United States General Accounting Office

GAO Report to the Chairman, Committee on

Labor and Human Resources, and the

Honorable Hank Brown, U.S. Senate

January 1995 RYAN WHITE CARE

ACT

Access to Services by

Minorities, Women,

and Substance Abusers

GAO/HEHS-95-49

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-255864 

January 13, 1995

The Honorable Nancy Kassebaum

Chairman

Committee on Labor and Human Resources

United States Senate

The Honorable Hank Brown

United States Senate

The acquired immunodeficiency syndrome (AIDS) epidemic, in its second

decade, continues to escalate at an alarming rate. AIDS is the second

leading cause of death for men between ages 25 and 44 and the fourth

leading cause of death for women in that age group. Since the first cases

were identified in 1981, more than 400,000 people in the United States

have been diagnosed with AIDS. Furthermore, as many as 1 million people

in the nation may be infected with the human immunodeficiency virus

(HIV), which causes AIDS.

AIDS is affecting minorities, women, and injection drug users (IDU) at an

increasing rate. As of September 1989, African-Americans and Hispanics

accounted for 43 percent of cumulative AIDS cases, women for 10 percent,

and IDUs for 21 percent. From July 1993 through June 1994, the distribution

of newly reported AIDS cases was 56 percent African-American and

Hispanic, 17 percent women, and 28 percent IDUs.

The African-American and Hispanic communities have been particularly

hard hit. These communities are disproportionately affected by the AIDS

epidemic. African-Americans represent 12 percent of the nation’s

population but account for 32 percent of the cumulative AIDS cases as of

June 1994. Similarly, while Hispanics account for 9 percent of the

population, 17 percent of the cumulative AIDS cases affect Hispanics.

Concerns have been raised whether all these affected populations have

been receiving needed HIV services.

This report responds to your request that we determine the extent to

which HIV-infected populations, such as African-Americans, Hispanics,

women, and IDUs, receive medical and support services funded by the

Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990.1

Because there are no national data to address this issue, we visited five

1

Support services include but are not limited to case management, counseling, financial assistance, and

transportation.

Page 1 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
B-255864 

locations—Baltimore, Denver, Los Angeles, Sacramento, and the Maryland

suburbs of Washington, D.C. We chose sites on the basis of varying size

and demographics of their HIV-infected populations, how long they have

been receiving Ryan White CARE Act funding, and the amount of funding.

At these locations, we interviewed program administrators and reviewed

incidence and utilization data provided by them. We also interviewed Ryan

White CARE Act-funded service providers and advocates for HIV-infected

people. Additionally, we discussed this issue with national HIV/AIDS

organizations and officials of the Department of Health and Human

Services’ Health Resources and Services Administration (HRSA). (See app. I

for our objective, scope, and methodology.)

Results in Brief We found that minorities, women, and IDUs generally use services at a rate

that reflect their representation in the HIV-infected population in the five

locations. Medical and support services providers and advocates of

HIV-infected people told us that this corresponds to their experience of the

usage of Ryan White CARE Act-funded services. These providers and

advocates also said, however, that barriers exist that may limit access to

services to certain groups.

Background The Ryan White CARE Act of 1990 (P.L. 101-381) was enacted to improve

the quality and availability of medical and support services for individuals

and families with HIV disease. For fiscal year 1994, 34 eligible metropolitan

areas (EMA)2

 received $320 million under title I of the act; the 54 states and

territories received $162.7 million under title II of the act.

EMAs award Ryan White CARE Act title I funds to providers of medical and

support services. These providers include hospitals, ambulatory care

facilities, community health centers, community-based organizations, and

hospices, among others. Ryan White CARE Act funds cannot be used for

in-patient care but can be used for in-patient case management services

that expedite hospital discharge.

