OFFICE  OF 
INSPECTOR  GENERA 
THE  RYAN  WHITE  CARE  ACT: 
SPECIAL  PROJECTS  OF  NATIONAL  SIGNIFICANCE  OFFICE  OF INSPE(XOR  GENERAL 
The  mission of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the integrity  of the Department  of Health  and Human  Services (HHS) 
programs  as well as the  health  and welfare  of beneficiaries  served  by those  programs.  This 
statutory  mission is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Office of Audit  Setices,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The  OIG  also informs 
the  Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS  Office of Audit  Services  (OAS)  provides  all auditing  services for HHS,  either  by 
conducting  audits with its own audit  resources  or by overseeing  audit work done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
caqing  out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the  Department. 
OFFICE  OF INVESTIGATIONS 
The  OIGS  Office of Investigations  (01)  conducts  criminal,  civil, and administrative 
investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of 
unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions, 
administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud 
control  units which investigate  and prosecute  fraud and patient  abuse  in the  Medicaid  program. 
OFFICE  OF EVALUATION  AND INSPECTIONS 
The  OIGS  Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and 
program  evaluations  (called  inspections)  that  focus on issues of concern  to the  Department, 
the  Congress,  and the  public.  The  findings  and recommendations  contained  in these  inspection 
reports  generate  rapid,  accurate,  and up-to-date  information  on the efficiency, vulnerability, 
and effectiveness  of departmental  programs. 
This inspection  was performed  under  the direction  of William C. Moran,  Regional  Inspector 
General,  and Natalie  Coen,  Deputy  Regional  Inspector  General,  Office of Evaluation  and 
Inspections,  Region  V.  Participating  in the  project  were: 
CHICAGO  HEADQUARTERS 
Barbara  Butz  (Project  Leader)  Alan  S. Levine 
Jean  DuFresne 
For  a copy of this report,  please  call (312) 353-4124.  Department  of  Health  and Human  Semites 
OFFICE  OF 
INSPECTOR  GENERAL 
THE  RYAN WHITE  CARE ACT:

SPECIAL  PROJECTS  OF  NATIONAL  SIGNIFICANCE 
 N SSWZC* 
%
+ 
JUNE  GIBBS BROWN 
E 
3 Inspector  General 
s 
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APRIL  1994 
*baa 
> 
OEI-05-93-00332  TABLE  OF  CONTENTS

PAGE 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

 
SPNS Grantee  Activities  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4


SPNS Expenditures  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

APPENDIX

fkSPNS  Grantees  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..+.  ..A-l
 INTRODUCTION

