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The community-based volunteer organizations that sprang up in high-incidence urban centers such as New York City and San Francisco were in part a response to a lack of sensitivity to the health care needs of gay men and lesbians by mainstream medical establishments. system of delivering and financing health care. It is often said about AIDS that it shines a harsh light to expose the cracks and flaws in the U.S. The Origins Of Community-Based Service Organizations 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 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.
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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. Further, as the nature of the epidemic shifts, the supply of volunteers may prove inadequate. 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. 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. In the 1985 fiscal year, Arno (1986) estimated the value of AIDS-related volunteer labor to be $1.2 million. Arno's studies (1986, 1988) are among the few exceptions. 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. 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. Community-based organizations are a key component in the care of persons with AIDS. … 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".
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As de Tocqueville said (1835-1839 ): "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.
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Observers of the American scene dating back to de Tocqueville and as recently as Bellah and colleagues (1985) have described Americans' penchant for forming voluntary associations as a way of coping with social problems. Even before AIDS had a name, there were volunteers: community-based organizations (CBOs) rapidly appeared, devoted to serving persons with AIDS, raising money for care and for research, fighting discrimination, and providing education to those at high risk. Thus, one of the prominent features of the HIV/AIDS epidemic has been the growth and influence of volunteer groups in providing education, support, and care, as well as advocacy. At the same time public health officials and providers of care, frustrated by governmental inaction at high levels and aware of their limited ability to gain the trust of the communities most affected, encouraged the active participation of volunteers. Already stigmatized by homophobia, distrustful of governmental intrusions and angry over the slowness of those same government agencies to take action, the gay community quickly began to organize volunteer efforts to help their own. The AIDS epidemic once more pushed to the fore the importance of volunteers. With the rise of governmental public health agencies and organized health care, however, the role of volunteers in epidemics became less prominent: it was expected that existing social and government institutions would respond to the needs of the sick and the protection of the well. From the early Christians who cared for the victims of third century plagues and earned the name parabolani or ''reckless ones" to the gravediggers of the Black Death and even to the volunteer "sanitary monitors" of the influenza epidemic of 1919, epidemics have always called forth volunteer helpers.