GAO

United States General Accounting Office

Report to Congressional Requesters

March 2000 HIV/AIDS

Use of Ryan White

CARE Act and Other

Assistance Grant

Funds

GAO/HEHS-00-54

Page 1 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Contents

Letter 3

Appendixes Appendix I: CARE Act Criteria for Counseling and HUD Policies

on Illicit Drug Use in Housing 34

Appendix II: Methodology and Information on Administrators’

Compensation 36

Appendix III: Dates When States and Territories Began Reporting HIV

Infection 42

Appendix IV: CARE Act Title I Awards, Fiscal Year 1999 43

Appendix V: CARE Act Title II HIV Grants, Fiscal Year 1999 46

Appendix VI: HOPWA Formula Grantees, Fiscal Year 1999 48

Appendix VII: Characteristics of CARE Act Clients and Persons Living

With AIDS at Seven Locations 51

Tables Table 1: The Ryan White CARE Act’s Programs Described 9

Table 2: Selected CDC HIV Prevention Program Funding,

Fiscal Year 1998 10

Table 3: Characteristics of Individuals Who Receive Services From

Providers Funded and Not Funded by the CARE Act 13

Table 4: Average Percentage of CARE Act Title I and Title II Funds

Spent on Services, Fiscal Year 1998 18

Table 5: Available CARE Act Title I and Title II Funds per AIDS Case

in Six States, Fiscal Year 1997 23

Table 6: Distribution of HOPWA Funds in Six States and Their

EMSAs, Fiscal Year 1997 25

Table 7: Compensation Characteristics at Nonprofit Organizations 31

Table 8: Organizations in Five Locations Funded by CARE Act Title I,

Fiscal Year 1998 39

Table 9: Compensation by Type of Nonprofit Organization 41

Figures Figure 1: Federal HIV/AIDS Funding, Fiscal Year 1999 6

Figure 2: Distribution of CARE Act Title I-III Funds, Fiscal Year 1998 16

Figure 3: Distribution of Selected CDC HIV Prevention Program

Funds, Fiscal Year 1998 20

Figure 4: Distribution of HOPWA Funds, 1994-98 22

Figure 5: ADAP Clients and AIDS Cases in Non-MSA Areas, 1998-99 28
Contents

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Figure 6: Distribution of AIDS Cases and CARE Act Clients in

Michigan, 1998 29

Figure 7: Distribution of AIDS Cases and CARE Act Clients in

Virginia, 1998 30

Abbreviations

ADAP AIDS Drug Assistance Program

AHRQ Agency for Healthcare Research and Quality

AIDS acquired immunodeficiency syndrome

CARE Act Ryan White Comprehensive AIDS Resources Emergency Act of

1990

CBC Congressional Black Caucus

CBO Congressional Budget Office

CDC Centers for Disease Control and Prevention

EMA eligible metropolitan area

EMSA eligible metropolitan statistical area

HCSUS HIV Cost and Services Utilization Study

HHS Department of Health and Human Services

HIV human immunodeficiency virus

HOPWA Housing Opportunities for Persons Living With AIDS

HRSA Health Resources and Services Administration

HUD Department of Housing and Urban Development

IRS Internal Revenue Service

MSA metropolitan statistical area

NCCS National Center for Charitable Statistics

SSI Supplemental Security Income
Page 3 GAO/HEHS-00-54 Federal HIV/AIDS Programs

United States General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-282771 Letr

March 1, 2000

The Honorable Dick Armey, Majority Leader

House of Representatives

The Honorable Thomas J. Bliley, Jr., Chairman

Committee on Commerce

House of Representatives

The Honorable Tom Coburn, Vice Chairman

Subcommittee on Health and Environment

Committee on Commerce

House of Representatives

Since the first cases of acquired immunodeficiency syndrome (AIDS) were

identified in 1981, more than 700,000 persons in the United States have

been diagnosed with AIDS. Recent developments in medical and

pharmacological therapies have improved the survival of AIDS patients. At

the end of 1998, an estimated 300,000 persons were living with AIDS. In

addition, it is estimated that hundreds of thousands of people are infected

with the human immunodeficiency virus (HIV) but have not progressed to

AIDS.

In addition to increasing, the AIDS population has changed over time, with

minorities and women representing a larger proportion of cases. For

example, for the 12 months ending June 1993, African Americans

accounted for 35 percent of reported AIDS cases, women 15 percent. For

the 12 months ending June 1999, the figures were 46 percent African

Americans and 23 percent women. The AIDS population by exposure

category, or how HIV was contracted, has also changed. Men who have sex

with men accounted for 48 percent of the reported AIDS cases during the

12 months ending June 1993. This group, however, accounted for only 34

percent of the reported AIDS cases for the period ending June 1999.

A number of federal HIV/AIDS programs provide for research, prevention,

health care, and support services to reduce the risk of contracting the

disease and to assist those who are infected with the virus. You asked us to

provide information on three programs that fund prevention activities,

health care, and other assistance: the Ryan White Comprehensive AIDS

Resources Emergency Act of 1990 (P.L. 101-381) (CARE Act), which is
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administered by the Department of Health and Human Services’ (HHS)

Health Resources and Services Administration (HRSA); the Centers for

Disease Control and Prevention’s (CDC) HIV/AIDS prevention grants; and

the Department of Housing and Urban Development’s (HUD) Housing

Opportunities for Persons Living With AIDS (HOPWA). You asked us to

determine (1) the characteristics of the persons who are served under the

CARE Act; (2) how CARE Act, CDC prevention, and HOPWA funds are

distributed to treatment, support services, housing, prevention, and

program administration; (3) whether the current approach to funding

under the CARE Act leads to advantages or disadvantages in particular

areas; (4) whether CARE Act services are reaching rural areas; and (5) how

the salaries of administrators of organizations providing HIV/AIDS services

compare with the salaries of administrators of other similar nonprofit

organizations. We also provide information related to your questions about

CARE Act requirements for counseling and HUD’s policies regarding illicit

drug use in HUD-funded housing (see app. I).

To conduct our work, we interviewed officials at HUD and at HHS,

including HRSA, CDC, and the Agency for Healthcare Research and Quality

(AHRQ). We obtained and analyzed data from these federal agencies. We

obtained funding and other data from six states and public tax records on a

sample of nonprofit organizations. We reviewed federal legislation and

regulations and relevant HIV/AIDS literature. We conducted our work

between June 1999 and January 2000 in accordance with generally

accepted government auditing standards. Appendix II provides detailed

information on our methodology for comparing administrators’

compensation for AIDS service organizations and similar nonprofit

organizations.

Results in Brief The CARE Act funds appear to be reaching groups of infected individuals

that have generally been found to be underserved, including the uninsured

and the poor. African Americans, Hispanics, and women are served by the

CARE Act in higher proportions than their representation in the AIDS

population. These vulnerable groups make up the majority of CARE Act

clients.

The CARE Act funds both health care and support services, such as case

management, housing, transportation, and nutrition. Most of the funds,

however, are used for medical treatment and medications. CDC supports a

wide range of state and local HIV prevention activities. About two-thirds of

CDC’s fiscal year 1998 HIV prevention funds to states, localities, schools,
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and organizations were used for health education and risk reduction,

public information, evaluation and research, capacity building and

infrastructure development, and community planning. About one-third was

used for counseling about the risks of contracting HIV and the need to

notify partners about potential HIV infection, testing for the virus, and

referring persons who test positive to appropriate care. HOPWA helps lowincome people with HIV/AIDS and their families secure housing and

provides other services. HOPWA funds may be used for a variety of

housing-related expenses, social services, and program development.

Between 1994 and 1998, about two-thirds of HOPWA funds were used for

housing assistance. All the programs have limitations on how program

funds can be used for administrative purposes.

The levels of funding differ in different areas, with urban areas generally

receiving higher funding per AIDS case when an area is designated as an

eligible metropolitan area (EMA). EMAs receive funds directly from the

federal government under title I of the CARE Act, in addition to the funds

provided through the states under title II. While HOPWA funds also vary

between states and their eligible metropolitan statistical areas (EMSA),

HOPWA state awards are allocated to provide assistance in areas of the

state that are outside any qualifying metropolitan area that receives a

HOPWA allocation.

While the vast majority of people with AIDS reside in urban areas, the

number of AIDS cases is growing in rural areas, which may offer more

limited medical and social services. CARE Act drug assistance services are

reaching the rural AIDS population in proportion to the AIDS cases in rural

areas. Other services under the CARE Act are being provided to individuals

who reside in rural areas, although data do not exist to show where the

individuals receive the services.

The compensation for administrators of organizations that received federal

HIV/AIDS funds was generally comparable to that of administrators of

similar nonprofit organizations. The median compensation for

administrators at organizations that received CARE Act or CDC HIV

prevention funds was $78,000, and the median at organizations that serve

only HIV/AIDS clients was $64,878. The median for other nonprofit

organizations providing such services as health care, family planning, and

substance abuse prevention and treatment services was $74,203.
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Background The CARE Act, CDC HIV prevention programs, and HOPWA accounted for

about 20 percent of the estimated $10 billion in federal spending on

HIV/AIDS programs for fiscal year 1999. For that period, estimated federal

spending for HIV/AIDS included $2 billion for research, $0.8 billion for

prevention activities, $5.8 billion for treatment, and $1.4 billion for income

and support. (See fig. 1.)

Figure 1: Federal HIV/AIDS Funding, Fiscal Year 1999

Note: CARE Act funds are assigned to “Treatment.” Some funds are used for support services. “Other”

includes primarily Medicaid, Medicare, Social Security Disability Insurance, Supplemental Security

Income, and National Institutes of Health research.

