recently as Bellah and colleagues (1985) have described Americans' penchant for forming voluntary associations as a way of coping with social problems. As de Tocqueville said (1835-1839 [1945:115-116]): "Americans of all ages, all conditions, and all dispositions constantly form associations … associations of a thousand other kinds, religious, moral, serious, futile, general or restricted, enormous or diminutive. … I have often admired the extreme skill with which the inhabitants of the United States succeed in proposing a common object for the exertions of a great many men and inducing them voluntarily to pursue it". AIDS has been no exception. Community-based organizations are a key component in the care of persons with AIDS. In many communities they play an important role in reducing the length of hospital stays for persons with AIDS by enabling them to be cared for at home by friends and family to the greatest extent medically appropriate.

Little of the research on the costs of providing care for persons with HIV disease or AIDS has looked explicitly at the contribution of volunteers. Arno's studies (1986, 1988) are among the few exceptions. In the 1985 fiscal year, Arno (1986) estimated the value of AIDS-related volunteer labor to be $1.2 million. Some researchers have attributed a drop of more than two-thirds in the annual cost of caring for persons with AIDS in San Francisco (from $150,000 to $40,000) to the contribution of volunteers. According to Arno (1988:57):

[An] important reason to determine the value of volunteer labor is that it is not equally available in all regions of the country or to all groups at risk. Further, as the nature of the epidemic shifts, the supply of volunteers may prove inadequate. Thus, full market value may have to be paid if services now provided by volunteers are to be available, and it is therefore vital to know what those services actually cost.

The volunteer and community-based organizations that formed in response to the epidemic appear to have reached a crucial crossroads as the epidemic moves into its second decade. Doubts have arisen about whether CBOs will be able to meet the needs of increasing numbers of persons with AIDS and about whether the needs of intravenous drug users, their sexual partners, and their offspring can be addressed in ways that replicate the response of the more affluent and organized gay community from which the volunteer movement arose.

THE ORIGINS OF COMMUNITY-BASED SERVICE ORGANIZATIONS

It is often said about AIDS that it shines a harsh light to expose the cracks and flaws in the U.S. system of delivering and financing health care.



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