PURPOSE 
To  describe  grantee  expenditures  under  the  Ryan  White  Acts Special  Projects  of 
National  Significance. 
BACKGROUND 
On August  18, 1990, Congress  passed  Public  Law  101-381 entitled  The  Ryan  White 
Comprehensive  AIDS  Resources  Emergency  (CARE)  Act of 1990 (the  Act).  The 
purpose  of the  Act was to provide  emergency  assistance  to localities  disproportionately 
affected  by the  Human  Immunodeficiency  Virus  (HIV)  epidemic  and  to make  financial 
assistance  available  to States  and  other  public  or private  nonprofit  entities  to provide  for 
the  development,  organization,  coordination  and  operation  of more  effective  and  cost 
efficient  systems  for the  delivery  of essential  services  to individuals  and  families  with HIV 
disease.  Congress  funded  the  Ryan  White  Act at  about  $221 million  for Fiscal  Year 
(FY)  1991,$276  million  for FY  1992, and  $348 million  for FY  1993.  The  FY  1994 
appropriation  is $579.4 million. 
The  Act, which  is administered  by the  Health  Resources  Semites  Administration 
(HRSA)  within  the  Public  Health  Semite  (PHS),  is multifaceted,  with four  titles  directing 
resources  to various  entities  and  allowing  grantees  maximum  flexibility in the  use of 
funds,  particularly  at the  local level.  Title  I provides  emergency  relief  grants  to cities,  or 
eligible  metropolitan  areas,  disproportionately  affected  by the  HIV  epidemic.  Title  11 
provides  formula  grants  to States  and  territories  to improve  the  quality,  availability,  and 
organization  of health  care  and  support  semices  for individuals  and  families  with HIV 
disease.  Title  III(a),  intended  to provide  formula  grants  to States  for early  intervention 
services  on an outpatient  basis,  has not  been  funded  to date.  Title  III(b)  supports  early 
intervention  services  on  an out-patient  basis,  including  counseling,  testing,  referrals, 
clinical  and  diagnostic  services,  and  other  thers peutic services.  Title  IV was to provide 
demonstration  grants  for research  and  services  for pediatric  patients,  and  requires  studies 
on partner  notification  and  HIV  disease  in rural  areas.  Congress  appropriated  $22 
million  for FY  1994 for existing  HRSA  pediatric  and  adolescent  AIDS  demonstration 
projects  to be  folded  into  Title  IV. 
Suecial  Proiects  of National  Simificance 
Up  to  10 percent  of funds  appropriated  for Title  11may be set aside  for Special  Projects 
of National  Significance  (SPNS)  grants.  The  SP!4S grants  are  competitive  grants  to 
public  and  private  nonprofit  entities  for special  projects  that  advance  knowledge  and 
skills in the  delivery  of health  and  support  sewices  to persons  with HIV  or AIDS. 
Projects  are  also chosen  for their  potential  for national  replication  and  must  include 
provisions  for internal  evaluation  and  dissemination  of findings.  Grants  are  provided  on 
a 3-year  cycle. 
1  In FY  1991, Title  II was funded  at $88 million,  and  out  of this, about  $4.4 million  went  to

22 SPNS grantees  with actual  spending  occurring  in FY  1992.1  In FY  1992, $5.7 million

was appropriated  for 26 SPNS projects  to spend  in FY  1993.  The  next year,  the  projects

were  funded  at $6.3 million.  For  FY  1994, nearly  $11 million  was appropriated  for SPNS

grantees  to spend  in FY  1995.  See Appendix  A for a description  of the  22 SPNS

projects  funded  in FY  1991 (1992).

Projects  must  target  one  of the  following goals:

Improve  access  to health  and  support  services  through  the  reduction  of 

sociocultural,  financial  and/or  logistical  barriers  as especially  experienced  by rural 
residen~  wome~  childreq  adolescen~  incarcerated  persons,  recently  released 
inrnat+  American  Indians  and  Alaska  Natives. 
Provide  advocq  semices  to ensure  adequate,  appropriate  and  timely  receipt  of 

health  and  support  semices. 
Reduce  social  isolation  of people  with HIV  to improve  their  quality  of life. 
 
Integrate  mental  health  setices  with  primary  care  services  to develop  a 

comprehensive  treatment  regimen. 
Grantees  submit  annual  reports  which  contain  a description  of the  projects  progress  in 
reaching  the  goal(s)  and  objectives  stated  in their  management  plan.  The  management 
plan  is required  as part  of the  grant  application,  and  must  describe  measurable  project 
objectives  that  specifically  relate  to the  selected  service  goal  (such  as access),  the 
projects  methodology,  and  the  population  to be  served  by the  proposed  project.  The 
annual  progress  report  must  also include  descriptions  of any problems  encountered,  steps 
taken  to remedy  the  problems,  and  any significant  findings  to date.  Continuation  funding 
decisions  are  based  upon  these  reports. 
SCOPE  AND  M131HODOLOGY 
The  Ryan  White  Act will come  up for reauthorization  in FY  1996.  This  study  is one  in a 
series  of studies  on the  implementation  of the  Ryan  White  Act which will provide 
information  useful  for the  debate  surrounding  reauthorization.  The  other  reports  are: 
The Ryan White CARE Act:  Funding Formulas  0E1-05-93-O0330
l%e Ryan White CARE Act:  FY 1992 Title I and Title II
Expenditures By Sewice  OEI-05-93-00331
lThe  meal  year for regular Title II grantees begins in April following the beginning of the fiscal year. 
However, due to the competitive nature of the grants, SPNS grantees do not reeeive their awards until [he 
following October, creating a year delay in spending.  This created some initial confusion  in our  requests  for 
information  from  both  HRSA  and  the  grantees.  However,  appropriated  IV  1991 funds  were  spent  and 
reported on by the grantees as FY 1S92 funds, and are so regarded in this report. 
2  i%e Ryan White CARE Act:  ConsorhaActivities  0EI-05-93-O0333