Source: Congressional Research Service.

 , 

 , 

 , 

 , 

 , 

 , 

CARE Act

CDC

HO A

Other

Research revention Treatment Income and Support

D llars in illi ns
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Medicaid is the largest source of federal assistance for health care for AIDS

patients.1 In 1998, Medicaid was estimated to cover 50 percent of adult

AIDS patients and about 90 percent of pediatric AIDS patients. States vary

in their Medicaid eligibility requirements. Most adults with AIDS or HIV

infection become eligible for Medicaid by meeting the disability criteria of

the federal Supplemental Security Income (SSI) program but usually not

until they have developed AIDS and have become too disabled by their

disease to work.2 Within broad federal guidelines, states have flexibility in

developing their Medicaid programs, including eligibility, services to be

covered by the program, and the scope of the prescription drug benefit, if

any.

AIDS Rates Vary

Geographically

The incidence of AIDS varies from state to state. AIDS cases reported for

the 12 months ending June 1999 ranged from less than one case per 100,000

people in North Dakota to 143.4 cases per 100,000 people in the District of

Columbia. The rates of AIDS cases also vary within states. For example, for

the 12 months ending June 1999, the rate of AIDS cases reported in New

York was 42.1 per 100,000 people. A large portion of this was accounted for

by the New York City metropolitan area, where the rate was 74.9 per

100,000 people for the same period. A comparison of Florida and Miami

shows similar differences. The rate of reported cases in Florida was 38.1

per 100,000 people while in Miami it was 72.5.

1

Medicaid is a joint federal and state program that pays for health care services for eligible

low-income or disabled individuals.

2

A disabled adult is unable to engage in any substantial gainful activity because of a

medically determined physical or mental impairment that has lasted (or can be expected to

last) at least 12 months or that is expected to result in death. An individual with AIDS or HIV

infection could also qualify for Medicaid on the basis of eligibility under another eligibility

category such as being a pregnant woman, a child under 21, or a member of a family with a

dependent child.
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Rural areas still account for only a small portion of AIDS cases, according

to CDC information. AIDS rates have increased in nonmetropolitan

statistical areas but do not indicate that the epidemic is increasing rapidly

there.3 Of the reported cases, 83 percent were from large metropolitan

statistical areas (MSA), where 62 percent of the population lived. Mediumsized MSAs accounted for 10 percent of the AIDS cases and 18 percent of

the population. Non-MSAs accounted for 7 percent of the AIDS cases and

20 percent of the population.4

The pattern of HIV cases is not as clear as the pattern of AIDS cases

because not all states report HIV cases. While information on people with

HIV is important in planning for surveillance purposes, only 33 states had

implemented HIV reporting as of June 30, 1999. Additionally, the states’

reporting practices vary. For example, states began HIV reporting on

different dates, and some states reported previously diagnosed cases along

with new cases, while others reported only newly diagnosed cases. Two

states report only pediatric cases. Appendix III lists the states that have

initiated HIV reporting.

The CARE Act Provides

Health Care and Support

Services

The CARE Act was enacted to improve the quality and availability of

medical and support services for individuals with HIV disease and their

families. The act was reauthorized in 1996. HRSA administers it.

Appropriations for fiscal year 1999 were $1.4 billion. Title I provides funds

to EMAs with substantial numbers of AIDS cases. Title II provides funds to

states and territories by formula, including for the AIDS Drug Assistance

Program (ADAP). Discretionary grants to community health centers and

other related entities are available under title III for providing primary

medical care, HIV counseling and testing, and a variety of support services.

Other discretionary grants are available under title IV for services for

women, children, and families. (See table 1.)

3

This is based on AIDS cases in adults and adolescents 13 years of age or older reported to

CDC in 1996 from the 50 states and the District of Columbia.

4

Large MSAs are defined as having populations larger than 500,000, medium-sized MSAs

between 50,000 and 500,000, and non-MSAs smaller than 50,000.
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Table 1: The Ryan White CARE Act’s Programs Described

Program Grantee

Fiscal year

1999 funding Purpose and requirements

Title

I. HIV Emergency Relief Grant

Program (formula and

supplemental grants)

51 EMAs in fiscal year 1999

with at least 500,000

population and 2,000 AIDS

cases reported in the most

recent 5 years

$485.8 milliona Provides HIV/AIDS outpatient health care, including

medications, and a range of support services,

including case management, substance abuse

treatment, housing, mental health treatment,

transportation, and nutritional services, among

others. Each EMA has to establish a planning

council of representatives of health care agencies,

community-based providers, health care planning

agencies, and persons with HIV disease, among

others. The planning councils establish priorities for

allocating funds.

II. HIV Care Grants (formula

grants)

50 states, the District of

Columbia, and U.S.

territories

$710 million, of

which $461

million was for

ADAP

In addition to ADAP, services include home and

community-based health care and support and

health insurance continuation. States provide the

services directly or through consortia of service

providers. States are required to periodically

convene people living with HIV disease, grantees,

providers, and public health agencies to develop a

statewide coordinated statement of need.

III. Early Intervention Services

(discretionary grants)

198 grantees, including

community and migrant

health centers, hospital or

university-based medical

centers, and city and county

health departments

$94.3 million Services include risk reduction, counseling, testing,

clinical care, medications, and case management.

IV. Coordinated Services and

Access to Research for Women,

Infants, Children, and Youth

(discretionary grants)

55 grantees and projects in

fiscal year 1998, including

health care facilities, public

health agencies, and

community-based

organizations

$46 million Health care and social services that benefit

children, youths, and women living with HIV and

their families.

Other

Special Projects of National

Significance

Funded by setasides from

titles I-IV not to

exceed $25

million annually

Supports the development and evaluation of

innovative models of HIV/AIDS care.

AIDS Education and Training

Centers Program

$20 million A national network of 15 centers that conduct

training and education for health care providers in

designated geographic areas.

Continued
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a

Additional funds were available to some EMAs. HHS in collaboration with the Congressional Black

Caucus (CBC) provided funds to target and enhance effective HIV/AIDS efforts that directly benefit

racial and ethnic minority communities: technical assistance and infrastructure support, increasing

access to prevention and care, and building stronger linkages to address the needs of specific

populations. For fiscal year 1999, CBC funds to the EMAs totaled $5 million.

Appendix IV lists the EMAs for fiscal year 1999 and title I award amounts;

appendix V shows the title II awards to the states, the District of Columbia,

and the territories.

CDC Funds HIV Prevention

Activities

CDC’s role includes vaccine research, research on HIV infection and

disease progression, surveillance programs, prevention research,

prevention program evaluations, state and local prevention activities,

school-based prevention activities, and prevention in occupational settings.

In this report, we focus on CDC-funded HIV prevention programs through

state and local health departments; national and regional minority

organizations; national business, labor, and faith partnerships; and other

community-based organizations. State, territory, District of Columbia, and

local education agencies also receive funding for prevention activities. The

major grantees received $289.8 million in fiscal year 1998, as shown in table

2.

Table 2: Selected CDC HIV Prevention Program Funding, Fiscal Year 1998

a

Excludes funding for surveillance activities.

Dental Reimbursement Program $7.8 million Assists accredited dental schools and postdoctoral

dental programs with uncompensated costs

incurred in providing oral health treatment to HIVpositive patients.

Program Grantee

Fiscal year

1999 funding Purpose and requirements

Continued from Previous Page

Type of grantee

Number of

grantees Funding

State, territorial, and local health departments 65 $252,824,319a

State and local education agencies 75 19,414,850

Community-based organizations 93 17,553,983
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HOPWA Provides Housing

Assistance and Other

Services

HOPWA provides housing assistance and supportive services for lowincome persons with HIV/AIDS and their families. Formula grants to states

and metropolitan areas that exceed thresholds for population and AIDS

cases constitute 90 percent of the funding. The remaining 10 percent of

funds are awarded competitively. Fiscal year 1999 funding of $200.5 million

was distributed to 63 metropolitan areas and 34 states, and $24.5 million in

competitive awards went to 24 projects. States, localities, and other

grantees provide emergency shelter, shared housing, apartments, single

room occupancy units, group homes, and housing combined with support

services. Grantees can also use HOPWA funds for a variety of housingrelated expenses, social services, and program development costs such as

housing information and resource identification, purchase, repair, and

construction. HOPWA funds are also used for health care, mental health

services, substance abuse treatment, nutritional services, case

management, and help with daily living.5 Appendix VI identifies grantees

and fiscal year 1999 award amounts.

The CARE Act Is

Assisting Underserved

HIV-Infected

Populations

African Americans, Hispanics, and women are served by the CARE Act in

higher proportions than their representation in the AIDS population. These

vulnerable groups, including the uninsured and poor, are the majority of

CARE Act clients. According to a recent HIV study, they generally receive

less appropriate health care for their disease when assessed in terms of

physician visits, emergency room visits, hospitalizations, and antiretroviral

and prophylactic drug therapies.

5

Health care services are limited to persons with HIV/AIDS and not other family members.

