Gregory and Kevin Huang-Cruz, New York, NY

Part II. PROGRAM DATA, FY 2002

Building on successes
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Responding to new dynamics
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Meeting growing demand for care act services

CARE act spending, FY 2002 Appropriation: $1.9 billion

The Ryan White CARE Act authorizes funding for outpatient medical care and essential support services. The largest portion of CARE Act spending is for services related to medical care.

Spending data in this chart are based in part on provider-reported estimates.
*Approximately 3.5 percent of spending under “Medications, ADAP Earmark” was for health insurance and adherence support.
**Title IV reflects only a portion of CARE Act spending for women, infants, children, youth, and families.

Cliff and Gloria Mosley, New York, NY

CARE act reporting

The data on the following pages are drawn from the CARE Act Data Report, which provides new information on CARE Act Programs.

When the CARE Act became law in 1990, its diverse programs were implemented by several bureaus and offices within HRSA, each with its own mandates, policies, and approaches. Today, all CARE Act programs are managed through the HIV/AIDS Bureau. that change has given the Agency the opportunity to construct a more unified reporting system.

HIV status of CARE Act-funded provider clients, duplicated,* 2002 (N = 1,044,172)**

The CARE Act is fundamentally a care program for people living with HIV disease. Therefore, the vast majority of clients are HIV-positive. Some clients, however, are HIV-negative—for example, some who receive HIV counseling and testing through early intervention services. In addition, affected family members, such as HIV-negative children of HIV-positive mothers, may receive services through the Title IV program for women, infants, children, youth, and families.

*Data are from the CARE Act Data Report. The utility of this source is limited by duplicated client counts. Data from the report collected and reported by individual providers are generally unduplicated. However, an individual client may receive services from more than one provider, and there is no way of knowing that the counts of individuals served by one provider are not also included in the counts of another provider. Thus, aggregating provider data to the national level results in duplicate client counts.
**Percentages may not add to 100 due to rounding.

HIV Status of New* CARE Act-funded provider clients,** 2002 (N = 370,059)

CARE Act providers reach out to individuals not in care and serve many new clients each year. Some clients receive many CARE Act services over time; others might receive only one service. Still others may be referred to non–CARE Act providers, ensuring that the CARE Act is always the payer of last resort.

*”New clients” are those who first received services from a particular provider agency during the reporting period (2002), although they might have received services from another
CARE Act–funded provider at a different time.
**Duplicated client counts. See note above.

Poverty level of HIV-positive Clients* served by CARE Act-funded providers, 2002 (N = 844,687)

In 2002, a year in which the Federal Poverty Level (FPL) was $18,100 for a family of four and the cost of antiretroviral therapy was as much as $14,000, 50 percent of HIV-positive CARE Act clients were living at or below the FPL.2 Poverty among CARE Act clients underscores the vital nature of essential support services—for example, food banks and transportation—and the importance of linking clients with other public and private programs for which they are eligible.

*Duplicated client counts. See note, page 16.

health insurance status of HIV-positive clients* served by CARE Act-funded providers, 2002 (N = 844,687)

In 2002, only 8.5 percent of CAREAct clients had any private health insurance, and only 27.9 percent were enrolled in Medicaid. The situation increases pressure on CARE Act programs in an age of rising outpatient treatment costs.

*Duplicated client counts. See note, page 16.

gender of HIV-positive clients* served by CARE Act–funded providers, 2002 (N = 844,687)

The proportion of female HIV-positive clients served by CARE Act–funded providers reached 31.3 percent in 2002. That year, women accounted for an estimated 21.5 percent of all people living with AIDS in the United States, 26 percent of new AIDS cases, and 28.4 percent of new HIV infections reported in the
30 areas with confidential name-based HIV infection reporting.3

*Duplicated client counts. See note, page 16.

ethnicity of HIV-positive clients* served by CARE Act–funded providers, 2002 (N = 844,687)

