Lifelong AIDS Alliance expected a warm reception from community leaders when it announced plans to rent its basement to MOMS Pharmacy, a national chain and a relative newcomer to Seattle. After all, MOMS specializes in HIV and AIDS medications. It dispenses medication in time- and date-stamped packages that are designed to help patients stick to their drug regimens, which can exceed 20 pills a day. Clients, public-health officials, and health-care partners all lauded the proposal.

But the prescription came with side effects.

Local health-care providers worry that by exclusively partnering with Lifelong, MOMS could use the nonprofit's good reputation to grab the lion's share of Seattle's HIV pharmaceutical market, harming local businesses that have been working with Lifelong's clients for years.

"To bring a corporation that stands to gain financially into the fold of Lifelong, and to expose your clients and my patients to such marketing trickery, seems to stretch the bounds of ethical standards beyond their breaking point," wrote Dr. Robert Killian, a physician who serves primarily LGBT patients, in a letter to Lifelong.

But MOMS and Lifelong say they want to better serve clients, not impact local businesses. "If [patients] have existing support and a pharmacy in place, we don't want to take that away," says Tony Luna, a MOMS spokesman. On the other hand, Lifelong spokespeople have said the agency may combine its meal-delivery program, which provides food to about 900 clients a week, with deliveries of medications from MOMS pharmacy. Those patients would be most likely to abandon their local pharmacists in favor of more convenient service from the national chain.

Pharmacist Guy Forte, who cofounded SeattleMeds, a pharmacy that opened last year and serves a couple hundred Lifelong clients, says sardonically that he wishes his pharmacy could be tied into Lifelong's food delivery service. "They didn't even consider that this might be hampering our business," he says.

From the perspective of a nonprofit, though, Lifelong's decision makes sense. The primary commitment of the organization, which serves thousands of people around Seattle, is to its clients. A recent report from the San Francisco Department of Public Health showed that homeless patients who had a nurse caseworker and date-stamped prescriptions from MOMS Pharmacy fared significantly better than before the program, and better than patients in other HIV-treatment programs. "If you have HIV, you have to stay on medications 95 percent of the time or the HIV breaks through and you lose," says Lifelong executive director David Richart, who adds, "Clients love the fact that they can come in to get food and meet with a case manager or a treatment counselor; adding this pharmacy is just one more piece." recommended