States and territories use title II funds to establish and operate HIV care

consortia that provide services to HIV-infected individuals and their

families. A consortium is an association of one or more public and

nonprofit service providers operating in areas determined by the state to

be most affected by HIV disease. The consortium uses the funds to plan,

2

To be eligible for funding, metropolitan areas must have a total of more than 2,000 AIDS cases or a per

capita incidence of 25 cumulative AIDS cases for every 100,000 people in the population.

Page 2 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
B-255864 

develop, and deliver medical and support services. In addition to funding

consortia, states use title II funds to provide HIV-infected people with home

and community-based care services, continuity of health insurance

coverage, and prescription drugs such as antiviral medications.

HRSA’s Division of HIV Services is responsible for awarding and monitoring

title I and II grants. One-half of title I funds and all of title II funds are

awarded on the basis of legislated formulas. EMAs apply to HRSA for

additional or supplemental funding. HRSA requires that EMAs, in their

applications, describe activities directed toward community-based and

minority service providers that would improve access to care for

low-income and underserved populations. Project officers monitor

grantees’ compliance with requirements and progress in serving affected

groups. HRSA also offers technical assistance, such as organizational

development and capacity building in underserved communities, to the

grantees through the project officers and a contractor.

Minorities, Women,

and IDUs Are

Receiving Ryan White

Services

At the five locations we visited, minorities, women, and IDUs appear to

access Ryan White CARE Act-funded medical and support services

generally in similar or somewhat greater proportion than their

representation in the HIV-infected population.3

 In a few instances, some

subpopulations used fewer services. For example, in Los Angeles,

Hispanics accounted for 23 percent of the estimated HIV-infected

population but used 13 percent of drug abuse treatment services during

the 3-month period we analyzed. To illustrate the use of services, figure 1

shows that the use of primary care services in Baltimore is generally in

proportion to or slightly higher than the estimated HIV-infected population.

(See app. II for the distribution of other services we analyzed in the five

locations.)

3

At some locations, some service providers did not report one or more client characteristic, such as

gender or risk group. In those locations, we could not compare all population and client

characteristics.

Page 3 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
B-255864 

Figure 1: Distribution of CARE

Act-Funded Primary Care Services in

the Baltimore EMA

(January-March 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30 28

69 71

1 1

24

30 32

49

Estimated HIV Population

Receiving Primary Care Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, primary care services providers

received 40.6 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, 839 primary care visits were conducted.

We also sought views on access from advocates for HIV-infected people

and medical and support service providers located in the five areas we

studied. We selected advocates and providers representing and serving

various populations, including minorities, women, and IDUs. The advocates

and providers affirmed that affected groups generally accessed services in

proportion to their representation in the HIV-infected population.

Page 4 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
B-255864 

Several Barriers May

Limit Access to

Services

Use rates of CARE Act-funded services may not fully explain access to

services. Providers and advocates told us about many barriers to access

that in their view are particularly difficult to overcome. HIV-infected people

often have other priorities and pressing needs that may affect the extent to

which they seek HIV- related care. Substance abuse and homelessness,

among other barriers, were mentioned as affecting the extent to which

HIV/AIDS- infected people seek services.

In some instances, lack of knowledge about and lack of motivation to seek

services affect the extent to which some people use services. Additionally,

the advocates and providers told us of other barriers, including a lack of

trust of the medical community, denial of the disease by some HIV-infected

people, and a reluctance to obtain care from a provider of a certain racial

or ethnic group or who primarily serves a different racial or ethnic group

than that of the person seeking services. As agreed, we did not try to

determine the extent to which these barriers limit access to services.

We discussed our findings with officials of HRSA’s AIDS Program Office, the

Division of HIV Services, and the Office of Science and Epidemiology. They

generally agreed with our findings, and we incorporated their suggestions

where appropriate.

We are sending copies of this report to the Secretary of Health and Human

Services; the Assistant Secretary for Health; the Administrator, Health

Resources and Services Administration; and other interested parties. We

will make copies available to others on request.