Further, the cost of these services is limited when payments are made by other sources.
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According to the HIV Cost and Services Utilization Study (HCSUS)—a

study of a nationally representative sample of HIV/AIDS patients—African

Americans, Hispanics, women, the uninsured, and people insured by

Medicaid are likely to visit physicians less frequently and to take fewer antiHIV medications for their HIV disease than other HIV-infected people.6

HCSUS analyzed usage patterns for six measures of health care: physician

visits, emergency room visits, hospitalizations, prophylaxis against

Pneumocystis carinii pneumonia, antiretroviral medication, and new

classes of pharmaceuticals that include protease inhibitors and

nonnucleoside reverse transcriptase inhibitors. The analysis showed that

compared with whites, African Americans and Hispanics received less

appropriate care for their HIV disease. Types of public and private health

insurance coverage also affected care. People who lacked health insurance

fared worse on most measures. Also, Medicaid recipients received less care

than privately insured persons. Women also did not fare as well as men on

most of the measures. Finally, exposure category was a significant factor;

those who had acquired their infection by injecting drugs or through

heterosexual sex had less favorable patterns of care than did men who had

sex with men.7

Individuals Served Under

the CARE Act Are More

Likely to Be Members of

Minorities, Uninsured, and

Poor

Analyses of the HCSUS data to determine the characteristics of persons

served under the CARE Act show that CARE Act clients are more likely to

be African American, have no insurance or rely on public insurance, and

have a lower income than other HIV/AIDS patients.8 (See table 3.)

6

HCSUS is being conducted under a cooperative agreement between RAND and AHRQ.

Additional funding has been provided by a number of agencies within HHS, the Robert

Wood Johnson Foundation, Merck & Co., and Glaxo-Wellcome Inc. The study is based on a

sample of 2,864 respondents representing the 231,400 persons who were at least 18 years

old, known to have been infected with HIV, and receiving medical care in the 48 contiguous

United States in early 1996.

7

M. Shapiro and others, “Variations in the Care of HIV-Infected Adults in the United States,”

Journal of the American Medical Association, Vol. 281 (1999), pp. 2305-15.

8

HCSUS defines CARE Act clients as all patients receiving care from a site that has received

CARE Act funds. It is possible that some individuals received services at a CARE Act-funded

site that were not funded under the CARE Act. AHRQ performed specific analyses of the

HCSUS data at our request.
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Table 3: Characteristics of Individuals Who Receive Services From Providers

Funded and Not Funded by the CARE Act

Also, a greater percentage of women (26 percent) are served under the

CARE Act than are not (18 percent). A greater percentage of persons

contracting the disease by injecting drugs or through heterosexual contact

were seen by providers funded by the CARE Act. A greater percentage of

men who contracted the disease through sexual contact with other men

were seen by providers not funded by the CARE Act.

Characteristic Funded Not funded

Gender

Male 74% 82%

Female 26 18

Race

White 40 62

African American 42 19

Hispanic 15 16

Other 3 3

Exposure category

Men who have sex with men 44 55

Persons who inject drugs 17 14

Men who have sex with men and inject drugs 8 8

Persons who have heterosexual contact 22 13

Other 3 4

Insurance status

No insurance 30 6

Medicaid only 33 23

Medicare and Medicaid 19 18

Private insurance 19 54

Income (highest income ever, in 1996

dollars)

$0−$5,000 25 12

$5,001−$10,000 30 20

$10,001−$25,000 27 23

More than $25,000 18 45
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Women Receive CARE Act

Services at Higher Rates

Than Their Representation

in the AIDS Population

Using separate data, we also compared the estimated number of people

living with AIDS and people receiving CARE Act-funded services in two

states and five metropolitan areas: Los Angeles, San Francisco, and Orange

County, California; Middlesex, New Jersey; Michigan; Virginia; and

Washington, D.C. These locations were selected because HRSA was able to

provide data on the unduplicated population of persons served under the

CARE Act.9 We compared the AIDS population as of June 30, 1998, with the

client population receiving services under the CARE Act in 1998.10

We found that women were receiving services funded by the CARE Act at

rates greater than their representation in the AIDS population as a whole.

At all seven locations, a greater percentage of women received such

services than their percentage in the AIDS population. Analyses also

indicate that minorities and individuals contracting the virus through

heterosexual contact are represented at higher rates among those served

under the CARE Act than in the AIDS population as a whole. While there is

variation across locations in the proportion of African Americans and

Hispanics in both the AIDS and client populations, at all seven locations a

greater percentage of African Americans are among the CARE Act clients

than in the AIDS population. This is also true for Hispanics at two of the

seven locations. In three locations, the percentages of Hispanics among

CARE Act clients were slightly higher than their representation in the AIDS

population. In two locations, they were slightly lower.

9

HRSA obtains client data from service providers, and clients may seek services from more

than one provider. Therefore, an unduplicated count of clients is typically not available.

HRSA initiated “Client-Level Data Demonstration Projects” at eight sites that can provide an

unduplicated count of clients. For California, however, limited data were available and are

therefore not included in our analysis.

10While both HIV-infected and AIDS patients can receive services funded under the CARE

Act, we are limited to comparing CARE Act clients with persons with AIDS because data on

HIV-infected persons are not uniformly reported. The percentage of CARE Act clients with

AIDS ranged from about 41 percent at one location to about 49 percent at another. Our

analysis of the seven locations shows CARE Act client characteristics and HCSUS data to be

similar. Also, we noted that the characteristics of persons with AIDS and CARE Act clients

vary by location.
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We also found that persons who contracted the HIV virus through

heterosexual contact were more likely to receive services funded by the

CARE Act.11 In the HCSUS data, we saw that a greater percentage of people

who injected drugs receive their services from providers funded under the

CARE Act. However, individuals who contracted HIV by injecting drugs had

less representation among individuals served under the CARE Act than in

the AIDS population at five of the locations. (See app. VII for detailed

results for each location.)

CARE Act, CDC

Prevention Programs,

and HOPWA Fund an

Array of Services

While the CARE Act funds both health care and support services, most of

the funds are used for medical treatment and medications. Included in CDC

prevention activities are counseling about the risks of contracting HIV and

the need to notify partners about potential HIV infection, testing for the

virus, and referring those who test positive to appropriate care. About onethird of fiscal year 1998 funds were used for these purposes. HOPWA funds

are used primarily for housing assistance; about two-thirds of the funds

between 1994 and 1998 were used for this purpose. All the programs have

limitations on the administrative use of program funds.

Most CARE Act Funds Are

Used for Treatment Services

To determine the distribution of CARE Act funds, we focused on titles I-III.

These titles accounted for 95 percent of the act’s fiscal year 1999

appropriations.12 About 56 percent of title I funds were used for health care

and medications in fiscal year 1998. For the same year, 34 percent of the

funds were used for case management and support services and 10 percent

were used for administration, planning councils, and program support.

(See fig. 2.)

11The proportion of AIDS cases that resulted from heterosexual contact is increasing in the

general population. Of the AIDS cases reported for the 12 months ending June 1993,

exposure to HIV through heterosexual contact accounted for 9 percent in which exposure

category was known. This compares with 15 percent of the AIDS cases reported for the 12

months ending June 1999 for the same exposure group.

12HRSA was not able to provide data on the distribution of funds among various services for

title IV and demonstration and training programs.
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Figure 2: Distribution of CARE Act Title I-III Funds, Fiscal Year 1998

Administration, Planning Councils, and

Program Support

Case Management and Support Services

Health Care

 

1 

Administration, Planning, and Evaluation

Health Care

Case Management and Support Services

ADAP

 

12 

12 

1 

Administration

Testing, Counseling, Referral, and Outreach

Case Management and Other

Health Care

 

8 

 

12 

Title III

Title I Title II
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Most title II funds are also used for medications and medical services.

About 66 percent of title II funds were devoted to ADAP services in fiscal

year 1998. Health services other than ADAP accounted for 12 percent of the

funds in the same year. Case management and support services accounted

for 12 percent of the funds. Grantees used 10 percent of the funds for

administration as well as planning and evaluation.

Most title III funds were also used for health care. In fiscal year 1998, health

care services, including medications and laboratory services, accounted for

74 percent of the funds. Another 12 percent were used for case

management and other services. About 8 percent were used for testing and

counseling, referral, and outreach. The remaining 6 percent went to

administration activities.

The Distribution of Funds Has

Changed With New Treatment

Approaches

Decreases in the number of new AIDS diagnoses and death rates have been

greatly influenced by new drug therapies generally administered in

combinations of three or more agents. These medications, however, are

expensive, with estimated annual costs of $10,000 and more per patient.

While the distribution of title I funds among various services has remained

relatively constant, title II money is increasingly supporting

pharmaceuticals.

Title II’s ADAP component provides funds to the states for providing

medications to HIV-infected individuals. In response to these expensive

therapies, federal funding for ADAP increased from $52 million in fiscal

year 1996 to about $461 million in fiscal year 1999, accounting for an

increasing proportion of the title II funds. ADAP represented 20 percent of

title II funding in fiscal year 1996 and 65 percent in fiscal year 1999. Title II

funds used for other health care services remained about the same—$59.3

million in fiscal year 1996 and $60.4 million in fiscal year 1998—but

represented a decreasing proportion of title II spending.

States With EMAs Spend

Proportionately Less on

Medications

The proportions of CARE Act funds spent on services for their HIV-infected

populations vary from state to state. For example, the percentage of CARE

Act funds devoted to health care services other than medications ranged

from 5 percent in one state to 41 percent in another for fiscal year 1998.

One state did not use any of its CARE Act funds for health care services.

With the majority of title II funds earmarked for ADAPs, states without

EMAs have most of their CARE Act funding allocated for medications. In

states with EMAs, and therefore title I funding, greater proportions of

CARE Act funds are spent, on average, for other services such as health
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care and support services. Table 4 shows the average percentage of title I

and title II funds spent on different services for fiscal year 1998.

Table 4: Average Percentage of CARE Act Title I and Title II Funds Spent on

Services, Fiscal Year 1998

Source: HHS, HRSA, Ryan White CARE Act State Profiles (Washington, D.C.: HHS, 1999).

The CARE Act Limits the Use of

Funds That Can Be Used for

Administrative Purposes

As shown in figure 2, under each title, not more than 10 percent was used

for administrative purposes. Each title contains limitations on the use of

funds for administrative activities. The portion of fiscal year 1998 title I-III

funds used for administrative purposes was within these limitations.

