In late February, several dozen demonstrators rallied outside the offices of Okaloosa AIDS Support and Informational Services, also known as OASIS, in downtown Pensacola.
"What do we want?" they chanted. "Patient choice! When do we want it? Now!"
They held signs and wore shirts reading “OASIS, Stop Being Greedy," To get into the clinic, patients had to push past a pair of protesters in inflatable, pink pig costumes.
It was a dramatic escalation in a conflict that has pitted OASIS, a small regional nonprofit, against the world’s largest HIV and AIDS health care provider, the AIDS Healthcare Foundation, also known as AHF.
Both sides say they are protecting patient choice and accuse the other side of greed, manipulation and dishonesty.
Caught in the middle are hundreds of low-income HIV and AIDS patients — people like Jonathan Jones.
Jones showed up at a different clinic run by AHF in February. About a month earlier, he’d started to worry that something might be wrong with his health after he couldn’t stop losing weight.
"I'm a recovering addict and alcoholic," Jones said, "And I was always skinny my entire life until I started drinking every day, and then I gained a bunch of weight. So, then, when I quit drinking, when I lost the weight, at first, I thought nothing of it. Sometime probably in January, I noticed my lymph nodes were starting to swell."
At first, Jones thought it was just a cold, but when the cold never came, he and his partner of 13 years, Zach, decided to get tested just to be safe. It was two days after Valentine’s Day when Jones learned he was HIV positive.
"I just pretty much froze," Jones recounted, "Because I was terrified for Zach that he might have it. As soon as they told me Zach didn't have it, I burst into tears. It's very, very scary."
Rodney Adams has been a counselor at AHF's Pensacola clinic for a decade. He’s usually the first person people see after they receive a diagnosis.
"One of the things I always say to my new patients is you're not walking around with a sign around your neck saying, 'I'm HIV positive,' " Adams said.
It’s gotten harder to convince patients of that since May, when OASIS terminated its contract with AHF for a federally funded AIDS care program it oversees.
Now, as soon as a patient receives a diagnosis, Adams has to send that person to someone else. That’s yet one more time to share the news.
"Our patients don't like change," AHF regional director Dawn Averill said. "You know, they don't like to have to tell their story over and over and over again."
The program at issue, known as “Ryan White Part B,” fills gaps in care for people living with HIV who aren’t covered by other resources. In 2019, OASIS became the lead agency for that program between Escambia and Walton counties. AHF was one of the subcontractors.
Since that contract was terminated, about 300 existing patients have been forced to change case managers. Nearly 100 others have had to switch medical providers to maintain benefits.
And new patients getting a diagnosis at AHF clinics, like Jones, must be sent to OASIS to be deemed eligible for support.
Averill said the risks extend far beyond any patient's health.
"We try to remove any barrier," she said, "Because, if someone is virally suppressed, if someone has an undetectable viral load, they are far less likely to transmit the virus. In order to have an undetectable viral load, you have to come to your appointments, and you have to take your medicine. And you're not going to do that if you don't feel you're in a safe space."
Jones said he didn’t feel safe after being sent to OASIS to have his eligibility verified. He felt scared — and confused.
"She just tried to tell me that, if I was sticking with AHF, then I would have to pay out of my own pocket. And I told her, 'Well, that is not what they told me. They said that they would still cover it.' I mainly needed it for my meds and stuff. I had to pretty much just beg that woman."
AHF medical director Dr. Mitchell Whitehead said Jones’ experience was not unique.
"The patients are sort of being told they can't see us," he said, "And these may be patients that we've been taking care of for years, or it may be a brand new patient, and they're getting these phone calls from this place saying, 'You can't see them anymore. We're not going to pay for you if you choose to still see Dr. Whitehead ... at AHF.' Of course, that's upsetting for us, upsetting for the patient, and not true. We're able to eat the cost of that."
OASIS director Kurt Goodman denied lying to patients.
He terminated AHF’s contract on the basis that it had violated a clause that capped the number of patients that could be assigned to any one case manager. He said that cap was meant to ensure the quality of care after a 2018 needs assessment noted caseloads in the region were well above industry standards.
AHF, meanwhile, has suggested the cap was a competitive maneuver aimed at redirecting patients and revenue toward OASIS and a partner agency. The foundation filed suit against OASIS and the Florida Department of Health in May.
The rift is only the latest escalation in a long-simmering dispute that Goodman said began when his predecessor rebuffed an attempt by AHF to acquire his organization. OASIS has denied most of AHF's allegations in court.
"I kind of look at the problem we have with AHF as kind of a David and Goliath type thing," Goodman said. "AHF is a very large, international corporation. They have their own way of doing things, and they expect people to bend to their will."
Indeed, AHF is an enormous organization. It operates in dozens of countries and has a $2 billion annual budget. Their CEO, Michael Weinstein, makes a salary of more than a $500,000 a year. Goodman's budget is just over $2 million. His salary is less than $74,000.
The foundation has been criticized in the past for political advocacy work that some have argued has a tenuous connection to its mission, as well as its aggressive expansion tactics, which have included high-paid lobbyists, attack ads and litigation when contract disputes threaten interests.
AHF has filed dozens of lawsuits in jurisdictions across the country, and they are represented by one of the most powerful lobbyists in Florida, Brian Ballard, who has close ties to Gov. Ron DeSantis and former President Donald Trump.
"What they're trying to do ... is hurt us financially," Goodman said, "Because they know we can't continue to pay a couple hundred thousand dollars every few months in attorney fees. Guess where that money's coming from? It's coming from services we can provide."
OASIS and AHF failed to come to terms during mediation last month. Now, the case might be headed to trial. In the meantime, Jones said he’s worried about the impact on other patients, who, like him, might find themselves caught in the fray.
"I had no idea how many people may have called up and been told the same thing and just given up and just stopped even trying to get the help that they need," Jones said, "and people could actually die over it. And I find that really scary. Nobody should ever feel like they can't get the help that they need with something like that."
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