'Backs to the wall or back to basics?' - the question, posed by the George House Trust conference on the future of the HIV voluntary sector, said it all.
The sense among the 150-plus delegates at the annual conference in Manchester, representing a spectrum of healthcare, social services and voluntary organisations, was that the answer is probably 'both'.
Downward pressure on HIV funding has already forced one major HIV charity - Body Positive - and several smaller ones, to close in the past year. In October the Terrence Higgins Trust and London Lighthouse merged, and speakers were convinced that the squeeze would tighten in the new NHS, thanks to the devolution of commissioning power to primary care trusts and eventually 'stage 5' care trusts.
There was also serious concern about the government's long awaited sexual health strategy, now nearly six months late. Public health minister Yvette Cooper declined an invitation to speak at the event due to diary commitments - promising instead that the draft strategy would be issued for consultation in the late autumn. Nothing has yet appeared.
'We've been waiting three years for a government HIV strategy, ' Neil Gerrard, MP for Walthamstow and chair of the all-parliamentary party group on HIV and AIDS, told the conference.
'We're in limbo until it appears.
We were told to expect it in June, then in November and now we're looking at next January. With a general election round the corner, if there are any further delays what really worries me is the prospect of the whole thing being buried.'
Norma Turner, an HIV clinical nurse specialist from Stockport, said the HIV prevention budget was in the most danger: 'As it stands, it looks like primary care trusts will start scrutinising their contracts with voluntary sector organisations, and if HIV isn't on their local health improvement programme - which in areas of low HIV prevalence it may well not be - they'll start pulling the plug.'
She called on voluntary sector groups to lobby at every conceivable level for HIV to be included on the NHS agenda - at local, regional and national level.
The consensus of the conference was that HIV charities should stick to their guns rather than pursue commissioners' agendas, and that HIV-positive people should be given every opportunity to voice their opinions.
One obstacle to this, argued Nik Barstow, chief officer of Central Manchester community health council, would be the abolition of CHCs - one of the few means of access to health authority and trust agendas for the public, including HIV service users - through the NHS plan.
Paul McCrory, himself HIV positive and director of the Network of HIV Self-Help Organisations, talked about the common misconception among policy-makers that, since the advent of combination therapies and resulting improvement in many HIV sufferers' health, HIV service users' needs had reduced or changed.
'People with HIV are still coping with uncertainty and anxiety, holding down jobs, parenting, seeking and sustaining relationships - you name it. We still need high-quality care, information and support, just like we always have.'
Gay rights campaigner Peter Tatchell called for the repoliticisation of the HIV agenda after 10 years of 'people's righteous anger being pacified' by the disease's portrayal as merely a healthcare issue. He argued that deficiencies in HIV provision should be seen in a wider context of discrimination against gay and lesbian communities. All HAs and local authorities should introduce strong equal opportunities policies prohibiting discrimination based on sexual orientation and HIV status, and insert these into job contracts, he said.
He urged local councils to set up registers of unwed partners, gay and straight, to help bring about equal rights as next of kin and in the event of illness. The blanket ban on gay men donating blood was 'pure homophobia'.
Campaigning writer and broadcaster Bea Campbell charted the recent history of the Labour Party's relationship with gay and lesbian issues. While the government had an outward veneer of political correctness - 'out' MPs in high-ranking ministerial jobs, for example - it was fundamentally disengaged from the gay agenda and, by extension, the needs of many HIV positive people. 'We need to engage this government very inventively, ' she said. 'It's not straightforwardly homophobic.'
During the 1980s, she suggested, Labour had become embroiled in debates about the 'modernisation' of domestic lives, challenging the supremacy of white, middle-class, heterosexual men. But in the early 1990s New Labour found a new twist on conservative morality and tapped into a consensus which accepted gay and lesbian lifestyles - but only under the hegemony of monogamous, middle-class, dual-earning respectability.
'The idea is that we have to play the game and not really show our difference, ' she said. 'We have to think about what we can do to get past that shroud of intolerance.'
Perhaps the government's sexual health strategy will light the way. It seems we'll have to wait and see.