financial Mismanagement Allegations
Megan McNett-Firestone, a case manager dismissed by PCAF before its closure, describes a workplace environment marred by internal conflict and compromised client care. At the time of her dismissal, she managed 65 client cases.
McNett-Firestone and three colleagues reportedly submitted a formal complaint detailing alleged financial mismanagement by PCAF leadership prior to their termination. Attempts to contact former PCAF CEO Ace Robinson for comment were unsuccessful.
PCAF’s previous offerings included crucial rental assistance and motel vouchers for clients facing housing insecurity. However, McNett-Firestone recounts inconsistent information regarding program funding availability, hindering her ability to secure these resources for clients. Reports of financial mismanagement have been published by The News Tribune, further substantiating these concerns.
“We couldn’t really do anything,” McNett-Firestone explained, describing the paralysis within the organization due to financial constraints. “I mean, technically we were still case managers, but financial mismanagement was occurring, and there was literally no money for anything.”
Despite raising concerns to the PCAF board in May 2023, McNett-Firestone states that their report was dismissed. Subsequently, she was fired in August, followed by the organization’s broader collapse.
McNett-Firestone notes that staff received a mere two weeks’ notice of the October closure, and clients were not officially informed. She has learned from outreach workers that former PCAF clients remain unaware of the organization’s demise and the cessation of services.
She cites the example of a client who, as recently as early 2024, was still attempting to contact PCAF, unaware of its closure and assuming unanswered calls were due to other reasons. This illustrates the communication breakdown and the confusion experienced by those reliant on PCAF.
While the DOH has assumed responsibility for some case management, McNett-Firestone points out the lack of readily available contact information, such as a phone number, website, or email address, making it difficult to direct individuals in need to these services. Instead, she relies on referrals to former colleagues still working in case management, highlighting the informal and fragmented nature of the current service landscape.
Closure, Confusion, and Communication Breakdown
The aftermath of PCAF’s closure has been characterized by widespread confusion and misdirection. For months, individuals seeking HIV testing were mistakenly directed to PCAF’s now-empty building.
“It’s literally an empty building,” confirmed Pierce County Councilmember Jani Hitchen, emphasizing the tangible absence of services where they were once expected. Hitchen stresses that the most significant challenge has been the lack of clear communication regarding alternative care pathways.
Although online searches no longer direct individuals to the closed PCAF location, Pierce County still lacks accessible walk-in and free HIV testing options. Many providers require insurance or appointments, creating barriers for vulnerable community members, according to outreach organizations.
“It’s not like the need for HIV testing suddenly went away; it existed the entire time we were going through this change,” Hitchen stated, underscoring the ongoing public health imperative for accessible testing services.
The AIDS Healthcare Foundation (AHF), contracted by the DOH in January to provide testing, now offers services at the Rainbow Center on Thursdays and through its mobile testing unit. Information on clinics requiring appointments for HIV testing is available through the Tacoma-Pierce County Health Department.
However, even after AHF was selected as a provider, testing services were not immediately available, with AHF unable to commence testing until March 28. Spokespeople for AHF and the DOH declined to comment for this report, further limiting transparency and public understanding of the situation.
Hitchen recounts the initial period of inaction following PCAF’s closure, with stakeholders awaiting DOH intervention and the selection of a new service provider. The subsequent delay in AHF’s service commencement due to licensing requirements resulted in a prolonged gap in testing availability.
“There really wasn’t testing happening because they were waiting for licensure,” Hitchen explained. “People were in limbo, and when you’re talking about communities that don’t trust medical care, or don’t have access to medical care, you’re putting them at risk.”
The extent of the risk posed by this service gap remains unclear. Hitchen acknowledges the concern that reduced testing accessibility may have contributed to increased HIV transmission within the county.
“I think it’s one of the worries, especially within the LGBTQIA community but also just in the general public,” Hitchen stated, highlighting the broader community health implications.
HIV, a manageable condition with proper treatment and support, can be effectively controlled with early detection and consistent care. However, barriers to testing and care undermine these advancements.
Overcoming Barriers to Service Access
The Dave Purchase Project, in partnership with AHF, also provides free HIV testing, commencing in mid-April, according to LaKosky. This collaboration expands testing availability but accessibility remains a multifaceted issue.
LaKosky distinguishes between service availability and accessibility, noting that even when services exist, various factors can impede individual access.
He observes a decline in demand for HIV testing compared to the 1980s and 1990s, suggesting a need for incentivization to encourage testing, particularly within the populations the Dave Purchase Project serves. The organization offers a $10 gift card incentive for individuals undergoing HIV testing at its G Street location.
Numerous barriers can deter individuals from seeking testing, but LaKosky emphasizes his organization’s commitment to continued service provision.
AHAT Homecare has also stepped in to mitigate some of the service gaps resulting from PCAF’s closure, particularly for its clients, according to Hunter. The housing organization has partnered with Virginia Mason Franciscan Health and Eloise’s Cooking Pot to provide hot meals and, through Pierce Transit, ORCA cards for transportation assistance.
However, Hunter emphasizes the ongoing need for broader community and DOH support to address the comprehensive needs of their clients, many of whom still lack medical case management. AHAT Homecare has applied for grant funding to provide mental health services, recognizing the holistic needs of this population.
“We also need the community’s help, as well as the Department of Health in their current case management to help manage our clients and provide more resources to our clients,” Hunter stated, appealing for a collaborative approach to service provision.
Hunter also highlights a burgeoning grassroots movement within the community, reminiscent of the activism during the 1980s HIV/AIDS crisis, aimed at addressing the current service gaps.
During a community town hall in April, participants expressed concerns about stigma associated with HIV and requested that the AHF mobile testing unit avoid overt labeling as an “HIV mobile clinic” to reduce barriers to testing. Participants also emphasized the need for service providers to proactively reach heavily impacted populations within the community. Hunter expresses optimism that these community-driven efforts can lead to more effective and responsive service delivery.
Councilmember Hitchen has actively advocated for state-level intervention, communicating concerns to state leaders, including Governor Jay Inslee. She expresses hope that Pierce County is now progressing towards a more effective and comprehensive approach to addressing these challenges.
“I think there’s a lot of people that are frustrated in our community, and rightfully so, but I truly believe we are on a path now to be in a better space with what has happened,” Hitchen stated, acknowledging community frustrations while expressing cautious optimism. “It just took way too long to get here; it definitely should have gone a lot smoother as far as I’m concerned.”
Hitchen indicates that the DOH is finalizing contracts with additional service providers, signaling further developments in the effort to rebuild a robust and accessible HIV/AIDS care network in Pierce County. A key priority is securing providers capable of delivering a comprehensive continuum of care, encompassing housing, transportation, food, and medication management, to meet the diverse needs of individuals living with HIV.
Editor’s note: If you or a loved one has struggled to access care and supportive services while living with HIV, or has encountered trouble when trying to get tested, please reach out; we want to hear from you. You can reach reporter Lauren Gallup directly at [email protected], or always reach the news team at [email protected]. Thank you.