The CARE Act defines administrative activities as routine grant

administration and monitoring, including the development of applications

for funds, the receipt and disbursal of program funds, the development and

establishment of reimbursement and accounting systems, the preparation

of routine program and financial reports, and compliance with grant

conditions and audit requirements. Also considered administrative

activities are all activities associated with a grantee’s contract award

procedures, including the development of requests for proposals, contract

proposal review activities, the negotiation and awarding of contracts,

monitoring contracts through telephone consultation, written

documentation of onsite visits, reporting on contracts, and funding

reallocation activities.

Grantees may not use more than 5 percent of awarded title I funds for

administrative activities. In addition, title I EMAs may use funds for

carrying out planning council support, program support, and serviceService All states States with EMAs

States without

EMAs

Medications 49.9% 38.5% 58.4%

Health care 20.4 24.4 17.6

Administration,

planning, and

evaluation 9.4 9.7 8.6

Case management 8.9 12.3 6.5

Support services 8.6 14.2 4.5

Health insurance

continuation 2.4 0.9 3.5
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related activities that are subject to a 10 percent aggregate administrative

cost cap. While subcontractors are not included in the 10 percent aggregate

cap, HRSA strongly recommends that all subcontractors include a cap on

administrative expenses.

The states may use title II funds to conduct administrative activities similar

to those under title I. The combined costs for administration, planning, and

evaluation cannot exceed 15 percent of a state’s award.13 For title III,

grantees may not use more than 7.5 percent of the grant amount for

administrative costs, including planning and evaluation.

CDC Funds a Range of

Prevention Activities

In fiscal year 1998, CDC provided $289.8 million to state and local health

departments and education agencies and community-based organizations

for HIV prevention activities. Major HIV prevention interventions include

counseling, testing, referral, and partner notification; health education and

risk reduction; school health; and public information. Evaluation and

research, capacity building and infrastructure development, and

community planning are support activities. About 62 percent of the fiscal

year 1998 funds were used for health education and risk reduction, school

health, public information, and support activities. Another 31 percent was

devoted to counseling and testing and partner counseling and referral

services. Grantees’ administrative expenses or indirect costs averaged 7

percent for fiscal year 1998.14 (See fig. 3.)

13States that receive a minimum allotment of title II funds (between $100,000 and $250,000)

may spend up to the amount required to support one full-time equivalent employee for

administration, planning, and evaluation.

14CDC uses a grantee’s federal negotiated indirect cost rate. Typical examples of indirect

costs are costs of general administrative services, general research and technical support,

security, rent, employee health and recreation facilities, and operating and maintenance

costs for buildings, equipment, and utilities.
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Figure 3: Distribution of Selected CDC HIV Prevention Program Funds, Fiscal Year

1998

CDC places several requirements on its grantees, including requirements

related to counseling and testing, and partner counseling and referral

services. Public health agencies that receive CDC HIV/AIDS prevention

funds are required to offer HIV prevention counseling and testing services

to persons potentially infected with HIV, their partners, and others who

have high-risk behaviors. CDC criteria require HIV prevention program

managers to ensure the confidentiality of the persons who use HIV

counseling and testing services. Additionally, persons who seek HIV testing

and others who have been determined to be at risk of infection are offered

counseling services, regardless of their ability to pay.

These programs must also refer clients who test either positive or negative

for HIV to appropriate services that may include medical care, drug

treatment, and support. Additionally, the grantees’ counselors are to assist

the client in developing a plan that ensures that all partners are counseled

about their exposure to HIV.

Administration, Planning Councils, and Program Support

Testing, Counseling, Referral, and Partner Notification

Health Education and Risk Reduction, Public Information, Support Services,

Directly Funded Community-Based Organizations, and School Health Education

 

31 

 
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HOPWA Funds Both

Housing Assistance and

Supportive Services

According to reports filed with HUD between 1994 and 1998 that accounted

for more than $302 million in HOPWA funds, most HOPWA money (64

percent) was spent on housing assistance. Support services accounted for

22 percent of the funds in those years. Support services include case

management, adult care and personal assistance, health care, alcohol and

drug abuse treatment, and child care, among others. Housing information

services accounted for 4 percent of the funds, while program development

services and administration expenses were 10 percent of the total. (See fig.

4.) Administrative costs may not exceed 3 percent of the grant amount for

grantees and 7 percent for program sponsors.15 HOPWA grantees reported

that 3 percent of grant funds were spent for their administrative expenses

and 5 percent were spent for program sponsors’ administrative expenses.

15Grantees can carry out program activities themselves or by contract with a program

sponsor. Program sponsors are nonprofit organizations or governmental housing agencies.
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Figure 4: Distribution of HOPWA Funds, 1994-98

Available CARE Act

Funds Vary in Different

Areas

In general, metropolitan areas designated EMAs and therefore receiving

title I funds receive more money per person living with AIDS than non-EMA

areas. While we are examining funding formulas in greater detail for you,

we include here some analyses of fiscal year 1997 title I and title II funding

for EMAs and states.16

The level of funding per person living with AIDS differs among states,

among EMAs, and between EMAs and states. In general, EMAs, with about

Housing Information Services

Program Development and Administration

Support Services

Housing Assistance

 4 

 

4 

1 

16The analysis includes only title I and title II funds. We assigned all ADAP funds, including

any title I contributions, to statewide distribution. Remaining title I funds and title II

consortia funds for the EMA community were assigned to the EMA. Other title II consortia

funds were assigned to the remainder of the state. We did not include title III grants in our

analysis because these are not distributed by formula. However, in fiscal year 1999 half of

the 26 title III grants in these six states were awarded to organizations located within the

EMAs.
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three-fourths of all AIDS cases, receive more funding per case. For those

areas, the additional money provided through title I is the primary

component of the greater availability of funds. (See table 5.)

Table 5: Available CARE Act Title I and Title II Funds per AIDS Case in Six States,

Fiscal Year 1997

a

Funds do not include state match.

b

Designated an EMA as of 1997.

c

Parts of Northern Virginia are included in the Washington, D.C., EMA. Those funds are not reflected in

the Virginia totals.

Sources: CDC, HIV/AIDS Surveillance Supplemental Report No. 1 (Atlanta: CDC, 1999); HHS, HRSA,

Ryan White CARE Act State Profiles (Washington, D.C.: HHS, 1999); HHS, HRSA, Division of HIV

Services, data on title I contributions to state ADAPs.

The states have discretion in how they distribute their title II funds. States

with EMAs may elect to give more title II money to non-EMA areas or may

Location

Estimated number living with

AIDS at the end of 1997

Funds per person

living with AIDSa

Arizona 2,430 $2,830

Phoenixb 1,670 3,133

Rest of Arizona 760 2,164

Georgia 8,776 2,846

Atlantab 6,119 3,081

Rest of Georgia 2,657 2,303

Michigan 4,050 2,939

Detroitb 2,765 3,296

Rest of Michigan 1,285 2,170

Texas 20,685 2,555

Austinb 1,408 3,462

Dallasb 4,639 2,769

Fort Worthb 1,347 2,514

Houstonb 7,258 2,457

San Antoniob 1,626 2,940

Rest of Texas 4,407 2,072

Virginiac 4,710 1,723

Washington 3,562 2,914

Seattleb 2,463 3,053

Rest of Washington 1,099 2,603
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choose to distribute title II funds without regard to title I funding.

Depending on how the title II funds are distributed, this can increase or

decrease the disparity in funding per case between EMA and non-EMA

areas. Also, EMAs may contribute a portion of their title I funds to their

state ADAP to fund drug assistance services.

For example, in Michigan, some title II money is set aside for consortia

while the ADAP and nonconsortia funds are available statewide. Detroit,

which has about two-thirds of the estimated persons living with AIDS in the

state, got $950,000, or about 37 percent, of the title II money Michigan

earmarked for its consortia in fiscal year 1997. However, Detroit is an EMA,

so this title II funding was in addition to the title I money of $6 million for

the same year. The Detroit EMA transferred $300,000 of its title I funds to

the state ADAP in fiscal year 1997. Thus, with the 2,765 people estimated to

be living with AIDS at the end of 1997 in the Detroit metropolitan area, the

title I and title II money going to Detroit amounts to about $3,296 per AIDS

case. This compares with funding of about $2,170 per case for the non-EMA

areas in Michigan for fiscal year 1997.

Georgia also has one EMA, Atlanta, that received $12.6 million in title I

funds. Unlike Detroit, only 2.5 percent of the title II consortium money

went to Atlanta, although 70 percent of the state’s persons living with AIDS

are in the Atlanta area. Georgia thus allocated its title II consortium funds

to areas that do not receive title I funding. In addition, the Atlanta EMA

transferred $1.2 million to the state ADAP in fiscal year 1997. However,

funding for persons outside the metropolitan area was still below

metropolitan area funding. In Georgia, fiscal year funding per AIDS case

was estimated at $3,081 for Atlanta and $2,303 for the rest of the state.

Virginia, which did not have a designated EMA in 1997, had only title II

money to distribute. The funding per person living with AIDS in Virginia

was $1,723.

This comparison does not consider the state’s rationale for distributing its

title II money among EMA and non-EMA areas. States’ funding decisions

may take into account the incidence of HIV infection as well as AIDS

prevalence and the degree of unmet need. Such factors as a state’s

Medicaid benefit package and the infrastructure investment required for

some types of services may also play a role. Further, individuals living

outside the EMA may travel to the EMA to receive certain services that

would be paid for out of title I funds.
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HOPWA Funds Also Vary

Among States and

Metropolitan Areas

An analysis of the distribution of HOPWA funds in the same six states

shows that HOPWA funds also generally vary by AIDS case among EMSAs

and the rest of the state. Table 6 shows HOPWA awards per person living

with AIDS at the end of 1997.