l%e Ryan White CARE Act:  Technical Repoti of W  1992
Expenditures  0EI-05-03-O0334
To  obtain  information  regarding  SPNS service  category  expenditures  we used  information 
in the  HRSA  AIDS  Activities  manual  issued  in December  1992, as well as grantee 
award  and  expenditure  information  given to us by HRSA.  We  also contacted  some  of 
the  grantees  for this information. 
This  inspection  was conducted  in accordance  with the  Standardsfor Inspections issued  by 
the  Presidents  Council  on Integrity  and  Efficiency. 
3 FINDINGS

SPNS GRANTEE  ACIWHTES 
The  SPNS grant  awards  for FY  1992 ranged  from  about  $112,000 to $275,000.  The 
scope  of the  projects  varied  widely.  For  example,  with a grant  of approximately 
$142,000, one  project  recruited  older  women  from  the  African-American  communities  in 
their  city to volunteer  as emotional  support  persons  and  network  conveners  for African-
American  women  with HIV  disease.  For  about  the  same  grant  amount,  another  grantee 
conducted  anti-discrimination  activities  by operating  a hotline,  developing  multi-lingual 
brochures,  developing  a directory  of resources  and  coordinating  the  activities  of public 
and  private  agencies  capable  of addressing  HIV  discrimination.  Several  of the  grantees 
focused  on coordinating  mental  health  services  with primary  care  services,  and  one  of the 
grantees  tested  a model  for training  members  of minority  populations  as community 
health  advisors  in rural  counties. 
Below  are  the  SPNS service  goals  and  target  populations  as served  by the  SPNS 
grantees:2 
Sexvice Goals  Target  Pomdations

access  - 13 grantees;
 rural  -3  grantees;

advocacy  seMces  -6  grantees;
 women  - 3 grantees;

social isolation  -5  grantees;  and,
 children  - 3 grantees;

mental  health  -6  grantees.
 adolescents  - 1 grantee;

prison  inmates  -2  grantees;

recently  released  inmates  -3
 grantees; 
Native  Americans  -1  grantee;
 and, 
open  population  - 3 grantees.

