Sacramento Region
2013 HIV/AIDS NEEDS ASSESSMENT
June 2014
Prepared for:
The Sacramento HIV Health Services Planning Council
Prepared By:
Lili Carbone Joy, MPH
Public Health Consulting Services
3621 Loma Drive
Shingle Springs, CA 95682
Phone: 530.306.9861
Fax: 530.677.2194
E-mail: [email protected]
Submitted To:
Sacramento Ryan White CARE Program
HIV Health Services Planning Council
7001 East Parkway, Suite 600B
Sacramento, CA 95823
Phone: (916) 876-5548
Fax: (916) 875-5888
Email: [email protected]
Website: www.sacramento-tga.com
ACKNOWLEDGMENTS
The 2013 Sacramento Region Needs Assessment has been a collaborative effort among Ryan
White service providers, consumers of HIV/AIDS services, community members and
governmental agencies across the Sacramento Region.
The HIV Health Services Planning Council (the Council) would like to recognize the
following individuals for their dedication to undertaking a community driven Needs Assessment
process:
Members of the Needs Assessment Committee
Members of the HIV Health Services Planning Council
Ryan White Service Providers throughout the Sacramento Region
Adrienne Rogers, Ryan White CARE Program Coordinator, Sacramento County DHHS
Paula Gammell, Ryan White CARE Program Planner, Sacramento County DHHS
Lili Carbone Joy, MPH, Public Health Consulting Services
In addition to the people and organizations listed above, the needs assessment process would
not be possible without the time and effort of each person living with HIV/AIDS who
participated by completing the extensive survey tool. Two-hundred and thirty-two people living
with HIV/AIDS (PLWH/A) completed the time-consuming survey. Survey respondents
participated in one of several survey sessions that were held in various locations throughout the
Sacramento Region.
Appreciation is extended to each and every participant for their openness to the process, and
for their truthful responses to thorough and detailed questions. The results presented in this
Needs Assessment represent their individual and cumulative perspectives about a vast array of
services needed (Service Need); services they needed but were unable to receive (Need/Receive
Gap); services they needed but did not ask for (Need/Ask Gap) and Barriers to Care.
Without the comprehensive input of the HIV/AIDS community throughout the Sacramento
Region, this Needs Assessment would not have been possible.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page i
Sacramento Region 2013 HIV/AIDS Needs Assessment
Table of Contents
EXECUTIVE SUMMARY ......................................................................................................................................... 1
SECTION A: INTRODUCTION
A-1. BACKGROUND ................................................................................................................................................ 5
A-2. REPORT FORMAT........................................................................................................................................... 5
SECTION B: METHODOLOGY
B-1. NEEDS ASSESSMENT SURVEY TOOL ........................................................................................................ 7
a. Consumer Survey ..................................................................................................................................... 7
b. Incentives ................................................................................................................................................. 8
c. Recruitment .............................................................................................................................................. 8
d. Quality Control ........................................................................................................................................ 8
B-2. NEEDS ASSESSMENT SURVEY ANALYSIS ............................................................................................... 9
a. Data Entry, Data Analysis and Confidence Intervals .............................................................................. 9
b. Consumer Survey Analysis ..................................................................................................................... 10
c. Prior HIV/AIDS Needs Assessments ...................................................................................................... 10
SECTION C: DEMOGRAPHICS
C-1. DEMOGRAPHICS: TGA, RW CLIENTS, NEEDS ASSESSMENT RESPONDENTS .............................. 11
a. Overall Demographics and Geography of TGA ..................................................................................... 11
b. Demographics of TGA, HIV/AIDS, Ryan White Clients and Needs Assessment Respondents ............... 11
c. Comparative Analysis by Race, Gender, Age, Mode of HIV/AIDS Transmission .................................. 13
d. HIV-Related Comorbidities, Complicating Factors and Special Populations ....................................... 16
e. Rural PLWH/A ....................................................................................................................................... 21
SECTION D: SERVICE NEEDS, GAPS AND BARRIERS TO CARE
D-1. CORE SERVICES NEEDS AND NEED/RECEIVE GAPS ......................................................................... 22
a. Overview of Survey Questions................................................................................................................ 22
b. Core Service Needs and Need/Receive Gaps Overall ............................................................................ 22
c. Core Service Needs, Gaps and Demographics by Service Category ..................................................... 25
Outpatient Medical Care .................................................................................................................... 26
Prescription Medications.................................................................................................................... 28
Oral Health Care ................................................................................................................................ 29
Medical Case Management ................................................................................................................ 30
Mental Health Services ....................................................................................................................... 31
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Medical Nutrition Therapy ................................................................................................................. 32
Health Insurance Assistance............................................................................................................... 33
Substance Abuse Outpatient Care ...................................................................................................... 34
