Minnesota’s HIV community in shock after Rainbow Health and another service provider close

Howard Crutcher cared about his clients.

Crutcher, 54, worked as medical case manager at the African American AIDS Task Force (AAATF) for five years. At any given time, he worked with about 40 people living with HIV, the virus that causes AIDS, and would connect them to medical clinics, food and housing services.

Black Minnesotans founded AAATF in 1994 to fill a need for HIV and AIDS service providers catering to someone other than white men. The organization underwent changes and started to shrink two years ago, when longtime executive director Gwendolyn Velez retired; she died shortly afterward. The transition was rough, Crutcher said, and staff frustrations trickled down to clients. He left in March, and the agency officially closed in May.

“To know that it’s closed is very painful and hurtful, because I know I have a lot of clients out there who are feeling it,” Crutcher said.

Minnesota’s AIDS service organizations are going through massive changes. Rainbow Health, formerly the Minnesota AIDS Project, abruptly closed on July 19. About 10,000 Minnesotans are living with diagnosed infections of HIV, 58% of whom are people of color. Now the state and other service providers are working to fill the gaps and connect hundreds of stranded patients to vital services.

The losses come as remaining service providers are preparing for steep budget cuts. The Aliveness Project, now the state’s largest AIDS service organization, took on many of Rainbow Health’s government contracts when the organization folded. But a week later, Aliveness Project Executive Director Matt Toburen learned that his own organization should brace for budget cuts.

Next year, the Minnesota Department of Human Services (DHS) expects to reduce its HIV support budget by $9 million, or about 30%. Those planned budget cuts are a result of decreased federal funding, and one-time state appropriations running out, Toburen said. And, he added, nearly half of the Aliveness Project’s funding comes through DHS. If the Legislature doesn’t provide additional funding, he expects that many of the Aliveness Project’s programs— including a food shelf, meal center and case management—will be cut in half.

The DHS budget cuts would mean “a lot fewer services in the community,” Toburen said.

Still, he stressed, anyone living with HIV in Minnesota can reach out to the Aliveness Project to be connected with services.

‘Heavy on my heart’

Kesha Royal Gute and her co-workers at Rainbow Health received no advance notice that the agency would close. They were called into a company meeting in early July where workers asked CEO Jeremy Hanson Willis and a board member about the viability of the organization moving forward, she said. There were discussions of more money coming in and plans to fundraise in the fall. But two weeks later, Royal Gute and her colleagues received an email about an urgent all-staff meeting. Two hours later, they learned Rainbow Health was closing at the end of the day. The nonprofit cited financial challenges in a statement issued on its website .

Royal Gute, 41, managed about 35 clients and is a member of the Service Employees International Union. She and her fellow case managers scrambled to contact as many people as they could that afternoon, doing an on-the-fly triage to reach those with the most urgent needs.

She wrote a letter to her clients as the day ended to let them know why she wouldn’t be calling anymore and giving tips on where to go for help. But she never got to send those letters, because she was locked out of the system at the end of the day and couldn’t access her clients’ contact information.

“It was tough,” she said.

Royal Gute was raised by Panamanian immigrants and worked with many Spanish speaking clients. She also helped people from Minnesota’s East African community and advocated for clients who didn’t speak perfect English. One of her clients was a Somali woman with young children who recently moved to Minneapolis from another part of the state. She fears what will happen when the woman tries to call her and the line is disconnected.

“She’s really heavy on my heart,” Royal Gute said.

Rainbow Health provided direct HIV services to about 2,500 people through contracts funded by the state, according to DHS.

The abrupt nature of the closure makes it especially difficult, Royal Gute said. If Rainbow’s leadership had been more up front with workers, they could have prepared their clients for the next steps, she said. Living with HIV is manageable today, and given the proper resources, people can thrive. But hiccups with paperwork can cause lapses in health insurance and other issues that can set people back for weeks, Royal Gute said. She feels for her clients.

“It feels like they’re the ones that are taking the brunt of this, even though it’s not their fault,” she said.