Grantees  include  community  based
 service  organizations  (10), State  and  local  health 
departments  (6), public  or private
 hospitals  (3), institutions  of higher  education  (2), and 
national  service  provider  organizations  (1).  In terms  of geographic  distribution,  11 of the 
projects  are  located  in the  east,  four  each  are  located  in the  midwest  and  the  south,  and 
two are  located  in the  west.  One  project  is located  in Puerto  Rico. 
SPNS EXPENDITURES 
From  the  FY  1991 appropriation,  HRSA  granted  $4.4 million  to 22 SPNS grantees  to 
spend  in FY  1992.  We  found  that  the  grantees  actually  spent  $3.3 million,  or 75 percent 
2The numbers of grantees add up to more than 22 because some projects address more than one service 
or population. 
4  of the  awarded  money,  leaving  over  $1 million  to carry  over  into  the  next year.  We 
divide  expenditures  into  four  broad  categories:  medical  services,  SUppOfi  servi~$ 
pharrnaceutix  and  administration/pkmning  and  evaluation.  The  medical  services  and 
support  services  categories  are  comprised  of a number  of semices  which  are  broken  out 
in Table  1.  Below,  Figure  1 shows that  22 percent  of the  funds  were  spent  on medical 
services,  65 percent  went  to support  services,  less than  1 percent  went  to 
pharmaceuticals,  and  at least  12 percent  were  expended  on administration  and  planning 
and  evaluation. 
It is important  to keep  in mind  that  due  to the  innovative  natures  of the  SPNS grantees, 
actual  services  provided  by the  grantees  may change  from  year  to year. 
FY 1992 SPNS Expenditures 
Rgum  1 
- Servic-(6!5%) 
Medical  Services  (22%) 
AdmilJFlanning  (12%) 
Table  1 breaks  out  SPNS grantee  expenditures  by actual  service  (as opposed  to category 
or goal)  provided.  We  obtained  this information  in two ways.  First,  if the  SPNS project 
was specific  in the  service  it provided,  such as mental  health  counseling,  we used 
information  provided  to us by HRSA. 
Second,  if their  activities  involved  more  than  one  service,  we contacted  the  grantees 
directly.  The  grantees  we contacted  were  able  to provide  us with specific  information  to 
varying  degrees.  Some  grantees  could  only describe  general  areas  of expenditure  while 
others  provided  specific  amounts  and  services.  For  example,  one  grantee  explained  that 
costs for mental  health  counseling,  outreach,  and  education/risk  reduction,  were  all 
included  under  the  heading  case management.  Also, in one  case,  the  amount  spent 
reported  by the  grantee  did not  match  ~he amount  given to us by HRSA.  In this case  we 
used  the  amount  reported  by the  grantee  as it was specifically  broken  down  by service. 
5
 SERVICES  FY 1992 EXPEND.  TOTAL 70  GRANTEES 
lvrAL  $3326,956  100%0  22 
* 
Pharmaceutical  S8Xi5  2 
Medical  SeMces?  $730Z18  2270 
Mental  Health  Treatment/  $712,123  21%  6 
Therapy/Counseling 
* 
Dental Care  $15,575  2 
* 
Medical Care  $2,520  1 
supportseMceS  $2JW70  65% 
Case Management  $1,028,730  3170  9 
0ther4  $787,293  24940  7 
Outreach  !$239,095  770  3 
Housing Assistance  $37,925  170  1 
* 
Education/Risk Reduction  $22,588  1 
* 
Other Counseling/Not Mental  $19,121  1 
Health 
* 
Transportation  $17,004  5 
* 
Client  Advocacy  $9,561  1 
* 
Food  Bank/Home  Delivered  S5,935  3 
Meals 
* 
Emergency  Financial  Assistance  $5,118  1 
~$  M15,983  13% 
Administration  S321,936  10%  22 
Planning  & Evaluation  S94,047  3%  3 
~  Table  1 
3This  category  presents  dollars  related  to  direct  mcd u  i services.  For  this  reason,  we  place  case 
management  in support  setvices rather  than  reedica1umms.= 
4Thme  activities  include  anti-discrimination  activll M.  [hc  dekclopment  of support  networks,  and  the 
training  of cultural  advisors. 
5For grantees  that we did not directly contact,  we assu mut 5 percent  of funds were spent for administrate ion 
because  the  grantees  we did  contact  often  allocated  signlfican[ly  more  than  5 percent  to  administration. 
According  to HRS~  because  of the innovative  nature  of I heir work,  SPNS grantees  are not held to the same 