Table 6: Distribution of HOPWA Funds in Six States and Their EMSAs, Fiscal Year

1997

a

We assume that the HOPWA awards for the EMSAs and states were spent in the award year.

Sources: CDC, HIV/AIDS Surveillance Supplemental Report No. 1 (Atlanta: CDC, 1999), and HUD

data on HOPWA formula awards for fiscal year 1997.

Location

Estimated number

living with AIDS at

the end of 1997 Awarda

Funds per person

living with AIDS

Arizona

Phoenix 1,670 $851,000 $510

Rest of Arizona 222 0 0

Georgia

Atlanta 6,119 4,090,000 668

Rest of Georgia 2,657 1,106,000 416

Michigan

Detroit 2,765 1,374,000 497

Rest of Michigan 861 603,000 700

Texas

Austin 1,408 704,000 500

Dallas 4,639 2,640,000 569

Fort Worth 1,347 582,000 432

Houston 7,258 3,316,000 457

San Antonio 1,626 709,000 436

Rest of Texas 3,856 1,709,000 443

Virginia

Richmond 930 429,000 461

Virginia Beach-Norfolk 1,496 556,000 372

Rest of Virginia 2,284 0 0

Washington

Seattle 2,463 1,317,000 535

Rest of Washington 789 434,000 550
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Page 26 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Awards per AIDS case in Texas ranged from $432 in Fort Worth to $569 in

Dallas. The average award in Texas was $443 per AIDS case. Washington

and Seattle were very similar, at $550 and $535, respectively. Other states

had a wider range of awards per case—for example, Michigan at $700 and

Detroit at $497. However, unlike the CARE Act title II funds, the HOPWA

state awards are allocated to provide assistance in areas of the state that

are outside any qualifying metropolitan area that receives a HOPWA

allocation.

CARE Act Services

Appear to Be Reaching

Less Populated Areas

While the vast majority of people with AIDS reside in urban areas, HIV

infection and AIDS are growing in rural areas, especially in the southern

states. The CARE Act is assisting in providing services for HIV-infected

populations living in rural areas. Although data on HIV/AIDS services in

rural areas are limited, it appears that both drug assistance services and

other services are reaching rural residents.

Rural areas, with smaller populations, may offer more limited medical and

social services, although access to medical care and support services is

critical for the well-being of both the HIV-infected populations and

individuals with other medical conditions in these areas. In some instances,

rural residents may be traveling to urban areas to receive services.

Our analysis of Arizona, Georgia, Michigan, Texas, Virginia, and

Washington showed that the incidence of AIDS cases in rural areas was

proportionately smaller than in metropolitan areas. In three of these states,

4 percent of the AIDS cases were in non-MSA areas as of June 30, 1998. The

1990 non-MSA populations for these states ranged from about 13 percent to

16 percent of the states’ populations. In the three other states, AIDS cases

in non-MSAs accounted for 7, 10, and 14 percent, and their 1990 non-MSA

populations were about 16, 25, and 33 percent.
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CARE Act Drug Assistance

Services Are Reaching Rural

Areas

Coverage for expensive combination drug therapies under the CARE Act is

available primarily through the ADAPs. Our analysis of AIDS cases and

ADAP clients in the six states shows that CARE Act drug assistance

services are reaching the rural AIDS population generally in proportion to

AIDS cases. We found that in five states the percentages of ADAP clients in

non-MSA areas were the same as or greater than the percentages of people

living with AIDS in non-MSA areas. In one state, there were 1 percent fewer

ADAP clients than the estimated number of people living with AIDS, while

in another state there were 8 percent more.17 (See fig. 5.)

17Reporting periods for ADAP clients varied: Two states provided number of clients

receiving medications during June 1999, two states included clients enrolled during June

1999, and two states provided the number of clients enrolled as of June 30, 1999. The

estimated number of people living with AIDS is as of June 30, 1998. As with other

comparisons in this report, we are not including people with HIV infection who have not

progressed to AIDS, since not all states report HIV cases.
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Page 28 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Figure 5: ADAP Clients and AIDS Cases in Non-MSA Areas, 1998-99

Other CARE Act Services

Appear to Be Reaching

Rural Areas

We were able to take a closer look at Michigan and Virginia because clientlevel data (unduplicated counts of clients) exist for them. We compared

individuals receiving CARE Act services in 1998 with the estimated

numbers of persons living with AIDS as of June 30, 1998. As figures 6 and 7

show, the distributions of the AIDS populations and CARE Act clients

appear to be reasonably similar.18 However, these data show where the

clients lived and do not necessarily reflect where the services were

provided. Rural clients may be traveling to urban areas to receive certain

services.

0 5 10 15 20

AIDS Cases

ADAP Clients

Arizona

Georgia

Michigan

Texas

Virginia

Washington

Per entage

18CARE Act client data are by zip codes; AIDS population data are by county.
B-282771

Page 29 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Figure 6: Distribution of AIDS Cases and CARE Act Clients in Michigan, 1998
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Page 30 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Figure 7: Distribution of AIDS Cases and CARE Act Clients in Virginia, 1998

Administrators’

Compensation Is

Generally Comparable

Our analysis shows that compensation to administrators of organizations

serving persons with HIV/AIDS is generally comparable in similar nonprofit

organizations. The median compensation for administrators for all

organizations that received CARE Act or CDC funds was $78,000, and the

median at organizations that serve only HIV/AIDS clients was $64,878. The

median for other nonprofit organizations was $74,203.
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The organizations vary by services provided, funds available to provide

these services, and the salaries and benefits provided to their

administrators. These nonprofit organizations provided health care, drug

treatment services, counseling, nutritional services, and legal and other

assistance to a diverse group of clients, including people with HIV/AIDS.

Revenues, as an indicator of organization size, varied from $206,000 to

more than $30 million. Compensation also varied, ranging from $23,434 to

$527,807.19 The average compensation among organizations that received

federal HIV/AIDS funds and other nonprofit organizations also varied. (See

table 7.)

Table 7: Compensation Characteristics at Nonprofit Organizations

a

We limited our analysis to organizations with revenues of $300,000 or more. However, in some cases,

the Internal Revenue Service (IRS) file used to identify the organizations had revenue amounts

different from those in the file used for the analysis.

Organizations that received CARE Act or CDC funds and served only

HIV/AIDS clients compensated their administrators $72,871 on average,

while organizations that served persons with HIV/AIDS and other clients

paid their administrators an average of $104,751. However, the average

compensation at all organizations that received either CARE Act or CDC

funds was $92,490. This compares with an average compensation of

$89,996 for other nonprofit organizations that did not receive CARE Act or

CDC funds. A more complete description of our analysis is in appendix II.

19IRS Form 990 instructions state that compensation includes salary, fees, bonuses, and

severance payments. For this report, we included in the computation of total compensation

contributions to employee benefit plans, deferred compensation, and expense account and

other allowances.

Receiving CARE Act and CDC funds

Item All organizations

Serving HIV/AIDS

clients only

Serving HIV/AIDS and

other clients

Not receiving CARE Act

or CDC funds

Revenue range $15,312–$27.7 million $415,312–$17.6 million $1.4 million–$27.7 million $206,142a

–$30.9 million

Compensation as

percentage of revenue 0.4−13 1−13 0.4−5 0.3−20

Compensation range $37,450–$223,804 $37,450–$197,014 $56,663–$223,804 $23,434–$527,807

Compensation median $78,000 $64,878 $89,783 $74,203

Compensation mean $92,490 $72,871 $104,751 $89,996
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Page 32 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Agency Comments We provided HHS and HUD the opportunity to comment on a draft of this

report. HHS said that it agreed with most aspects of the report but thought

it should provide more information on the role of Medicare, Medicaid, and

State Children’s Health Insurance in meeting the needs of HIV/AIDS

patients. We agree that these programs, especially Medicaid, do play

important roles in the care of HIV/AIDS patients. Our emphasis was on the

CARE Act program, however, although we do include some information on

other programs that also serve HIV/AIDS patients.

HUD provided technical comments, as did HHS, and we incorporated them

where appropriate.

As we agreed with your offices, unless you publicly announce the report’s

contents earlier, we plan no further distribution of it until 30 days from the

date of this letter. We will then send copies to the Honorable Donna E.

Shalala, Secretary of Health and Human Services; the Honorable Claude

Earl Fox, Administrator of the Health Services and Resources

Administration; the Honorable Jeffrey P. Koplan, Director of the Centers for

Disease Control and Prevention; the Honorable Andrew M. Cuomo,

Secretary of Housing and Urban Development; and others who are

interested. If you have any questions or would like additional information,

please call me at (202) 512-7114. Marcia Crosse, Roy Hogberg, and Donna

Bulvin made major contributions to this report.

Janet Heinrich

Associate Director, Health Financing and

Public Health Issues
Page 33 GAO/HEHS-00-54 Federal HIV/AIDS Programs
Page 34 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix I

CARE Act Criteria for Counseling and HUD Apendxies

Policies on Illicit Drug Use in Housing ApendxiI

This appendix briefly describes the Ryan White Comprehensive AIDS

Resources Emergency Act of 1990 (CARE Act) criteria for counseling

people with human immunodeficiency virus (HIV) and referring them to

appropriate care and federal policies related to substance abuse in

federally subsidized housing.

The CARE Act Has

Requirements for

Counseling About HIV

Grantees receiving title III (early intervention services) money are

statutorily required to provide certain counseling services for persons who

test positive and negative for HIV. As stated earlier in this report, about 8

percent of fiscal year 1998 title III money was spent on counseling, testing,

referral, and outreach.