If you or your staff have any questions about this report, please call me at

(202) 512-7119 or Bruce D. Layton, Assistant Director, at (202) 512-6837.

Other contributors to this report include Roy Hogberg, Howard Cott,

Marie DeCocker, and Mark Vinkenes.

Mark V. Nadel

Associate Director

National and Public Health Issues

Page 5 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Contents

Letter 1

Appendix I 

Objective, Scope, and

Methodology

8

Appendix II 

Use of Certain Ryan

White CARE

Act-Funded Services

in Five Locations

11

Tables Table I.1: Services and Reporting Period Used in Analysis of

Clients Served

9

Table I.2: Providers and Advocates Interviewed 10

Figures Figure 1: Distribution of CARE Act-Funded Primary Care

Services in the Baltimore EMA

4

Figure II.1: Distribution of CARE Act-Funded Financial Voucher

Services in the Baltimore EMA

11

Figure II.2: Distribution of CARE Act-Funded Mental Health

Services in the Baltimore EMA

12

Figure II.3: Distribution of CARE Act-Funded Housing Services in

the Baltimore EMA

13

Figure II.4: Distribution of CARE Act-Funded Counseling

Services in the Baltimore EMA

14

Figure II.5: Distribution of CARE Act-Funded Case Management

Services in the Baltimore EMA

15

Figure II.6: Distribution of CARE Act-Funded Transportation

Services in the Baltimore EMA

16

Figure II.7: Distribution of CARE Act-Funded Primary Care

Services in the Denver EMA

17

Figure II.8: Distribution of CARE Act-Funded Case Management

Services in the Denver EMA

18

Figure II.9: Distribution of CARE Act-Funded Primary Care

Services in the Los Angeles EMA

19

Page 6 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Contents

Figure II.10: Distribution of CARE Act-Funded Drug Abuse

Treatment Services in the Los Angeles EMA

20

Figure II.11: Distribution of CARE Act-Funded Case Management

Services in the Los Angeles EMA

21

Figure II.12: Distribution of CARE Act-Funded Case Management

Services in the Sacramento title II Consortium

22

Figure II.13: Distribution of CARE Act-Funded Primary Care

Services in the Suburban Maryland HIV Alliance

23

Figure II.14: Distribution of CARE Act-Funded Case Management

Services in the Suburban Maryland HIV Alliance

24

Figure II.15: Distribution of CARE Act-Funded Mental Health

Services in the Suburban Maryland HIV Alliance

25

Abbreviations

AIDS acquired immunodeficiency syndrome

CARE Comprehensive AIDS Resources Emergency

EMA eligible metropolitan area

HIV human immunodeficiency virus

HRSA Health Resources and Services Administration

IDU injection drug user

Page 7 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix I 

Objective, Scope, and Methodology

Our objective was to determine the extent to which selected human

immunodeficiency virus- (HIV) infected subpopulations, that is,

African-Americans, Hispanics, women, and injection drug users (IDU) were

receiving services in proportion to their representation in their areas’

HIV-infected populations. To conduct our study, we visited five locations:

Baltimore, Denver, and Los Angeles eligible metropolitan areas (EMA); the

Sacramento, California, Consortium; and the Suburban Maryland HIV

Consortium (serving the Maryland suburbs of Washington, D.C.). We

chose sites on the basis of varying size and demographics of HIV-infected

population, how long they have been receiving Ryan White CARE Act

funding, and the amount of funding. We cannot generalize the results of

our work to all Ryan White CARE Act-funded EMAs and consortia.

To determine the extent to which HIV-infected populations were being

served, we compared the estimated HIV-infected population at each site

with service provider reports of clients served. The estimates and reports

identified such characteristics as race/ethnicity, gender, and mode of HIV

transmission. Each EMA estimated its own HIV-infected population. The

consortia did not have the estimated HIV-infected population for their areas

so we used reported AIDS cases for our analysis.