5 percent  cap as other  grantees  under  Title  II.  Therefore,  we believe 5 percent  is a conservative  estimate.  We 
did not make the same 5 percent  assumption  for planning  and CVJIuat ion, as these expenditures  must be built 
into  the project  design. 
6  APPENDIX  A
lHE  SPNS GRANTEES: 
Arecii  Municipal  Government 
Arecii,  Puerto  Rico 
This  project  identifies  women  and  children  with HIV  disease  in five low-income  housing 
projects,  and  attempts  to improve  their  access  to medical  and  psychosocial  services 
through  coordination  with private  and  public  agencies. 
Association  for the  Care  of Childrens  Health 
Bethes@  Maqdand 
This  project  assists communities  to develop  local family-to-family  support  networks  in 
order  to reduce  isolation  and  increase  social  and  emotional  support  for families  affected 
by HIV  disease. 
Chase-Brexton  Cliniq  Inc. 
Baltimore,  Maryland 
The  Chase-Brexton  Clinic provides  a basic  mental  health  assessment  for its HIV-infected 
clients  and  offers  case  management  services  to clients  following  the  assessment. 
The  Damien  Center,  Inc. 
Indianapol@  Indiana 
The  Indiana  HIV  Advocacy  Program  attempts  to increase  access  to care  for HIV-
infected  people  by eliminating  the  barrier  of discrimination.  To  this end,  the  Advoca~ 
Program  educates  legislators  and  others  about  civil rights  protection  for HIV-infected 
persons,  strengthens  linkages  between  advocacy  resources  and  creates  new resources  in 
targeted  areas,  uses the  Indiana  HIV  Services  Coalition  to advocate  for  protection  for 
HIV-infected  persons,  and  maintains  a data  base  of collected  discrimination  cases  against 
HIV-infected  persons. 
Family  Planning  Council  of Southeastern  Pennsylvania 
Philadelphi~  Pennsylvania 
The  Inmates  and  AIDS  Intervention  Program  assists HIV-infected  inmates  and  their 
dependents  receive  care  in the  community  after  their  release  or parole. 
A-1
 The  Fortune  Society,  Inc. 
New Yorlq  New York 
Through  its ETHICS  II program,  The  Fortune  Society  addresses  the  needs  of recently 
released  inmates  with  HIV  disease.  The  goals are  to train  new staff to provide  sefices 
including  counseling,  education,  career  development,  court  advocacy,  and  outpatient  drug 
treatment. 
Henry  Street  Settlement 
New York  New York 
The  Henry  Street  Settlementss  Community  Consultation  Center  (CCC)  has  developed 
the  first school-based  AIDS  Bereavement  Group  for young  children.  Among  other 
mental  health  semices,  the  CCC  helps  children  whose  parent  has died  from  AIDS  resolve 
emotional  feelings  and  adjust  after  the  parents  death. 
Indiana  State  Board  of Healt@  Acquired  Disease  Division 
Indianapol.@  Indiana 
The  Indiana  Integration  of Care  Project  integrates  mental  health  services  with primary 
health  care  of HIV-infected  clients  on a State-wide  basis.  Referrals  to a State-wide 
system  of comprehensive  health  care  and  human  services  are  enhanced  by a voucher 
system. 
Massachusetts  AIDS  DkriminationInitiatiwI,nc. 
hkwtoq  Massachusetts 
The  Massachusetts  AIDS  Discrimination  Initiative  provides  information  through  an 
AIDS  discrimination  hotline,  multi-lingual  brochures,  and  a directory  of public  and 
private  resources  to persons  who experience  HIV  discrimination.  The  Initiative  also 
documents  the  nature  and  scope  of HIV  discrimination,  and  coordinates  activities  of 
public  and  private  agencies  available  to address  HIV  discrimination. 
Michigan  Protection  and  Advocacy  SeMces 
Lansii&
Michigan 
The  HIV/AIDS  Advocacy  Project  provides  legal  education  and  advocacy  services  for 
persons  with HIV  disease  to allow them  to gain  access  to support  services  and  medical 
care. 
Missouri  Department  of Heal@  Bureau  of AIDS  Prevention 
Jefferson  City, Missouri 
This  moiect creates  Rural  Resource  Centers  (RRCS)  to work with the  established 
. . 
network  of local  community  action  agencies  to provide  a wide  range  of services  for rural 
HIV/AIDS  clients.  The  RRCS will provide  information  about  support  services  available, 
A-2  including  emergency  financial  assistance  and  programs  to finance  dental  and  medical