Counseling and testing services include pretest counseling and counseling

individuals with either negative or positive test results. Before testing for

HIV, counselors are to provide information on preventing HIV as well as on

how the virus is transmitted. They are also to convey information on the

accuracy and reliability of test results. Other information includes the

benefits of testing, the significance of test results, and encouragement to

undergo testing. Counselors should also stress the confidentiality of

receiving early intervention services, the availability of anonymous testing,

and laws related to discrimination against individuals with HIV disease.

Post-test counseling for individuals who test negative for HIV should

contain information about reducing the risk of contracting the virus, the

accuracy and reliability of test results, and their significance. The

counseling should also include information on the appropriateness of

further HIV counseling, testing, and education and referral to HIV

prevention services.

People who test positive for the virus need counseling in addition to the

information on risk reduction and significance and the reliability of HIV

test results. Important information that should be conveyed is the

availability of appropriate health care, including antiretroviral therapies,

mental health care, and social and support services. In addition to telling

them about the availability of early intervention services and primary care,

counselors should make them aware of the benefits of counseling others

whom they may have exposed to HIV and assist them in locating those

persons.
Appendix I

CARE Act Criteria for Counseling and HUD

Policies on Illicit Drug Use in Housing

Page 35 GAO/HEHS-00-54 Federal HIV/AIDS Programs

HUD’s Policy Against

Illicit Drug Use in

HUD-Funded Housing

Federal law authorizes the secretary of the Department of Housing and

Urban Development (HUD) to make grants to public housing agencies, forprofit and nonprofit owners of federally assisted low-income housing, and

others for use in eliminating drug related and violent crime (42 U.S.C.

11902(a)). The grants may be used to employ security personnel, reimburse

local law enforcement agencies for additional security, make physical

improvements for security, conduct training and buy equipment for

volunteer tenant patrols, among other things (42 U.S.C. 11903(a)). The

secretary is required to establish a clearinghouse to respond to inquiries

from the public requesting assistance in investigating, studying, and

working on substance abuse problems. The clearinghouse is also to collect

and disseminate information on programs to assist the public in this area.

Federal law also requires the secretary to establish regional training

programs to educate and prepare officials to confront drug abuse in

housing.

In addition, HUD has a zero tolerance policy regarding illegal activities in

HUD-funded programs. Housing Opportunities for Persons Living With

AIDS (HOPWA) is subject to all federal criminal statutes and procedures

regarding the sale, possession, and use of illegal substances. Grantees,

project sponsors, and other contracted agents are required to comply with

them and have no ability to waive or modify them in order to condone onsite use of illegal substances. HUD may use established remedies to

enforce compliance on these matters, such as suspending grant awards.

According to an Office of HIV/AIDS Housing official, HUD has not taken

any enforcement actions against HOPWA-funded housing grantees.
Page 36 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix II

Methodology and Information on

Administrators’ Compensation ApendxiI

To compare the compensation of top administrators of organizations

receiving CARE Act and Centers for Disease Control and Prevention (CDC)

HIV prevention funds with those of other nonprofit organizations, we first

randomly selected five eligible metropolitan areas (EMA)—Dallas, Kansas

City, Philadelphia, St. Louis, and San Francisco—that received title I CARE

Act funds for fiscal year 1999.1 We identified grantees that received at least

$250,000 in title I fiscal year 1998 funds from a list of grant recipients in

each of the five EMAs that the Health Resources and Services

Administration (HRSA) provided. We excluded hospitals, state and county

health departments, and universities from our sample because their size,

types of services, and range of clients would not have been comparable to

those of most of the organizations that receive CARE Act funds or CDC HIV

prevention funds. Through an EMA representative, we requested copies of

the latest tax filing, Internal Revenue Service (IRS) Form 990, for the 49

organizations that met our selection criteria. We could not obtain the form

for seven. In addition, because of incomplete or insufficient information,

we excluded eight more organizations from our analysis. As a result, our

analysis includes 34 organizations that received title I CARE Act funds in

fiscal year 1998.

We identified seven additional organizations that received $250,000 or more

in CDC HIV prevention grants for fiscal year 1998.2 We were able to obtain a

Form 990 for six of these grantees, but we eliminated one because of

incomplete information. In total, we identified 39 organizations that

received more than $250,000 in CARE Act or CDC prevention funds in fiscal

year 1998. Of the 39 organizations, 15 served only HIV/AIDS clients, and 24

served both HIV/AIDS and other clients.

1

The compensation line item from IRS Form 990 includes salary, fees, bonuses, and

severance pay. We also included as part of total compensation contributions to employee

benefit plans, deferred compensation, and expense account and other allowances. These

line items were also obtained from Form 990.

2

Because of the limited number of CDC prevention grantees, we included these grantees;

they are in San Antonio, Tex.; Jersey City, N.J.; New York, N.Y.; Hartford, Conn.; and San

Francisco, Calif.
Appendix II

Methodology and Information on

Administrators’ Compensation

Page 37 GAO/HEHS-00-54 Federal HIV/AIDS Programs

To select nonprofit organizations for comparison, we contracted with the

Urban Institute’s National Center for Charitable Statistics (NCCS). NCCS

identified and provided data for 273 nonprofit organizations whose annual

revenue was at least $300,000, located in the same five cities, that provided

health care, family planning services, and drug abuse prevention and

treatment services.3 We eliminated 24 organizations that serve HIV/AIDS

clients. We also eliminated 121 because of incomplete or questionable

information. Therefore, we used 128 organizations in our analysis.

The nonprofit organizations were limited to the following IRS National

Taxonomy for Exempt Organization classifications:

• health treatment facilities, primarily outpatient;

• ambulatory health centers and community clinics;

• family planning centers;

• public health programs (includes general health and wellness promotion

services);

• alcohol, drug, substance abuse, and dependency prevention and

treatment;

• alcohol and drug abuse prevention only; and

• alcohol and drug abuse treatment only.

Our analysis contains a number of qualifiers that limit drawing any

conclusions about the appropriateness of compensation among HIV/AIDS

service providers and other nonprofit organizations. First, although IRS

Form 990 is the most commonly used data source of such financial

information about nonprofit organizations, it can contain numerous errors.

Several studies have shown that a sizable number of these forms contain

errors and omissions. Also, we limited our selection of the organizations

that were funded by the CARE Act to five locations, which resulted in a

sample of 34 organizations that received $250,000 or more in CARE Act

funds. We obtained data for only five of the seven organizations that

received $250,000 or more in CDC HIV prevention funds. We compared the

organizations that received CARE Act or CDC funds with 128 nonprofit

organizations with total revenues of at least $300,000 in the same locations.

Further, our analysis is based only on salary and other compensation and

does not consider other factors such as differences in job responsibilities,

working conditions, and job satisfaction that would be needed for a more

3

Of the 273 organizations, 107 were in San Francisco, 31 in Dallas, 92 in Philadelphia, 21 in

Kansas City, and 22 in St. Louis.
Appendix II

Methodology and Information on

Administrators’ Compensation

Page 38 GAO/HEHS-00-54 Federal HIV/AIDS Programs

complete analysis. Additionally, because of the small number of

organizations in each location, we did not perform separate analyses by

location. Therefore, we did not take into account geographical differences

in cost of living.

The 15 organizations that provided services exclusively to HIV/AIDS clients

gave their top administrators compensation ranging from $37,450 to

$197,014. However, only one organization in this group paid its

administrator more than $100,000. While the median compensation was

$64,878, the average compensation was $72,871. Revenue at these

organizations ranged from $415,312 to $17.6 million, and about 73 percent

of them reported revenues between $1 million and $4 million. The

organization with the lowest revenue ($415,312) paid its top administrator

the fourth lowest compensation ($54,600), while the organization with the

highest revenue paid its top administrator the highest salary ($197,014). As

a portion of total revenue, their compensation accounted for 13 and 1

percent, respectively.

In the HIV/AIDS dedicated organizations, we also found that the portion of

CARE Act or CDC funds as a percentage of total revenue ranged from 12

percent to 77 percent. At the organization with the highest revenue ($17.6

million), CARE Act or CDC funds accounted for 18 percent of total

revenue, while at the organization with the lowest revenue ($415,312),

CARE Act or CDC funds accounted for 77 percent of total revenue.

The 24 organizations that served HIV/AIDS and other clients gave their top

administrators compensation ranging from $56,663 to $223,804. Further,

nine top administrators earned $100,000 or more in compensation. The

median was $89,783, and the average compensation among these

organizations was $104,751. Revenue at these organizations ranged from

$1.4 million to $27.7 million. As a percentage of total revenue, top

administrator compensation ranged from 0.4 percent to 5 percent of total

revenue. The organization with the lowest revenue ($1.4 million) paid its

top administrator the lowest compensation ($56,663), but this was not true

of the organization with the highest revenue, which paid its top

administrator the fifth highest compensation ($129,927) in the group.

At these 24 organizations, CARE Act or CDC funds accounted for from 1

percent to 51 percent of total revenue. At the organization with the highest

revenue, CARE Act or CDC funds accounted for 2 percent of total revenue,

while at the organization with the lowest total revenue, CARE Act or CDC

funds accounted for 20 percent of total revenue. Table 8 provides
Appendix II

Methodology and Information on

Administrators’ Compensation

Page 39 GAO/HEHS-00-54 Federal HIV/AIDS Programs

information on the organizations in the five locations that received at least

$250,000 in CARE Act title I funds in fiscal year 1998.