At each location, we reviewed one or more medical or support service

funded by the Ryan White CARE Act. For each EMA and consortium, we

selected the top priority services they identified. We did this by choosing

those services that cumulatively accounted for about half of the funds as

estimated by the EMAs and consortia. The percent of funding accounted for

ranged from 41.3 percent in Denver to 69.9 percent in Baltimore. Using this

method for selecting services, the number of services we used for analysis

varied from one service in Sacramento to seven services in Baltimore. For

Denver and Los Angeles, we identified three services and, for Suburban

Maryland, we identified two.4

For the identified services, we obtained data on the characteristics of

clients served by Ryan White CARE Act-funded providers. We obtained the

data from provider-generated reports to the EMA or consortia. The data

were generally for a 3-month period but, since reporting requirements

varied at the EMAs and consortia, reporting periods were not consistent

across locations. Table I.1 shows the services and reporting periods for

each location.

4

In Denver, we identified three services—primary care, case management, and dental care—that

comprised about 50 percent of projected 1994 title I funds. However, because Denver’s dental care

program was in a developmental stage, the small number of clients did not allow us to analyze client

characteristics.

Page 8 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix I 

Objective, Scope, and Methodology

Table I.1: Services and Reporting

Period Used in Analysis of Clients

Served

Location Services Reporting periods

Baltimore Primary care January - March 1994

Financial vouchers

Mental health

Housing services

Counseling

Case management

Transportation

April - June 1994

Denver Primary care

Case management

July - September 1994

June - August 1994

Los Angeles Primary care July 1993 - June 1994

Substance abuse treatment

Case management

January - March 1994

Sacramento Case management July - September 1992

Suburban Maryland Primary care

Case management

Mental health

May - August 1994

Using the estimated HIV-infected populations or reported AIDS cases and

the client demographics, we compared the population and client

characteristics to determine the extent to which the HIV-infected

populations were receiving medical and support services.

At each location, we also interviewed service providers who received Ryan

White CARE Act funds for 1994 or advocacy groups. We discussed their

views on our interpretation of the data, comparing HIV-infected

populations with clients served as well as barriers that may limit access to

HIV-related medical and support services. Table I.2 shows the providers

and advocates we interviewed at each location.

Page 9 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix I 

Objective, Scope, and Methodology

Table I.2: Providers and Advocates

Interviewed Location Provider or advocate

Baltimore Chase Brexton Clinic

AIDS Action Baltimore

HERO (Health Education Resource Organization)

Denver Colorado AIDS Project

Empowerment Program

People of Color Consortium Against AIDS

Denver Indian Health and Family Services

Urban League of Metro Denver

Denver Department of Health and Hospitals

Children’s Hospital Dental Clinic

Los Angeles AIDS Health Care Foundation

Drew University of Medicine and Science - HIV

Cochair of Women’s Caucus of Los Angeles AIDS Regional Board

Sacramento Women’s Civic Improvement Club

Sacramento AIDS Foundation

Suburban Maryland Black Women’s Health Council

Greater Baden Health Clinic

To get a broader perspective about access to services, we discussed

access to services with two organizations—the National Minority AIDS

Council and AIDS Action Council. We also discussed our analysis with

officials of Health Resources and Services Administration’s Division of HIV

Services.

We conducted our work from June through December 1994 in accordance

with generally accepted government auditing standards.

Page 10 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.1: Distribution of CARE

Act-Funded Financial Voucher

Services in the Baltimore EMA

(April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

19

69

76

1 2

24

44

32

53

Estimated HIV Population

Receiving Financial Voucher Assistance

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, financial voucher services providers

received 10.2 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, 937 financial vouchers were provided.

Page 11 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.2: Distribution of CARE

Act-Funded Mental Health Services in

the Baltimore EMA (April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

34

69

64

1 1

24 24

32

41

Estimated HIV Population

Receiving Mental Health Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, mental health services providers

received 6.8 percent. 

