At the height of the initial wave of the HIV/AIDS epidemic, the Upper Room AIDS Ministry (URAM) was founded in response to the community’s cries for help. Located first in the basement of a church, URAM provided for the very basic needs of those who were most affected by the epidemic. In addition to AIDS, the community served by URAM was one disproportionately affected by homelessness, mental health and substance use issues. URAM was the agency of last resort for medically underserved communities of color in Harlem. Founded to address the lack of response from established providers, URAM responded to the unique personal, social, and institutional barriers faced by the community it served.