Home Health Care .............................................................................................................................. 35
D-2. SUPPORT SERVICES NEEDS AND NEED/RECEIVE GAPS .................................................................. 35
a. Support Service Needs and Need/Receive Gaps Overall........................................................................ 35
b. Support Service Needs, Gaps and Demographics by Service Category ................................................. 38
Social Service Case Management .......................................................................................................... 39
Emergency Financial Assistance............................................................................................................ 40
Prevention for Positives ......................................................................................................................... 41
Food Bank / Home Delivered Meals ...................................................................................................... 42
Other Support Services .......................................................................................................................... 43
Medical Transportation Services ........................................................................................................... 44
Health Education / Risk Reduction ........................................................................................................ 45
Housing Services .................................................................................................................................... 46
Legal Services ........................................................................................................................................ 47
Residential Substance Abuse Care ......................................................................................................... 48
Child Care Services................................................................................................................................ 49
D-3. BARRIERS TO CARE ..................................................................................................................................... 49
a. Description of Categories of Barriers to Care and Categorical Rankings ............................................ 49
b. Analysis of Barriers to Care by Category .............................................................................................. 50
c. Highest Ranked Barriers to Care ........................................................................................................... 54
d. Lowest Ranked Barriers to Care ............................................................................................................ 55
e. Barriers to Care by Demographics ........................................................................................................ 55
f. Need/Ask Gap as Barrier to Care ......................................................................................................... 57
SECTION E: SUMMARY OF FINDINGS AND IMPLICATIONS
E-1. SUMMARY OF NEEDS ASSESSMENT FINDINGS.................................................................................... 59
a. Core Services: Largest Needs and Need/Receive Gaps ........................................................................ 59
b. Support Services: Largest Needs and Need/Receive Gaps .................................................................... 59
E-2. IMPLICATIONS FOR RW PRIORITY SETTING AND ALLOCATIONS ............................................. 60
a. FY13 RW Funding Sources and TGA Direct Service Allocations .......................................................... 60
b. RW Direct Expenditures in Rural Counties............................................................................................ 61
c. Analysis of RW Client Service Expenditure Trends ............................................................................... 61
d. Trends in Service Needs and Gaps ......................................................................................................... 63
e. Demographic Disparities in Service Needs and Gaps ........................................................................... 64
f. Implications for Priorities and Allocations Decisions ........................................................................... 66
E-3. IMPLICATIONS FOR SERVICE SYSTEM IMPROVEMENTS .............................................................. 67
a. Top 10 Barriers to Care ......................................................................................................................... 67
b. Service System Improvements to Address Demographic Disparities and Barriers to Care ................... 68
E-4. IMPLICATIONS FOR FUTURE NEEDS ASSESSMENTS ........................................................................ 69
Sacramento Region FY13 HIV/AIDS Needs Assessment
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TABLES AND FIGURES
TABLES:
Table 1:
Table 2:
Table 3:
Table 4:
Table 5:
Table 6:
Table 7:
Table 8:
Table 9:
Table 10:
Table 11:
Table 12:
Table 13:
Table 14:
HIV/AIDS Demographics TGA, RW Clients, Needs Assessment ............................................................. 12
Co-Morbidities for TGA, RW Clients and Needs Assessment Respondents ............................................. 17
Core Service Needs and Need/Receive Gaps by Service Subcategory....................................................... 23
Core Service Categories Ranked by Level of Need ................................................................................... 24
Core Services Categories Ranked by Level of Need/Receive Gap............................................................. 24
Support Service Needs and Need/Receive Gaps by Service Subcategory .................................................. 36
Support Service Categories Ranked by Level of Need ............................................................................... 37
Support Services Categories Ranked by Level of Need/Receive Gap ........................................................ 37
Barriers to Care by Category and Subcategory .......................................................................................... 51
Top 10 Barriers to Care FY13 Compared to FY11 .................................................................................... 54
Need/Ask Gap Barrier to Care.................................................................................................................... 57
Core Service Categories Summary of Findings .......................................................................................... 59
Support Service Categories Summary of Findings ..................................................................................... 59
Top 10 Barriers to Care Summary .............................................................................................................. 67