care.

Montefiore  Medical  Center,  Department  of Family  Medicine

Bromq  New York

In three  Montefiore  Ambulatory  Care  Network  sites,  and  through  a Drug  Abuse

Treatment  Program,  this project  integrates  an AIDS-related  mental  health  service  into  its

primary  care  network.  The  mental  health  service  provides  culturally  sensitive

psychosocial  care  to improve  patients  participation  in medical  and  psychosocial  regimens.

National  Native American  AIDS  Prevention  Center

Oaklan~  California

The  National  Native  American  AIDS  Prevention  Center  operates  community-based

programs  in Tucson,  Arizona  and  Oklahoma  City, Oklahoma.  The  programs  provide

case  management  and  client  advocacy  services  to increase  access  to care  for Native

Americans  with HIV  disease.

New York  University  College  of Dentistry	
New Yorlq  New York	
The  New York  University  Dental  Center  provides  clinical  outreach  programs  to adult 
women,  adolescents,  and  children  from  social  groups  at  high risk for HIV-infection. 
Dental  screening  and  detection  of various  oral  pathologies  related  to HIV-infection  are 
provided  as are  routine  and  emergency  dental  care,  and  referral  to other  medical  and 
social  care.  In addition  to making  care  accessible  to an often  neglected  segment  of the 
HIV-infected  population,  the  project  educates  dental  students  and  increases  their 
knowledge  of and  confidence  about  working  with HIV-infected  patients. 
North  Carolina  Department  of Environrnen~  Heah@  and Natural  Resources	
Raleig&  North  Carolina	
Project  REACH  (Rural  Education,  Advocacy  and  Care  for HIV)  trains  members  of 
minority  populations  as community  health  advisors  in five rural  counties.  The  advisors 
help  community  residents  access  local  or regional  services  and  overcome  the  barriers  of 
transportation,  confidentiality,  geographic  or social  isolation,  and  stigmatization  of people 
living with  HIV. 
outreach  Inc.	
Atlan@  Georgia	
Mothers  Offering  Mothers  Support  (MOMS)  recruits  older  women  to serve  as support 
network  conveners  and  emotional  support  persons  for African  American  women  with 
HIV  disease.  The  program  also gathers  information  from  females  with HIV  disease, 
regarding  access  to care  and  support  services. 
A-3  Protection  and Advocacy  System	
Albuquerque,  New Mexico	
The  project  is a State-wide  effort  to address  discrimination  issues in a largely  rural  State 
with significant  minority  populations.  The  project  provides  advocacy  services  to people 
with HIV/AIDS,  and  training  to health  care  providers  on advocacy  and  legal  issues. 
Rhode  Island State  Department  of Health,  AIDSBID  Division	
Providence,  Rhode  Island	
This  project,  in collaboration  with the  Rhode  Island  Department  of Corrections,  helps 
HIV-infected  inmates  access  semices  in the  community  upon  their  release.  The  program 
provides  pre-release  counseling,  discharge  planning,  and  follow-up  monitoring,  to ensure 
the  continuity  of medical  semices  and  psychosocial  care. 
St. Josephs  Hospital  and Medical  Center	
Patersmq  New Jersey	
The  program  provides  mental  health  services  to HIV  patients  receiving  care  the 
hospitals  primary  care  clinics.  Each  HIV  patient  receives  a thorough  mental  health 
assessment  and  is assigned  to the  most  appropriate  treatment,  including  support  services 
for the  patients  family and  linkages  to drug  rehabilitation  programs  if necessary. 
Trustees  of Health  and Hospitals	
lbsto~  Massachusetts	
No One  Alone  with HIV  (NOAH)  is a hospital-based  program  designed  to  increase  the 
sensitivity  of primary  care  providers  to the  potential  or actual  mental  health  problems  of 
HIV/AIDS  patients.  The  program  aims  to increase  the  use of available  mental  health 
services  and  psychosocial  support  for HIV-infected  patients  and  their  families. 
University of Miami School  of Medicine,  Department  of Obstetrics/Gynecology	
M*  Florida	
Through  home  visits, the  Transitional  Advocacy  for HIV-infected  Women  and  their 
Children  project  provides  information,  support,  and  guidance  to women  newly informed 
that  they  have  HIV-disease.  Other  assistance  includes  meal  vouchers,  transportation, 
pre-enrollment  in the  social  service  network,  and  other  advocacy. 
Ware  County Board  of Health	
Waycr~  Georgia	
This  project  tests  a model  of establishing  HIV  wellness  centers  in five counties  to provide 
early  medical  and  social  services  for rural  people  with HIV/AIDS.  Case  management  is 
used  to overcome  barriers  to care  such as isolation,  poverty,  transportation,  and  limited 
health  resources. 
A-4