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons. 

3. During the 3-month period, 1,301 mental health visits were conducted.

Page 12 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.3: Distribution of CARE

Act-Funded Housing Services in the

Baltimore EMA (April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

2

69

98

1 0

24 25

32 32

Estimated HIV Population

Receiving Housing Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, housing services providers received

3.5 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, 59 encounters occurred to assist in providing housing.

Page 13 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.4: Distribution of CARE

Act-Funded Counseling Services in the

Baltimore EMA (April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

12

69

88

1 0

24

37

32

53

Estimated HIV Population

Receiving Counseling Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, counseling services providers received

3.4 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, 133 counseling visits were provided.

Page 14 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.5: Distribution of CARE

Act-Funded Case Management

Services in the Baltimore EMA

(April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

11

69

88

1 1

24

42

32

52

Estimated HIV Population

Receiving Case Management Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, case management services providers

received 3 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, 383 case management visits were conducted.

Page 15 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.6: Distribution of CARE

Act-Funded Transportation Services in

the Baltimore EMA (April-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women Injection drug

users

Population Group

30

4

69 71

1 0

24

29 32

46

Estimated HIV Population

Receiving Transportation Services

Notes:

1. Of the $4.6 million title I and II funds awarded in 1994, transportation services providers

received 2.4 percent.

2. The Baltimore EMA estimates its HIV-infected population to be about 16,500 persons.

3. During the 3-month period, transportation to, for example, medical appointments and support

groups was provided 214 times.

4. The race/ethnicity and gender were unknown for about 25 percent of the clients, and, for about

41 percent of the clients, transmission mode was unknown.

Page 16 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.7: Distribution of CARE

Act-Funded Primary Care Services in

the Denver EMA (July-September 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women

Population Group

73

68

12 13 11

15

8 9

Estimated HIV Population

Receiving Primary Care Services

Notes:

1. Of the $4.4 million title I and II funds awarded in 1994, primary care services providers

received 22.7 percent.

2. The Denver EMA estimates its HIV-infected population to be about 7,076 persons.

3. During the 3-month period, about 1,240 clients received primary care services.

Page 17 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.8: Distribution of CARE

Act-Funded Case Management

Services in the Denver EMA

(June-August 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Women

Population Group

73

62

12

18

11

16

8

13

Estimated HIV Population

Receiving Case Management Services

Notes:

1. Of the $4.4 million title I and II funds awarded in 1994, case management services providers

received 18.6 percent.

2. The Denver EMA estimates its HIV-infected population to be about 7,076 persons.

3. During the 3-month period, about 938 clients received case management services.

Page 18 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.9: Distribution of CARE

Act-Funded Primary Care Services in

the Los Angeles EMA (July

1993-June 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Asian/Pacific

Islanders

Women

Population Group

57

44

18 19

23

33

2 2 4

10

Estimated HIV Population

Receiving Primary Care Services

Notes:

1. Of the $27.6 million title I and II funds awarded in 1994, primary care services providers

received 37.2 percent.

2. The Los Angeles EMA estimates its HIV-infected population to be about 52,000 persons.

3. During the 12-month period, about 5,830 clients received primary care services.

Page 19 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.10: Distribution of CARE

Act-Funded Drug Abuse Treatment

Services in the Los Angeles EMA

(January-March 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Asian/Pacific

Islanders

Women

Population Group

57

36

18

43

23

13

2 0

4

28

Estimated HIV Population

Receiving Drug Abuse Treatment Services

Notes:

1. Of the $27.6 million title I and II funds awarded in 1994, drug abuse treatment services

providers received 9.1 percent.