Hispanics account for roughly 1 in 5 CARE Act clients. At the end of 2002, 19.8 percent of the people living with AIDS in the United States were Hispanic.4

*Duplicated client counts. See note, page 16.

race of HIV-positive clients* served by CARE Act–funded providers, 2002 (N = 844,687)

In FY 2002, approximately 65 percent of CARE Act clients were racial minorities. At the end of 2002, they were served in roughly equal proportion to their representation among people living with AIDS.4

*Duplicated client counts. See note, page 16.

age of HIV-positive clients* served by CARE Act–funded providers, 2002 (N = 844,687)

Antiretroviral therapy has led to longer, healthier lives, and now almost one-third of CARE Act clients are age 45 or older. These data echo trends in surveillance, which show that 41.3 percent of people living with AIDS in 2002 were age 45 or older.4 Just two percent of CARE Act clients are children age 12 or younger, in large part because of advances in the prevention of perinatal transmission of HIV.

*Duplicated client counts. See note, page 16.

type of service USED BY CARE Act–funded provider clients,* 2002

In 2002, 319,295 clients received outpatient medical care through CARE Act–funded providers, almost four times the number receiving any other service except case management. The number of clients relying on those providers for outpatient medical care illustrates the inability of other public programs to meet demand.

*Duplicated client counts. See note, page 16.

health care services used by care act–funded provider clients,*
by median Number of visits per year, 2002

*Duplicated client counts. See note, page 16.

support services used by number of CARE Act-funded provider clients,* 2002

Many essential support services funded through the CARE Act are directly related to primary health care. For example, services such as treatment adherence counseling, health education risk reduction, nutritional counseling, and food bank/home-delivered meals are inextricably linked to the health status of people living with HIV and AIDS because such supports help keep people in care.

*Duplicated client counts. See note, page 16.

organization type of CARE Act–funded providers, 2002 (N = 2696)

Community-based organizations constitute the largest segment (47.6 percent) of the CARE Act provider community, accounting for more than three times the number of providers in the next largest category, hospitals.

minority providers: CARE Act–funded providers with >50 percent minority representation on the Board of Directors and professional staff, 2002, by percentage of providers (N = 2,696)

Minorities are playing a vital role in reaching individuals living with HIV/AIDS in their communities. Approximately one-fourth of all CARE Act providers in FY 2002 had boards of directors in which more than 50 percent of board members consisting of more than 50 percent racial and ethnic minorities. For about 35 percent of providers, more than half of all professional staff members were minorities.

public health service section 330 funding among care act–funded providers, FY 2002 (N = 2,696)

Less than 7 percent of CARE Act providers also receive Public Health Service Section 330 funds, which support the Nation’s federally funded community and migrant health centers.

number of care act funding sources for care acT–funded providers, FY 2002 (N = 2,696)

In 2002, 28.2 percent (763) CARE Act providers received funding through more than one CARE Act source. More than half of those funded by multiple programs were funded through Titles I and II.

care act funding sources by number of providers, 2002 (N = 2,696)

The Title I program, which funds 51 Eligible Metropolitan Areas across the United States, provides support to more organizations than does any other CARE Act program.

The Title II program, which includes the AIDS Drug Assistance Program (ADAP), supports grants to States and Territories.

The Title III program funded 273 Early Intervention Services grants, 60 planning grants, and 59 capacity-building grants in 2002.

The Title IV program funds services for women, infants, children, youth, and families. Of the 301 Title IV grants in 2002, 36 were funded through the Title IV Youth Initiative.

The Special Projects of National Significance (SPNS) program funded 80 agencies in 2002 through a variety of initiatives, which included adherence and outreach to HIV-positive individuals who were not in care.

The reauthorization in 2002 provided for two CARE Act dental programs. In 2002, 66 organizations received funding through the Dental Reimbursement Program, and 12 received Community-Based Dental Partnership grants.

Number of Providers (% Providers)