Table 8: Organizations in Five Locations Funded by CARE Act Title I, Fiscal Year 1998

Location Total revenue Title I funds Salary

Benefits

and

expenses

Total

compensation

Total

compensation

as a % of

revenue

Title I funds

as a % of

revenue

Dallas

1 $514,196 $253,433 $40,000 0 $40,000 8% 49%

2 415,312 318,723 54,600 0 54,600 13 77

3 1,691,200 282,500 54,041 $1,923 55,964 3 17

4 2,007,229 642,600 50,000 7,190 57,190 3 32

5 1,137,791 496,822 60,000 2,397 62,397 6 44

6 3,773,898 1,526,053 64,878 0 64,878 2 40

7 2,610,912 349,900 70,258 0 70,258 3 13

8 4,112,524 500,984 85,326 0 85,326 2 12

Kansas City

1 2,254,491 304,493 63,656 340 63,996 3 14

Philadelphia

1 2,331,515 433,233 52,982 0 52,982 2 19

2 1,433,529 566,863 51,896 4,767 56,663 4 20

3 1,611,038 269,863 58,266 0 58,266 4 35

4 18,509,917 363,999 74,770 0 74,770 0.4 2

5 3,400,227 1,524,141 73,798 3,567 77,356 2 45

6 4,718,978 384,607 85,750 2,315 88,065 2 8

7 4,307,284 778,872 87,063 10,560 97,623 2 18

8 22,106,787 528,252 110,250 6,951 117,201 1 3

9 27,742,432 440,993 119,657 10,270 129,927 0.5 2

10 25,480,535 287,975 169,825 31,672 201,497 1 1

San Francisco

1 1,107,951 373,912 65,000 0 65,000 6 34

2 1,971,651 334,395 68,275 3,343 71,618 4 17

3 4,483,191 430,000 71,769 2,153 73,922 2 10

4 1,558,470 278,051 78,000 0 78,000 5 18

5 2,353,199 276,827 75,000 3,000 78,000 3 12

6 4,104,965 2,108,102 65,747 13,903 79,650 2 51

Continued
Appendix II

Methodology and Information on

Administrators’ Compensation

Page 40 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Compensation for top administrators in the 128 other nonprofit

organizations ranged from $23,434 to $527,807. Further, 33 organizations

paid the top administrator $100,000 or more. Total revenues of the

organizations ranged from $206,142 to $30.9 million.4 The median

compensation was $74,203 and the average was $89,996. As a percentage of

total revenue, total compensation ranged from 0.3 percent to 20 percent.

The organization with the highest revenue ($30.9 million) did not pay its

administrator the highest compensation. Nor did the organization with the

lowest revenue pay its administrator the lowest compensation. Table 9

provides information on compensation at nonprofit organizations by type.

7 1,505,562 595,113 86,798 300 87,098 6 40

8 13,375,684 252,033 86,700 4,800 91,500 1 2

9 4,603,175 517,398 92,292 0 92,292 2 11

10 10,487,800 979,699 108,925 0 108,925 1 9

11 16,669,156 1,660,850 120,450 0 120,450 1 10

12 16,311,005 1,122,477 141,428 11,999 153,427 1 7

13 17,589,710 3,078,915 183,892 13,122 197,014 1 18

14 19,497,658 1,699,928 130,384 93,420 223,804 1 9

St. Louis

1 2,471,436 321,894 75,210 4,528 79,738 3 13

Location Total revenue Title I funds Salary

Benefits

and

expenses

Total

compensation

Total

compensation

as a % of

revenue

Title I funds

as a % of

revenue

Continued from Previous Page

4

We limited our analysis to organizations with revenues of $300,000 or more. However, in

some cases, the IRS file we used to identify the orgnizations had revenue amounts different

from those in the file used for analysis.
Appendix II

Methodology and Information on

Administrators’ Compensation

Page 41 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Table 9: Compensation by Type of Nonprofit Organization

To further compare the compensation of top administrators for

organizations receiving CARE Act or CDC funds, we considered two

surveys of nonprofit organizations that show salaries. One survey by the

Congressional Budget Office includes salary and benefits. This study,

which considered large nonprofit organizations with annual revenue of $50

million or more, found that chief executive officer salary and benefits

averaged about $212,000 per year.5 Another survey by The NonProfit Times,

a publication by the NPT Publishing Group, which conducts annual salary

surveys, found that chief executive salaries averaged $73,687.6 In

comparing different types of nonprofit organizations, The NonProfit Times

reported that foundation executives averaged $103,976, followed by chief

executives at health organizations at $89,044.

Category Range

Number of

organizations

Alcohol and drug abuse prevention only $54,266–$125,916 7

Alcohol and drug abuse treatment only $33,390–$135,844 30

Alcohol, drug, and substance abuse

dependency prevention and treatment $29,500–$131,994 23

Family planning center $63,568–$267,867 8

Public health programs (includes general

health and wellness promotion services) $28,577–$318,625 16

Ambulatory health center, community clinic $23,434–$346,339 33

Health treatment facility, primarily outpatient $36,000–$527,807 11

5

Congressional Budget Office, Comparing the Pay and Benefits of Federal and Nonfederal

Executives (Washington, D.C.: CBO, Nov. 1999).

6

The NonProfit Times Online, The 1998 Salary Survey (Cedar Knolls, N.J.: The NonProfit

Times Online, Feb. 1999).
Page 42 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix III

Dates When States and Territories Began

Reporting HIV Infection ApendxiI

a

Confidential HIV infection reporting for pediatric cases only.

b

Confidential infection reporting for children younger than 6 years old.

State and territory Date

Alaska Jan.-June 1999

Arizona Jan. 1987

Arkansas July 1989

Colorado Nov. 1985

Connecticut July 1992a

Florida July 1997

Idaho June 1986

Indiana July 1988

Iowa July 1998

Louisiana Feb. 1993

Michigan April 1992

Minnesota Oct. 1985

Mississippi Aug. 1988

Missouri Oct. 1987

Nebraska Sept. 1995

Nevada Feb. 1992

New Jersey Jan. 1992

New Mexico Jan. 1998

North Carolina Feb. 1990

North Dakota Jan. 1988

Ohio June 1990

Oklahoma June 1988

Oregon Sept. 1988b

South Carolina Feb. 1986

South Dakota Jan. 1988

Tennessee Jan. 1992

Texas Jan. 1999

Utah April 1989

Virginia July 1989

Virgin Islands Dec. 1998

West Virginia Jan. 1989

Wisconsin Nov. 1985

Wyoming June 1989
Page 43 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix IV

CARE Act Title I Awards, Fiscal Year 1999 ApendxiIV

Eligible metropolitan area Title I award CBCa

Arizona

Phoenix $3,865,319 $19,445

California

Los Angeles 33,540,737 261,519

Oakland 6,218,532 55,004

Orange County 4,300,690 23,586

Riverside-San Bernardino 6,463,388 36,460

Sacramento 2,578,873 12,423

San Diego 8,872,685 52,934

San Francisco 36,218,513 67,788

San Jose 2,486,136 15,214

Santa Rosa 1,127,018 0

Colorado

Denver 4,150,341 19,265

Connecticut

Hartford 4,019,409 48,703

New Haven 6,100,471 62,746

District of Columbiab 18,322,558 259,988

Florida

Fort Lauderdale 10,810,324 118,291

Jacksonville 3,683,146 41,591

Miami 21,248,387 279,163

Orlando 4,907,180 54,824

Tampa-St. Petersburg 7,236,728 48,163

West Palm Beach 6,711,944 87,953

Georgia

Atlanta 13,147,268 157,991

Illinois

Chicago 18,227,884 191,570

Louisiana

New Orleans 5,695,360 68,148

Maryland

Baltimore 13,478,549 202,463

Massachusetts

Bostonb 10,647,381 68,508

Continued
Appendix IV

CARE Act Title I Awards, Fiscal Year 1999

Page 44 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Michigan

Detroit 6,585,744 73,909

Minnesota

Minneapolis-St. Paulb 2,548,603 12,783

Missouri

Kansas Cityb 2,952,910 16,204

St. Louisb 3,664,771 33,669

Nevada

Las Vegas 3,402,697 25,747

New Jersey

Bergen-Passaic 4,320,176 48,163

Jersey City 5,015,785 63,737

Middlesex-Somerset-Hunterdon 2,555,029 26,467

Newark 14,390,269 192,110

Vineland-Millville-Bridgeton 688,648 8,732

New York

Dutchess County 1,220,662 12,153

Nassau-Suffolk 5,632,012 49,963

New York 96,961,856 1,260,780

Ohio

Cleveland 2,933,058 31,148

Oregon

Portlandb 3,115,251 0

Pennsylvania

Philadelphiab 16,011,451 205,884

Puerto Rico

Caguas 1,610,314 29,348

Ponce 2,487,768 33,849

San Juan 11,912,865 217,047

Texas

Austin 3,175,509 27,997

Dallas 10,164,078 82,552

Fort Worth 2,935,543 21,606

Houston 15,489,996 177,707

San Antonio 3,014,654 44,742

Virginia

Norfolkb 3,665,087 49,963

Eligible metropolitan area Title I award CBCa

Continued from Previous Page
Appendix IV

CARE Act Title I Awards, Fiscal Year 1999

Page 45 GAO/HEHS-00-54 Federal HIV/AIDS Programs

a

Included in title I award. A Department of Health and Human Services (HHS) and Congressional

Black Caucus (CBC) initiative to further address HIV/AIDS in racial and ethnic communities.

b

EMA boundaries include jurisdictions in more than one state.