2. The Los Angeles EMA estimates its HIV-infected population to be about 52,000 persons.

3. During the 3-month period, about 91 clients received drug abuse treatment services.

Page 20 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.11: Distribution of CARE

Act-Funded Case Management

Services in the Los Angeles EMA

(January-March 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites

African - Americans

Hispanics

Asian/Pacific Islanders

Women

Injection drug users

Population Group

57

50

18 19

23

27

2 2 4

8 6 5

Estimated HIV Population

Receiving Case Management Services

Notes:

1. Of the $27.6 million title I and II funds awarded in 1994, case management services providers

received 8.3 percent.

2. The Los Angeles EMA estimates its HIV-infected population to be about 52,000 persons.

3. During the 3-month period, about 91 clients received drug abuse treatment services.

Page 21 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.12: Distribution of CARE

Act-Funded Case Management

Services in the Sacramento Title II

Consortium (July-September 1992)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites

African - Americans

Hispanics

Asian/Pacific Islanders

Women

Injection drug users

Population Group

68

60

19

24

12

8

1 1

10

17 15 17

Total AIDS Cases

Receiving Case Management Services

Notes:

1. Of the $861,899 title II funds awarded in 1994, case management services providers received

45.2% of the funds.

2. The Sacramento Title II Consortium did not have estiamtes of its HIV population. The

consortium has about 630 AIDS cases.

3. During the 3-month period, about 375 clients received case management services.

4. Client data more recent than 1992 were not available.

Page 22 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.13: Distribution of CARE

Act-Funded Primary Care Services in

the Suburban Maryland HIV Alliance

(May-August 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Injection drug

users

Population Group

37

25

58

67

4 6

16 14

Total AIDS Cases

Receiving Primary Care Services

Notes:

1. Of the $1.9 million title I and II funds awarded in 1994, primary care services providers

received 24.2 percent.

2. The Suburban Maryland HIV Alliance did not have estimates of its HIV population. The

consortium has about 1,200 AIDS cases.

3. During the 4-month period, 612 primary medical care visits were conducted.

4. Data were not available to compare share of AIDS cases by gender.

5. Injection drug users comprise 10% of the AIDS cases in one county and 21% in another

county. We estimate that about 16% of the AIDS cases in the consortium are injection drug users.

Page 23 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.14: Distribution of CARE

Act-Funded Case Management

Services in the Suburban Maryland HIV

Alliance (May-August 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Injection drug

users

Population Group

37

21

58

74

4 5

16 14

Total AIDS Cases

Receiving Case Management Services

Notes:

1. Of the $1.9 million title I and II funds awarded in 1994, case management services providers

received 17.2 percent.

2. The Suburban Maryland HIV Alliance did not have estimates of its HIV population. The

consortium has about 1,200 AIDS cases.

3. During the 4-month period, 673 case management visits were conducted.

4. Data were not available to compare share of AIDS cases by gender.

5. Injection drug users comprise 10% of the AIDS cases in one county and 21% in another

county. We estimate that about 16% of the AIDS cases in the consortium are injection drug users.

Page 24 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
Appendix II 

Use of Certain Ryan White CARE

Act-Funded Services in Five Locations

Figure II.15: Distribution of CARE

Act-Funded Mental Health Services in

the Suburban Maryland HIV Alliance

(May-August 1994)

Percent

0

10

20

30

40

50

60

70

80

90

100

Whites African -

Americans

Hispanics Injection drug

users

Population Group

37 35

58

63

4 2

16 16

Total AIDS Cases

Receiving Mental Health Services

Notes:

1. Of the $1.9 million title I and II funds awarded in 1994, mental health services providers

received 7.2 percent.

2. The Suburban Maryland HIV Alliance did not have estimates of its HIV population. The

consortium has about 1,200 AIDS cases.

3. During the 4-month period, 154 mental health visits were conducted.

4. Data were not available to compare share of AIDS cases by gender.

5. Injection drug users comprise 10% of the AIDS cases in one county and 21% in another

county. We estimate that about 16% of the AIDS cases in the consortium are injection drug users.

(108203) Page 25 GAO/HEHS-95-49 Access to Ryan White CARE Act Services
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