‘They have too many staff’, ‘they all get paid too much’, ‘they’re swallowing up smaller community groups’, ‘they don’t spend enough money on HIV’, ‘their posters are everywhere’... just some of the complaints we hear about ACON. We spoke to Stevie Clayton, ACON’s CEO, to hear her thoughts.

The first Australian case of AIDS was diagnosed at St Vincent’s Hospital, Sydney, in 1982. A year later Sydney’s gay community formed the AIDS Action Committee to deal with what was, at that stage, a complete unknown. In 1984 the AIDS Council of NSW was formed, and received government funding. Over time, largely due to the work of these councils and advancements in medicine and research, the council’s focus evolved and it became a broader health and wellbeing organisation for NSW’s gay, lesbian, bisexual and transgender community. While HIV information, support and advocacy is still an important part of their work, their focus now also includes sexual health, mental health, lesbian health, drugs and alcohol, anti-violence, youth, ageing and community care.

ACON’s budget is extremely complex and is made up of many different components – some is government funded, some is tied to their charity status, and some is income generated by ACON itself. Many of these pots of money come with certain rules on what they can and cannot be spent on.

“First we have our core grant, that’s our largest chunk of money which is a bit over $7.5 million,” says Stevie Clayton, ACON’s CEO. “It’s negotiated with NSW Health every three years, and our triennial funding agreement specifies a whole range of things that we have to achieve each year to fulfill the terms of that grant. That includes work that we do in HIV prevention and the provision of services to people with HIV – a whole range of services. It spells them out in quite a lot of detail and specifies everything from counselling services and peer support programs to education and social marketing. It’s not just about HIV prevention, it’s also care and support, education, engagement in research – it talks about our work not in the sort of narrow focus that some would expect, it’s much broader and also includes the work we do with young gay men – raising their esteem, helping them come out, helping them get the skills to negotiate condom use – it takes into account the breadth of the work that we do.”

A spokesperson from NSW Health would not directly pass comment on ACON’s efficiency but they did confirm that when it comes to the expectations, scope, strategies, deliverables, reporting, performance and independent financial acquittal of their grants to ACON for the provision of HIV prevention, education, treatment, care and support programs and services in NSW, the requirements are “consistently met”.

“HIV remains a significant public health issue in NSW,” says a NSW Health spokesperson. “Efforts to control HIV in NSW have resulted in this state having relatively low rates of HIV infection by international standards. ACON plays a lead role in the implementation of effective and pragmatic approaches to preventing HIV infection.”

A Consensus Statement produced at a NSW HIV Think Tank held in 2007 provided an expert assessment of the effectiveness of NSW efforts to reduce HIV infection in the gay community, and they noted a number of strengths in the NSW response, including: effective partnerships between government, clinicians, researchers and the community; the maintenance of a skilled workforce; sustained investment in HIV prevention programs targeting gay men and comprehensive social marketing initiatives.

On top of ACON’s core grant sits a number of smaller grants, which are tied to specific projects. “First we identify a need in the community and then we go searching for the appropriate funding program out there,” says Clayton. “For example, we’ve seen a lot of research that says there’s a higher rate of smoking in the GLBT community compared to the rest of the community. So when funding bodies out there invite NGOs to submit their funding applications for quit smoking programs, then we apply. Recently, out of quit smoking money, we’ve asked if we could run a quit smoking program for positive people, because they have even higher rates of smoking and it has an even worse impact on them because of their HIV medications. We’re constantly turning over these projects. When you apply for this money you have to be very specific about what you want to achieve in what time frame. At the end of that grant, and in the case of our large grant every 12 months, we are externally audited and we report back. Our annual report to NSW Health every year is two lever arch folders thick, that’s the level of detail required.”

ACON also generates its own income by selling party tickets, discounted vitamins and even condoms to brothels. They also receive donations and make interest on money held in bank accounts. They have more freedom with how they use this money, because it’s not tied to their charity status.

“The bulk of that money, we’re very careful to tell people, is used generally for the programs and services that we provide, the whole breadth of our work, not specifically for HIV. Generally we use that money for funding the programs that we either can’t get government funding for, or for things that aren’t fully funded. We also do a lot of advocacy work, like lobbying politicians. Because we’re not allowed to use government funds for advocacy, we often use this money for that. For example, when the government tries to introduce tougher laws to penalise people with HIV who happen to pass it on to someone else, we’re in there lobbying to make sure those laws don’t get passed. We’ve supported the Gay and Lesbian Rights Lobby in their advocacy work around recognition of same sex relationships too, because we see a strong link between human rights and the impact that has on the health of our community.

“When we’ve done any market research asking the community what they think is the most important work that ACON does, advocacy is always really high on the list,” says Clayton. ACON also uses donations and their own generated income to pay for material that governments deem too explicit to touch. “If we think it’s really important, we’ll pay for it ourselves,” says Clayton.

There’s also money raised around World AIDS Day, primarily through the sale of red ribbons. “We tell people that the money is for our HIV/AIDS work – our services for people with HIV and also for HIV prevention. Last year we raised about $50,000 and the bulk of that has been spent on running The Luncheon Club.”

Clayton says that late last year, Carol Anne King and the remaining community of The Luncheon Club approached ACON and told them that after 15 years of running the HIV charity which provides food for impoverished people living with HIV, they were worn out and wanted a rest. “They came to us and begged us to do it, they said they couldn’t do it anymore and they were going to leave, and the clients would have been left in the lurch. We thought long and hard about it and decided that we couldn’t leave those people without that service.”

Clayton says that since being in the hands of Bobby Goldsmith Foundation (BGF) and ACON things have improved.