Washington

Seattle 5,303,343 0

Total $485,846,900 $5,000,000

Eligible metropolitan area Title I award CBCa

Continued from Previous Page
Page 46 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix V

CARE Act Title II HIV Grants, Fiscal Year 1999ApendxiV

State and territory Formula ADAPa Total

Alabama $3,314,520 $3,980,313 $7,294,833

Alaska 269,662 323,829 593,491

Arizona 2,224,423 4,057,517 6,281,940

Arkansas 1,505,463 1,807,868 3,313,331

California 30,669,853 65,267,693 95,937,546

Colorado 1,968,440 3,787,302 5,755,742

Connecticut 3,629,583 7,793,350 11,422,933

Delaware 1,392,956 1,672,761 3,065,717

District of Columbia 3,319,351 7,690,410 11,009,761

Florida 24,976,515 48,505,772 73,482,287

Georgia 7,658,435 13,815,288 21,473,723

Guam 8,929 10,723 19,652/

Hawaii 1,101,864 1,323,197 2,425,061

Idaho 264,304 317,396 581,700

Illinois 6,967,711 14,548,730 21,516,441

Indiana 3,253,801 3,907,398 7,161,199

Iowa 658,975 791,345 1,450,320

Kansas 981,136 1,426,136 2,407,272

Kentucky 1,851,917 2,223,914 4,075,831

Louisiana 5,010,641 8,061,420 13,072,061

Maine 441,103 529,708 970,811

Maryland 6,496,978 14,175,575 20,672,553

Massachusetts 4,213,646 8,413,129 12,626,775

Michigan 3,740,253 6,712,489 10,452,742

Minnesota 971,008 2,024,469 2,995,477

Mississippi 2,269,803 2,725,742 4,995,545

Missouri 2,683,738 5,127,655 7,811,393

Montana 250,000 227,324 477,324

Nebraska 548,253 658,381 1,206,634

Nevada 1,568,357 3,079,595 4,647,952

New Hampshire 308,492 553,298 861,790

New Jersey 12,427,002 25,275,844 37,702,846

New Mexico 1,125,079 1,351,076 2,476,155

New York 41,145,958 85,949,879 127,095,837

North Carolina 5,301,431 6,371,503 11,672,934

Continued
Appendix V

CARE Act Title II HIV Grants, Fiscal Year

1999

Page 47 GAO/HEHS-00-54 Federal HIV/AIDS Programs

a

AIDS Drug Assistance Program.

North Dakota 100,000 75,060 175,060

Ohio 4,920,576 6,914,078 11,834,654

Oklahoma 1,773,340 2,129,553 3,902,893

Oregon 1,543,178 2,790,079 4,333,257

Pennsylvania 8,590,475 15,041,980 23,632,455

Puerto Rico 7,895,807 15,505,206 23,401,013

Rhode Island 1,069,718 1,284,594 2,354,312

South Carolina 4,968,208 5,966,180 10,934,388

South Dakota 100,000 105,084 205,084

Tennessee 4,461,029 5,357,124 9,818,153

Texas 17,245,801 32,998,423 50,244,224

Utah 946,495 1,136,619 2,083,114

Vermont 250,000 238,047 488,047

Virginia 4,847,006 8,252,286 13,099,292

Virgin Islands 283,949 340,986 624,935

Washington 2,933,765 5,400,015 8,333,780

West Virginia 624,763 797,778 1,422,541

Wisconsin 1,730,610 2,082,373 3,812,983

Wyoming 100,000 96,506 196,506

Total $248,904,300 $461,000,000 $709,904,300

State and territory Formula ADAPa Total

Continued from Previous Page
Page 48 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix VI

HOPWA Formula Grantees, Fiscal Year 1999 ApendxiVI

State and territory Grantee Amount

Alabama State of Alabama $796,000

Birmingham 365,000

Arizona State of Arizona 366,000

Phoenix 923,000

Arkansas State of Arkansas 552,000

California State of California 2,427,000

Los Angeles 8,769,000

Oakland 1,670,000

Riverside 1,372,000

Sacramento 656,000

San Diego 2,168,000

San Francisco 8,510,000

San Jose 649,000

Santa Ana (for Orange County) 1,143,000

Colorado Denver 1,164,000

Connecticut State of Connecticut 920,000

Hartford 1,413,000

New Haven 1,214,000

Delaware State of Delaware 113,000

Wilmington 485,000

District of Columbia Washington, D.C. 6,475,000

Florida State of Florida 3,164,000

Fort Lauderdale 4,186,000

Jacksonville 983,000

Miami 8,418,000

Orlando 1,753,000

Tampa 1,661,000

West Palm Beach 2,635,000

Georgia State of Georgia 1,297,000

Atlanta 3,407,000

Hawaii State of Hawaii 132,000

Honolulu 364,000

Illinois State of Illinois 534,000

Chicago 4,219,000

Continued
Appendix VI

HOPWA Formula Grantees, Fiscal Year 1999

Page 49 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Indiana State of Indiana 636,000

Indianapolis 579,000

Kentucky Commonwealth of Kentucky 561,000

Louisiana State of Louisiana 1,063,000

New Orleans 2,031,000

Maryland Baltimore 4,689,000

Massachusetts Boston 1,890,000

Michigan State of Michigan 677,000

Detroit, 1,526,000

Minnesota State of Minnesota 92,000

Minneapolis 670,000

Mississippi State of Mississippi 769,000

Missouri State of Missouri 396,000

Kansas City 813,000

St. Louis 944,000

Nevada State of Nevada 190,000

Las Vegas 1,308,000

New Jersey State of New Jersey 1,430,000

Dover (for Monmouth) 595,000

Jersey City 2,271,000

Newark 5,777,000

Paterson (for Bergen-Passaic) 1,160,000

Woodbridge (for Middlesex) 671,000

New Mexico State of New Mexico 391,000

New York State of New York 2,218,000

Buffalo 352,000

Islip (for Nassau-Suffolk) 1,362,000

New York City 48,668,000

Rochester 542,000

North Carolina State of North Carolina 1,212,000

Charlotte 397,000

Raleigh 386,000

Ohio State of Ohio 822,000

Cincinnati 395,00

Cleveland 670,000

Columbus 458,000

Oklahoma State of Oklahoma 723,000

State and territory Grantee Amount

Continued from Previous Page
Appendix VI

HOPWA Formula Grantees, Fiscal Year 1999

Page 50 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Oregon Portland 803,000

Pennsylvania Commonwealth of Pennsylvania 1,135,000

Philadelphia 3,428,000

Pittsburgh 491,000

Puerto Rico Commonwealth of Puerto Rico 1,841,000

San Juan 5,891,000

Rhode Island Providence 424,000

South Carolina State of South Carolina 1,657,000

Tennessee State of Tennessee 525,000

Memphis 538,000

Nashville 479,000

Texas State of Texas 2,086,000

Austin 767,000

Dallas 2,505,000

Fort Worth 655,000

Houston 6,466,000

San Antonio 805,000

Utah State of Utah 368,000

Virginia Commonwealth of Virginia 463,000

Richmond 492,000

Virginia Beach (for Norfolk) 702,000

Washington State of Washington 487,000

Seattle 1,401,000

Wisconsin State of Wisconsin 325,000

Milwaukee 393,000

State and territory Grantee Amount

Continued from Previous Page
Page 51 GAO/HEHS-00-54 Federal HIV/AIDS Programs

Appendix VII

Characteristics of CARE Act Clients and

Persons Living With AIDS at Seven Locations ApendxiVI

Note: Numbers are percentages.

Orange

County,

Calif.

Los

Angeles

San

Francisco Middlesex, N.J. Michigan Virginia

Washington,

D.C.

Characteristic CARE

Act AIDS

CARE

Act AIDS

CARE

Act AIDS

CARE

Act AIDS

CARE

Act AIDS

CARE

Act AIDS

CARE

Act AIDS

Gender

Male 85.0 89.6 84.9 90.5 88.5 93.8 59.6 67.7 74.3 82.0 64.9 80.8 67.4 77.9

Female 15.0 10.4 15.1 9.5 11.5 6.2 40.4 32.3 25.7 18.0 35.1 19.2 32.6 22.1

Race

White 53.7 63.0 37.5 43.0 56.7 67.4 35.9 40.0 32.7 41.4 30.1 38.9 17.4 23.4

African

American 6.0 5.2 21.7 21.4 24.1 16.0 42.4 36.5 63.0 54.8 66.3 56.4 76.6 71.0

Hispanic 37.0 29.0 38.1 32.7 14.0 12.7 20.5 22.5 3.6 3.3 3.0 3.9 5.3 4.9

Asian Pacific or

Native

American 3.3 2.7 2.7 2.5 5.1 3.9 1.2 0.8 0.8 0.4 0.6 0.8 0.7 0.6

Exposure

category

Men who have

sex with men 56.2 71.1 66.1 73.6 59.7 71.8 23.3 25.3 44.7 53.2 37.3 48.9 31.5 44.8

Persons who

inject drugs 15.8 13.3 7.1 9.6 17.5 12.8 36.2 43.2 19.0 24.6 18.0 21.5 19.7 28.9

Men who have

sex with men

and inject

drugs 4.4 5.6 5.3 6.1 12.4 11.9 4.7 4.4 5.0 6.7 7.2 6.2 5.4 4.6

Persons who

have

heterosexual

contact 22.3 7.7 14.9 8.1 8.7 2.7 34.9 21.4 26.6 12.1 34.8 19.2 39.8 17.9

Other 1.4 2.2 6.7 2.7 1.6 0.8 0.8 5.6 4.8 3.4 2.7 4.3 3.6 3.8

Stage of

illness

HIV but not

AIDS 50.6 59.3 52.0 58.1 57.9 57.3 58.7

AIDS 49.4 40.7 48.0 41.9 42.1 42.7 41.3

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