“One Hand on Their Halos and One Foot on Their Workers Necks”: Nonprofit Capitalism and the Home Care Worker

In January 1987, Larry Kramer published a now famous letter in the New York Native decrying the organizational priorities of the Gay Men’s Health Crisis (GMHC), a non-profit he helped found. Frustrated with the group’s increasing focus on service-provision supported by a growing staff of medical personnel, therapists, and teachers, Kramer argued the GMHC had strayed far from its original purpose as a political organization. Whether the group could do both was a subject of debate.

Five months later, union leaders from AFSCME’s Council 1707 would rally in an effort to win home care workers employed by nonprofits the right to unionize. In his remarks to the crowd, AFSCME president Gerald McEntee described the city’s “do good agencies” of treating home care workers as “second class slaves”-- refusing them the rights to organize, health insurance, and paying them full time wages below the poverty line.

While these home care workers were an integral part of the model of service client-centered provision that the GMHC and other non-profits advocated for, their labor struggles are often lost in accounts of volunteer-led home care programs like the Buddy Program. This paper places the organized movement for increased benefits and pay for low paid home health aids alongside the growth of a robust AIDS bureaucracy dominated by non-profit service providers. Using various reports, studies, and requests for proposals created by government agencies seeking non-profit collaborators in meeting the healthcare needs of those with chronic illnesses like AIDS, it examines the ways that these groups shaped paradigms of what care looked like in response to the first years of HIV/AIDS. I argue that these first decades of the GMHC also provide useful context for a larger story about the professionalization of gay politics and the role of Community Based Organizations within the context of neoliberalism.