ABSTRACT
In both developed and developing countries there are now large AIDS organizations which have grown in a few years from being volunteer-run small organizations, dependent mainly on resources raised from their own communities, to large, professional service organizations, funded by either state, international agencies or major donors, and controlled by paid staff rather than members or volunteers. (Note that in developing countries, many organizations originate with a small number of paid staff, and may then seek to develop processes of inclusion for both clients and volunteers.) Perhaps the comment of one executive officer of a large American AIDS organization who told me that he tried to make sure his Board members rarely entered the building is extreme, but he was articulating a commonly heard feeling that 'the professionals know best'. A more sensitive assessment of the shifts came from Christopher Spence, director of London Lighthouse, who spoke of struggling 'with the relationship between the early unpaid pioneers and the first professional paid staff; with the balance of power between those who use the services and those who
To some extent it is inevitable that as organizations grow they will become reliant on paid staff, and the early leadership will be supplanted by a new generation of professional managers. (There are echoes here of a Weberian shift from charismatic to bureaucratic authority.) But there are costs to these changes. Organizations which grew out of affected communities come to lose their ties with those they claim to represent, while moving almost inexorably into a dependent relationship with government and/or foreign donor agencies which makes them neo-agents of the state. As Carlos Caceres has written, reflecting on the trajectory of Latin American HIV/AIDS groups:
Many southern NGOs, started by intellectuals or professionals with some emotional interest in particular issues and with different degrees of social commitment and sophistication in their critical analysis and strategies ... tend at some point to implicitly reformulate their focus in terms of self-legitimation and consolidation of their institutional power ... Groups lose the initial focus on the development of services for persons with HIV and adopt a self-legitimizing narcissistic strategy, losing self-critical capacity and turning their attention to the possibilities of funding for organizational stability.' 3
The trajectory hinted at by Caceres is the subject of an important paper by John MacLachlan, who writes out of his own experience as a positive man who was very involved in the development of London Lighthouse. MacLachlan sees the essential role of community organizations as involving the empowerment of those most affected, defining empowerment as 'becoming aware of oneself as a totality, a whole and integrated personality fully able to establish clear positions about oneself and one's life, to take control over what happens to oneself, and to take responsibility for one's positions, actions and feelings'. 4 He argues that the original 'owners' of self-help groups - namely people with the virus - have handed control over to professionals, and in the process have allowed themselves to become disempowered: 'What was a self-help movement gave rise to an industry, and the perceptions, needs and demands of the various components of that industry have, mostly unintentionally and partly through the acquiescence of people with the virus, diverted what the self-help movement was all about'. 5 At the same
time the demands offunders, the growth of professional HIV workers, and exhaustion, illness and death amongst the original founders of the movement have all contributed to the decline of their original commitment to empowerment and participatory control.
