FINDINGS FROM THE FIELD Results of Recent Minority AIDS Initiative Studies Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. Slides and report summaries available at www.positiveoutcomes.net

HAB-Funded MAI Projects PROJECT I Qualitative case studies in five Title I Eligible Metropolitan Areas (EMAs) PROJECT II Geoanalysis used to assess the relationship between the physical location of HAB MAI-funded programs and the underlying distribution of HIV+ residents in five EMAs PROJECT III A national survey of CARE Act and/or MAI-funded direct service grantees and subgrantees

What do we know about the history of MAI funding by HAB grantees?

Project I: Case Study Methods A qualitative study used case studies to evaluate the impact of MAI funds on HIV service and financing systems Title I case study sites were selected based on regional distribution and the ranking of the total amount of MAI-funds within the regions Chicago, Dallas, Oakland, Palm Beach County, and Philadelphia were studied Key stakeholders were interviewed Title I grantee and Planning Council staff, Planning Council members, MAI-funded subgrantees, and consumers

Project I: Case Study Findings Implementation of MAI funding by Title I grantees was described as problematic Organizational eligibility for MAI funding was unclear including whether non-African American or non-minority providers could be funded Planning Council allocation discussions raised racial divides among Council members Title I MAI clinical data requirements tend to guide the selection of clinical providers that can generate required data Several Title I grantees consolidated funding to minority providers using MAI funds, rather than blending MAI and Title I Reductions in Title I funds have reduced the flexibility of blended MAI/Title I funding in the future Potential unintended consequences may result if MAI funds are cut significantly or no longer appropriated by Congress

Are minority and MAI-funded providers physically located in the geographic areas with the highest rates of HIV infection among racial/ethnic minority populations?

Project II: Geoanalysis Study Objectives We explored the geoanalytic relationship between the location of minority and/or Title I MAI-funded providers and Population-adjusted HIV and/or AIDS case rates Rates of racial/ethnic minority populations We computed the probability that MAI-funded and/or minority provider agencies are located in geographic areas with high or moderate HIV/AIDS case rates or racial/ethnic minority populations We mapped the relationship between the physical location of MAI-funded and/or minority provider agencies and HIV and/or AIDS case rates and racial/ethnic minority

MAI-funded agencies varied in their probability of locating in high case rate areas EMA (MAI in High Case Area) Moderate Case Area) Low Case Area) (Not Enough Data Area) Chicago 0.00 0.22 0.78 Dallas 0.50 0.25 Oakland 1.00 Palm Beach 0.33 Philadelphia 0.24 0.35 0.41  = Probability

Minority providers varied in their probability of locating in high case rate areas EMA (Minority in High Case Area) Moderate Case Area) Low Case Area) (Not Enough Data in Area) Chicago 0.04 0.65 0.31 0.00 Dallas* 0.05 0.15 0.80 Oakland 0.46 0.23 Palm Beach* 0.25 0.12 0.63 Philadelphia 0.55 0.18 0.27  = Probability *Unable to map all service providers

What do we know about MAI-funded direct service agencies?

Project III: Methods Grantee lists were obtained from HAB MAI-funded agencies were identified by HAB or via grants management documents Grantees of Titles I, II, III, IV, DRP, or SPNS funds in FY 2003-2004 provided lists of their funded subgrantees State Title II programs provided consortia contact information A total of 3,188 unduplicated programs operating in 2,818 agencies were identified

Project III: Methods OMB clearance was obtained for the survey form All identified programs were contacted via facsimile and asked to complete a six-page survey form Agencies without facsimiles were sent the form by USPS Respondents could return their surveys by a web-based survey site, fax, or USPS The program response rate is 45%, while the agency response rate is 48% Four hurricanes significantly impacted the response rate CADR data were linked to the survey results to provide organizational, client, and utilization data and to reduce the survey response burden

MAI-Funded Agencies 28% (n = 402) of responding agencies report receiving MAI funds Among MAI-funded providers 49% of MAI-funded programs are clinics or other health programs 40% are CBOs or ASOs 5% are mental health or substance abuse treatment centers 5% operate in other settings 1% provide housing services Only 5% self-identify as faith-based organizations Most, but not all, MAI-funded programs are minority providers