FIGURES:
Figure 1:
Figure 2:
Figure 3:
Figure 4:
Figure 5:
Figure 6:
Figure 7:
RACE (TGA, Epidemiology, RW, Needs Assessment) ............................................................................. 13
GENDER (TGA, Epidemiology, RW, Needs Assessment) ....................................................................... 14
AGE (TGA, Epidemiology, RW, Needs Assessment) ............................................................................... 15
MODE OF TRANSMISSION (TGA, Epidemiology, RW, Needs Assessment) ....................................... 16
FY13 Sacramento TGA Distribution of HIV/AIDS Funding ..................................................................... 60
FY13 RW CARE Program Part A, MAI and Part B Direct Services Allocations....................................... 61
Support Services as a Percentage of RW Expenditures: FY1999-FY2012 ................................................. 62
CHARTS:
Core Services: Needs and Need/Receive Gaps by Demographics
Outpatient Medical Care........................................................................................................................ 26
Prescription Medications ....................................................................................................................... 28
Oral Health Care ................................................................................................................................... 29
Medical Case Management .................................................................................................................... 30
Mental Health Services .......................................................................................................................... 31
Medical Nutrition Therapy ..................................................................................................................... 32
Health Insurance Assistance .................................................................................................................. 33
Substance Abuse Outpatient Care .......................................................................................................... 34
Home Health Care ................................................................................................................................. 35
Support Services: Needs and Need/Receive Gaps by Demographics
Social Service Case Management .......................................................................................................... 39
Emergency Financial Assistance............................................................................................................ 40
Prevention for Positives ......................................................................................................................... 41
Food Bank / Home Delivered Meals ...................................................................................................... 42
Other Support Services .......................................................................................................................... 43
Medical Transportation Services ........................................................................................................... 44
Health Education / Risk Reduction ........................................................................................................ 45
Housing Services .................................................................................................................................... 46
Legal Services ........................................................................................................................................ 47
Residential Substance Abuse Care ......................................................................................................... 48
Child Care Services................................................................................................................................ 49
Sacramento Region FY13 HIV/AIDS Needs Assessment
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APPENDIX
Attachment 1:
Attachment 2:
Attachment 3:
Attachment 4:
Attachment 5:
Attachment 6:
Attachment 7:
Needs Assessment Committee ............................................................................................................ 71
Demographic Crosstabs of Needs Assessment Respondents .............................................................. 72
Service Needs by Service Category and Demographics ..................................................................... 78
Service Gaps by Service Category and Demographics ....................................................................... 92
Barriers to Care by Demographics .................................................................................................... 106
Detailed Survey Results .................................................................................................................... 120
FY13 Needs Assessment Survey Tool .............................................................................................. 147
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EXECUTIVE SUMMARY
BACKGROUND/METHODOLOGY
The Ryan White (RW) HIV Health Services Planning Council (HHSPC) is required to conduct a biannual assessment of people living with HIV/AIDS (PLWH/A) as part of its RW Part A funding for the
Sacramento Transitional Grant Area (TGA), which includes Sacramento, El Dorado, and Placer
Counties. The goal of the Needs Assessment is to collect and analyze data on Service Needs; Service
Gaps; and Barriers to Care for PLWH/A to assist the Council with effective planning for service funding
and service delivery. RW Program staff, service agency staff, and volunteers conducted survey sessions
in group and one-on-one sessions in both English and Spanish. In total, 232 Persons Living with
HIV/AIDS completed the survey, a 28.9% increase over the FY11 Needs Assessment survey.
FINDINGS
Demographics of Need Assessment Respondents
The survey sample was representative of PLWH/A across the Sacramento Region, and were from all
three counties of the TGA (Sacramento 77%, Placer 6.5% and El Dorado 6.0%). Although not part of
the TGA under RW Part A funding, 9.5% of respondents were from Yolo County, which receives RW
Part B funds. In addition, survey respondents were representative of the TGA’s HIV/AIDS
epidemiology and RW client caseload in terms of race, age, gender and mode of HIV transmission with
a few exceptions. Whites, males, youth were underrepresented. African American women were
overrepresented: 38% of females vs. 21% of males were African American. PLWH/A experiencing
homelessness were highly represented: 18% reported being currently homeless or having been during
the past two years. The efforts to reach Latinos and homeless clients proved substantially more
successful than in previous Needs Assessment surveys.
