The brighter outlook for those diagnosed with HIV is putting a financial strain on long-term support services. Laura Donnelly reports on how they are coping

Last week, the BBC soap EastEnders caught up with the changing nature of HIV.Mark Fowler - living under the shadow of an HIV diagnosis for the best part of a decade - embraced a new life beyond Albert Square. His parting shot? 'I'm gonna live forever!'

The social conscience of soap may not have caught up with the nuances of combination therapy which mean an increasingly positive outlook for people with HIV.

But it does reflect shifting perceptions of HIV, which are forcing the voluntary sector to switch its focus to the long-term challenges and costs of living with the virus, rather than dying as a result of it.

HIV charities remain among the most unpopular of causes, and as NHS spending on combination therapies rises, statutory funding for the voluntary organisations continues to drop.

For the plethora of groups struggling to get a slice of the cake, consolidation and merger seem inevitable. Over the past decade, the Terrence Higgins Trust has built up a reputation to become Britain's best-known HIV organisation. Merger with London Lighthouse last month gave the new organisation a combined budget of£8.5m, making it the largest HIV charity.

The Terrence Higgins Trust has spent the past two years consolidating its position, through merger with eight smaller organisations at a time when several went to the wall. Merge or die seems to be the message within the voluntary sector community.

Paul Ward, deputy chief executive of Terrence Higgins Trust Lighthouse, sets out a clear agenda for the new organisation. Last week it began consultation on new ways of providing services.

The three-pronged approach offers a frontline service with basic information by phone and email, regional centres commissioned by health authorities and local authorities, and specialist advice for specialist, technical and legal areas.

Mr Ward argues that its new shape will allow it to work more efficiently on national areas such as policy and law, and give it the flexibility to support people at a local level.

It is hard to argue against merger. Duplication in the HIV field is well documented: a website search for HIV-related groups suggests there are 372, 185 of which are in London. The costs are hard to justify.

But leading voices in the field express some concerns that specialist groups - focusing on the needs of those from ethnic backgrounds, for example - could be squeezed out.

Hywel Sims, head of marketing for the National Aids Trust, says: 'There is a genuine sense that we need a multiplicity of providers to meet the multiplicity of needs of people with HIV.'

Despite the improving outlook for individuals diagnosed with HIV, the number of new diagnoses of people with HIV continues to rise - in 1999, the Public Health Laboratory Service recorded the highest number of new diagnoses in a decade. The increase is affecting particular groups and communities. Doctors in Lambeth, Southwark and Lewisham HA fear that black African communities 'are on the brink of an epidemic'.

Peter Taylor, regional director for London Lighthouse within the merged organisation, insists that it is determined to work in partnership with specialist groups, to ensure their survival.

He lists, as evidence for that commitment, current ways of working which include weekly 'Africa Days' to encourage West London's HIV positive African population to use the Lighthouse facilities.

Mr Taylor confirms that the voluntary sector has had to change its ways of working to fit in with the changing nature of HIV.

'When Lighthouse started we were pretty much a hospice. Now people come here for support, re-training, to move forward. That is a quantum leap.'

One man's story Paul Theobold was living in New York in the early 1980s when he became aware of the symptoms that later led to a diagnosis of HIV.

'People were so sick, there were no services for people with HIV; they were ignoring their diagnosis - there wasn't much you could do.'

Paul,51, now lives in North London. He developed AIDS in 1992, and has Hepatitis C and severe back problems.

He gave up full-time paid work in 1993, and he has used services provided by the Terrence Higgins Trust and Lighthouse for the past six years.

Paul is concerned that the positive spin placed on new treatments for HIV could encourage organisations to downplay the need for support services: 'The drop-in services have been undervalued; they are seen as places where people have coffee and fags and talk about the night before. In fact, they are great for exchange of information and peer support.'