During the early 1990s a major re-structuring of public health services began (and continues) which was to transform dramatically the way in which AIDS services were funded and provided. Two reforms - the introduction of an internal market into the health service and the introduction of community care legislation designed to establish a market in social services - have transformed the relationship between the voluntary sector and funders.

The internal market in the health service has given district health authorities and trusts the task of purchasing services from providers, often agencies which previously formed part of the health service. Purchasers also increasingly buy services from voluntary organisations. For instance, regional health authorities in London have contracts with a range of voluntary organisations in London which provide services to people with HIV or which do prevention work. The introduction of this system has required voluntary organisations to introduce careful monitoring procedures in order to provide purchasers with information on the users of their services, and to engage in consultation with service users and potential service users to ensure that their needs are being met.

In 1993 the Department of Health announced that funding to a number of organisations which had been receiving Section 64 (new charity development) money was to be cut. The move was interpreted as a sign that AIDS was being downgraded as a Government priority, especially in the light of the fact that the Department would make no commitment to the continuation of ring-fenced AIDS funding (money designated for AIDS funding only) or current levels of funding after 1995. The Health Secretary told the press that AIDS would henceforth have to compete for funding with other health problems, and that the Department would be looking at ways of targeting funding more effectively in the future.

Another factor which has seriously affected the coordination of AIDS services is the abolition of regional health authorities and the transfer of health services commissioning to district health authorities. This shift has made life even more difficult for service providers, especially in London, by forcing them to seek funding from many different sources.