Highest Ranked Service Needs and Need/Receive Gaps
It is important to understand both Service Needs and Need/Receive Gaps to gain a clear picture of
what services PLWH/A are most in need of, and which services they are having the most difficulty
obtaining. The following chart summarizes % Need and % Need/Receive Gaps for RW Core Services,
ranked by highest % Need:
CORE SERVICE CATEGORIES SUMMARY
% Need and % Need/Receive Gap
Core Service Category
% Need
% Need/Receive Gap
Outpatient Medical Care
95%
12%
Medications
91%
12%
Oral Health Care
77%
26%
Medical Case Management
73%
18%
Mental Health Services
70%
27%
Medical Nutrition Therapy
50%
17%
Health Insurance Assistance
39%
22%
Substance Abuse Outpatient Care
34%
19%
Home Health Care
19%
19%
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Because the Council is legally mandated to allocate no more than 25% of its Part A annual funding
on Support Services, those services have been analyzed separately from Core Services as shown below:
SUPPORT SERVICES CATEGORIES SUMMARY
% Need and % Need/Receive Gap
Support Service Category
% Need
% Need/Receive Gap
Social Service Case Management
79%
25%
Emergency Financial Assistance
78%
47%
Prevention for Positives
69%
12%
Food Bank / Home Delivered Meals
69%
24%
Other Support Services
58%
50%
Medical Transportation Services
55%
36%
Health Education / Risk Reduction
40%
10%
Housing Services
37%
35%
Legal Services
28%
59%
Substance Abuse Residential Care
9%
38%
Child Care Services
8%
32%
Highest Ranked Barriers to Care
Nearly one-third of survey respondents reported a gap of more than six months without seeing a
medical provider. A fifth reported being out of care more than a year at some point since their HIV
diagnosis. One-third reported that the most common care setting for them was in the hospital or
emergency room. Follows are the top 10 (out of 32) reported Barriers to Care:
Rank
1
2
3
4
5
6
7
8
9
10
TOP 10 BARRIERS TO CARE
Not knowing that a service or treatment was available to me.
My state of mind or mental ability to deal with the treatment.
Experience or expertise of the person providing the services to me.
Not knowing the location of the service(s).
The amount of time I had to wait between scheduling an appointment
and the actual day of the appointment.
Sensitivity of the organization and person providing services to me
regarding my issues and concerns.
My ability to find my way through the system.
The amount of time I had to wait in the waiting room prior to my
appointment.
Not knowing who to ask for help.
No transportation.
% Agree
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
Largest Demographic Disparities for Service Needs and Gaps
Several populations had higher Service Needs and Gaps than survey respondents overall. Latinos
reported highest Service Needs and Need/Receive Gaps, followed by African Americans, followed by
Whites. Females reported Gaps at rates 10% or higher than men in 30% of service categories. African
American Women reported Gaps at rates 10% or higher than respondents overall in 35% of services.
Homeless PLWH/A reported Service Needs at rates 10% or higher than respondents overall in 55% of
services. On the other end of the spectrum, Injection Drug Users reported Service Gaps of 10% or lower
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 2
than respondents overall in 40% of services; and Rural respondents (El Dorado, Placer and Yolo
Counties) had equal or lower Service Needs and Gaps than respondents overall across all services.
IMPLICATIONS
Implications for Priority Setting and Allocations
Follows are examples of funding decisions that can be considered by the Council to address the most
highly reported Service Need and Need/Receive Gaps, and to address the largest demographic
disparities among PLWH/A in the Sacramento Region:
•
Latinos, African American Women and Homeless PLWH/A reported higher Needs and
Need/Receive Gaps than respondents overall. The Council should consider funding outreach and
other targeted services, for these vulnerable populations.
•
Rural survey respondents reported equal or lower Service Needs and Gaps than overall respondents
across all service categories. The Council should continue its current practice of allowing the TGA’s
rural Counties to have local control and contract flexibility in applying allocations to meet the local
service demand when no other funding sources are available.
•
Current trends in the medication reimbursement service gap have widened since earlier needs
assessments. While the AIDS Drug Assistance Program (ADAP) supports compensation for some
medications, PLWH/A may need assistance paying for drugs not covered by ADAP.