“The numbers are increasing, the building that it’s in is rented from City Of Sydney and we’ve managed to get the council to come in and fix up the kitchen, we’ve repainted the place, we’ve had nutritionists plan out the meals in the kitchen, we’ve struck deals with providers of food to increase the quantity of fresh fruit and vegetables. We’ve had a lot of success in negotiating and that’s allowed us to really increase the standard that we’ve been able to make available and bring down the cost, as well as getting more volunteers actively engaged in the place.”

Clayton says that ACON annually gives away a portion of their fundraising dollars to smaller community organizations too. “That’s part of what we do, even though fundraising is difficult for us, because of our size and because people see us as a government funded organisation not as a fundraising organisation. The amount we fundraise is really small, but we still see that it’s easier for us than it is for smaller organisations, who are trying to fundraise as well as run the service.”

According to ACON’s 2007-2008 Annual Report, ACON’s total expenditure was $9.2 million, with their two largest types of spending being $5.9 million on employees’ salaries, followed by only $659,926 on program materials and services. Members of the community have criticised the large salaries bill.

“We spend a lot of money on salaries because that’s the sort of organisation we are – we deliver services through people,” says Clayton. “For example – we provide a counselling service, and we employ a load of counsellors. In doing their job they may only use a tiny bit of paper and a desk, but it’s people that deliver the service, so that’s where the expense comes from.”

Clayton says that ACON benchmark their salaries against other similar organisations to make sure they’re not out of kilter. “In our meetings with NSW Health we tell them how much we’ve spent on infrastructure and we make sure that percentage-wise it’s a reasonable amount. If you compare the salaries to any other similar service provision organisation, you’ll see that it’s not huge percentage wise. As for the salaries that we pay individuals, we benchmark that against other organisations, usually against the organisations that we lose staff to. We also compare our staff turnover to make sure we’re not losing lots of staff or having people stay here for a really long time because we pay too much.”

Clayton says that when compared to other NGOs, ACON tries to pitch its salaries in the middle of the field. “At the bottom we couldn’t get anyone decent and we couldn’t afford to pay at the top of the scale. That being said, we do demand quite high standards from our staff. We end up losing a lot of people to the health department because they pay much better than we do. We’ve recently done a whole load of new comparisons, and we’ve found that over the last three years we’ve dropped well below the middle of the range.”

So given that money is tight, how does ACON justify some of its recent spending, like the distribution of penis shaped keyrings or the full page ads taken out in street press that are written completely in Spanish? Surely these aren’t giving them the most bang for their buck?

“It seems like it gets harder and harder all the time, but we’re constantly trying to re-invent the messages and keep them new and different, remembering that we’ve always got new people coming along who are just coming out at any age. We still need the basic information,” says Clayton. “Then we’ve got the people who know so much about HIV and safe sex and STIs and are making their own choices, and they’re not always the choices that we want them to make. There are people who are affected by drug and alcohol use, homelessness, mental health – and they’re probably not making the choices they want to make themselves. It’s certainly not an easy area and what we’re looking for are different approaches for different needs and different people.”

Clayton says that one new avenue for ACON has been working with groups and sporting teams, like the Sydney Convicts for example – they give the group money, and the group in turn agrees to spread the safe sex message. “We’re trying to find a way to get health information out to a much broader range of people geographically, but also in terms of community attachment. For example we support the HIV/AIDS legal centre, some sporting organisations, some community groups down in Albury-Woodonga, we’re looking at helping a new group setting up in Tamworth, and we’re looking at a range of groups around the state.”

Clayton says that the hardest people to reach are those at the two ends of the spectrum – those who are totally removed from the gay community, and those who are totally entrenched in it.

“The ones that don’t go to Oxford Street don’t read the community publications, and we’ll never have the money to use mainstream media to reach them. At the other end of the spectrum we’ve got what some people call the ‘sex pigs’ and ‘party boys’, who are the highly experienced ones who think that we’re the sex police and that we should just shut up and go away, that they know more than we do and they’re just not interested. We just keep looking for opportunities to reach those groups.

“The bulk of the community is actually in between, and we do get to them with messages, because the research tells us that the vast majority of gay men in NSW still use condoms most of the time. We are virtually the only place in the world to see a stable rate of HIV transmission over ten years, we do have escalating rates of STIs and I desperately wish we could get a greater in-road into them than what we are. But we are in a much better position than many other places. So, most gay men are making healthy choices.”

In Sydney these days, it seems that the two loudest community voices are Mardi Gras and ACON – one is a commercial enterprise, and the other is a health bureaucracy with finger in pies all over town, in sporting groups, parties, sex venues and even community activism. While the constant barrage of ACON’s messages are coming from a good place, does Clayton feel that Sydney has become a bit of a ‘nanny state’ as a result?

“I do ponder on it sometimes… We try focus on the values, ethics and principles that we think are important and that we hold dear and that we apply to our work. But at the same time we are a reflection of the community that owns us, that we are a part of, and I do think we’re living in a world that has become more conservative. We have a lot of people out there who are now having a sense of ownership of ACON and who are accessing our services, people who are perhaps more conservative. We’re trying to find that balance without censoring and without becoming too tame.”

Over time, as ACON has expanded, some members of the community have perceived the growth as ‘swallowing up’ smaller community groups. While this expansion has no doubt come from the best of intentions, perhaps it’s becoming a case of ‘be careful what you wish for’.

“The future that I’d like to see isn’t ACON taking on more projects,” says Clayton. “It certainly feels like people are increasingly turning to us and the expectation that we’ll be able to fix all of their problems is huge, demanding and scary.”

Photos from the 2008 Red Ribbon Working Bee, Paddington RSL.