Ongoing massive changes to health care delivery and organization continue and ambitious plans to restructure the system are much debated within government, practitioner and community circles. The HIV community and service providers are vitally interested in the implications of Local Health Integration Networks, primary care reform, alternative practice structures and other key changes. I recently made a speech to AIDS community groups outlining the possible implications of major reform directions, and arguing that community groups need to be proactive in working to shape the terms of health reform debate. I also stressed that the long history of community involvement, consumer-driven care, multi-disciplinary and integrated delivery, and overall innovation from providers and AIDS service organizations puts them in a strong position to make an important contribution to progressive reform. I had earlier made a speech to the Ontario Society of Physicians in HIV Care along similar lines.