MAI-Funded Minority Providers CADR client data were matched to survey results Poverty, homelessness, lack of health insurance, enrollment in Medicaid, and being HIV+ (but not having AIDS) are associated with the HIV+ clients of MAI-funded minority programs 76% of HIV+ clients of these programs have a household income at or below the FPL 22% of HIV+ clients have no permanent housing 30% of HIV+ clients of have no insurance, 43% are enrolled in Medicaid, and 8% have private insurance Among clients whose HIV/AIDS status are reported, 58% have HIV but not AIDS and 42% have been diagnosed CDC-defined AIDS

How are MAI funds used? Add new service categories (25%) In the 12 months before the survey, MAI funds were used to Add new service categories (25%) Increase service volume (44%) Expand capacity to provide services (22%) 50% provided existing services to new racial/ethnic minority clients 38% expanded outreach services to minority populations that know their HIV status but are not in care 32% expanded outreach services to racial/ethnic minority populations at-risk for HIV disease 27% provided new HIV services to existing racial/ethnic minority clients 22% expanded funding to existing services to new racial/ethnic minority clients 20% expanded staffing by hiring racial/ethnic minority direct service staff

How are MAI funds used? MAI-funded programs were asked to assess the extent to which MAI funds expanded their programs to meet the unmet HIV services needs of minority communities Among programs sure of the extent to which MAI funds allowed them to expand their HIV programs 24% expanded their HIV programs a lot, 57% expanded their programs somewhat, and 18% report that MAI funds did not expand their ability to meet the unmet needs of HIV racial/ethnic communities A variety of ways to expand the capacity of their programs receiving these funds Expanded their target populations (27%) Increased the number of direct service staff (21%) Increased their geographic service area (12%) Expanded the number of direct service sites including satellite sites, co-located service sites, and mobile van locations (9%) Expanded week day office or clinic hours (7%) Established evening office or clinic hours (7%) Established Saturday office or clinic hours (4%)

MAI-funded programs report using those funds to target an array of minority populations

What challenges are CARE Act and MAI-funded programs encountering? 35% of all CARE Act-funded providers report that obtaining CARE Act funds was very difficult or difficult during the previous twelve months Among MAI-funded programs, 6% reported MAI funds were very easy to obtain, 47% reported that they were easy to obtain, 31% reported that they were somewhat difficult to obtain, 11% reported that they were very difficult to obtain, and 6% of MAI-funded programs reported that they did not know Ease of obtaining MAI funds in the 12 months prior to the survey differed significantly between minority and non-minority providers 51% of MAI-funded minority providers reported that obtaining MAI funds was very difficult or difficult compared to 40% of MAI-funded non-minority providers

Sufficiency of Funding Responding programs were asked if their funds were sufficient to meet the current need for services of their HIV program’s clients or patients 57% of all MAI-funded providers report that they cannot meet their client’s need Only 7% of all MAI-funded providers report that they have sufficient funds to expand services to meet their client’s needs Only 5% of MAI-funded providers report that they have sufficient funds to add new types of services

Other Challenges Experienced By MAI-Funded Programs Barriers to obtaining funds Reduced availability of funds, difficulty in preparing and submitting proposals, and inability to apply directly for funding Ease of obtaining MAI funding was associated with organizational setting 68% of behavioral health programs report that MAI funds were very difficult or difficult to obtain during the twelve months prior to the consultation, compared to 53% of CBOs, 36% of health programs, and 25% of housing programs 40% of programs located in EMAs report encountering barriers in obtaining MAI funds, compared to 29% of programs outside EMAs

To what extent will a shift to core services impact minority providers? HAB and grantees have focused considerable resources to enhance the capacity of minority providers, including expansion of clinical capacity MAI funding also was initiated, in part, to expand the number of minority providers delivering HIV services

Non-Minority Providers To what extent will a shift to core services impact minority providers? Core Services Case Management Other N 1,391 347 604 Minority Providers 45% 53% 32% Non-Minority Providers 55% 47% 68% Source: FY 2003 CADR