The collapse was easier to see coming at AAATF, Crutcher said. But that didn’t make it any easier for him and other workers. When longtime executive director Velez left, the new leadership struggled to provide workers with the resources needed to serve their clients, he said.

“It was a shock to us that the place closed but it wasn’t a shock to us that it was going downhill,” Crutcher said.

Crutcher worked through the COVID pandemic, meeting with clients to make sure they had their housing documents in order and their transportation needs met. That work is critical, and wasn’t being done as well due to funding struggles and leadership changes, he said.

“If you take that stress away from clients, they’re able to focus on their housing, they’re able to focus on trying to feel good,” Crutcher said.

Changing face of HIV

People of color disproportionately suffer from HIV, and cases are rising faster for them than for white Minnesotans, according to the Minnesota Department of Health (MDH).

Black Minnesotans (African Americans and Black Africans) accounted for 31% of the 342 new cases in 2023, despite being 8% of the state’s population.

HIV diagnoses are also rising among Hispanic men, particularly immigrants from Latin America. One in four new cases are found in foreign-born residents, and nearly half of those new cases are in Latin American immigrants.

Nearly 80% of Minnesota’s confirmed HIV cases are in cisgender men; 42% of Minnesotans living with HIV have AIDs.

The African-born population has the highest rate of progression to AIDS within one year of HIV diagnosis, with 40% rapidly developing the most advanced state of the infection. Tom Bichanga, director of diversity, equity and inclusion at the Aliveness Project, said there is often a stigma for men seeking HIV care in the African immigrant community.

“Our community is so small, one person knows, there’s another person, now your information is everywhere in the community,” Bichnaga said.

Bichanga grew up in Kenya and runs an African outreach program for Aliveness that would host barbecues in Brooklyn Park to promote testing and other services. But with the expected DHS budget cuts, Toburen said he did not see how the Aliveness Project would fund this program next year.

Raquelle Lenoir, an Aliveness Project board member and director of development at the University of Minnesota Youth and AIDS Projects, worked at Rainbow Health from 2016 to 2019. She was one of about six people of color on staff when she started, and said she felt the organization was mostly set up to serve white men. More diverse staff would be added when the group had funding to do outreach in specific communities.

“They never hired more Black people, they only hired Black people when they had a Black grant,” she said.

That’s why AAATF felt so important to people of color living with HIV, according to Val Rubin-Rashaad, executive director of the U’s Youth and AIDS Projects.

“It was born out of a need,” she said. “Twenty-five years ago there weren’t Black HIV case managers.”

Crutcher sees a need for culturally-specific programs like those AAATF offered. Working with case workers who are also people of color helps build trust, he said.

“To be able to see someone who is like you, the culture is like yours…you tend to relate a little bit more,” Crutcher said.

Thinking holistically

The Minnesota Department of Human Services reached an agreement with Aliveness Project in August to expand its service delivery, which will transfer former Rainbow Health contract responsibilities under its control.

At the Aliveness Project office in south Minneapolis last week, volunteers packed up kits to distribute at homeless encampments. They were stuffed full of clean syringes, HIV tests, water and Narcan, which can be administered to counter opioid overdoses.

James McMurray, social services director at the Aliveness Project, had a blowup mattress in his office to give to a client later. The organization would like to hire about 25 people to help manage new clients, he said, hopefully including people who were working at Rainbow Health. They want people who lost services to come in as soon as possible.

Rubin-Rashaad at the U’s Youth and AIDs Projects has worked in HIV for nearly 30 years. Her number pops up when people search for resources online. Her phone’s been ringing since AAATF and Rainbow Health closed. It’s time to make a statewide plan to consolidate HIV services. Patients should have the same experience and quality service anywhere they go, and workers should have more protections from sudden collapses of nonprofit service providers, she said.

“This is really the time for us to think outside the box and think about how to administer care holistically,” Rubin-Rashaad said.

Lenoir said that directing most state and federal funding through Aliveness would ensure people could get the resources they need in one place that offers culturally specific services but emphasizes ease of access.

“This is the time for the page to be turned,” she said.

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