•
The Council should monitor the impact of the Affordable Care Act (ACA) on PLWH/A. While
many RW patients may receive subsidies for insurance premiums, many may need help with
expenses not covered under their out-of-pocket maximum (e.g., deductibles, copayments).
•
Over 75% of respondents reported needing both Medical and Social Service Case Management, but
over 25% of those did not receive it. Given the importance of retention in ongoing medical care, the
Council should continue to monitor service utilization and allocate funds proportionately.
•
Over three-quarters of survey respondents need Oral Health Care, but over one-quarter of those did
not receive it, even with recent increases in dental care funding. The Council should consider further
funding enhancements to support improved access to Oral Health Care.
•
Over two-thirds of respondents reported needing Mental Health Services, but one-quarter of those
did not receive it. The Council should investigate ways to improve access to, and funding for,
Mental Health Services.
•
Needs, Gaps and Barriers for Transportation Services have worsened since earlier needs
assessments, and RW transportation funding has dropped significantly over time. The Council
should continue to explore alternate transportation delivery systems and increased allocations to
transport patients to appointments.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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•
Over a third of respondents need Treatment Adherence Services; and one-fifth of those did not
receive them. This is an area to consider for increased funding and program development.
•
Latinos, African Americans and African American Women reported higher needs and gaps than
respondents overall for Childcare, and the Council should consider increase Childcare funding.
•
Services for food banks, food vouchers, food delivery and medical nutrition therapy had high
Service Needs and Gaps. Current trends worsened since past assessments, while funding decreased.
The Council should consider funding improved access to nutritious food and nutrition services.
Implications for Service System Improvements
Although not meant to be an exhaustive list of strategies, follows are examples of service system
improvements for the Council to consider while addressing the most highly reported Barriers to Care,
and largest demographic disparities, to retain patients in ongoing medical care:
•
Wait times before and during appointments are reported as barriers for over a third of respondents.
Further research is required to understand the extent of the issue and possible remediation activities.
The survey tool should be more specific in terms of “wait times.” Cares Community Health
performs confirmatory lab tests prior to a client’s initial visit to verify HIV status, and the survey
tool should distinguish between wait times for initial lab work and subsequent medical visits.
•
Sensitivity to patient needs, both by provider organizations and individual employees, is among the
greatest reported barriers. The Council may consider funding technical assistance to providers with
the goal of increasing sensitivity to the unique needs of PLWH/A within various demographic
subgroups (i.e., African American Women, Latinos, and the Homeless Population).
•
Lack of patient awareness is among the most commonly reported barriers to care. Improved
outreach to, and case management for, PLWH/A should be a priority for the Council. For example,
service providers should work to improve awareness of available services through direct client
contact; broader marketing and social media campaigns.
•
To support retention in ongoing medical care, Case Managers and other support staff should make
contact with patients and inquire about and encourage re-entry into medical care. Primary Care
providers should continue making appointment reminder calls, facilitating transportation assistance;
and implementing/maintaining “no-show” tracking and follow up protocols.
•
Service Providers should consider the use of peer advocates to provide outreach to specific
populations and locations to get and retain PLWH/A in ongoing medical care.
•
The Council should consider technical assistance, capacity building and networking with current
organizations throughout the region to educate them about findings and implications of the Needs
Assessment, and to improve the overall system of care for PLWH/A.
•
The Council should network with other organizations throughout the Sacramento Region to
maximize other funding opportunities and services for PLWH/A.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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SECTION A: INTRODUCTION
A-1. BACKGROUND
The Sacramento HIV Health Services Planning Council is responsible for the prioritization and
allocation of funding under the Ryan White Treatment Modernization Act of 2006, formerly the Ryan
White (RW) Comprehensive AIDS Resources Emergency (CARE) Act. A unique characteristic of the
RW CARE Act is its inclusion of local control of funding decisions and, very importantly, community
input into those decisions.
In March of 2013, as a condition of RW Part A funding, the HIV Health Services Planning Council
(HHSPC) Needs Assessment Committee embarked on its bi-annual assessment of people living with
HIV/AIDS (PLWH/A) in the Sacramento TGA, including Sacramento, El Dorado, and Placer counties.
The goal of the Needs Assessment is to provide the Council with data on service needs: gaps in services
and barriers to care for PLWH/A to assist with effective planning for service funding and service
delivery. In total, 232 Persons Living with HIV/AIDS completed the Needs Assessment Survey in
FY13.
A-2. REPORT FORMAT
In an effort to comprehensively understand the demographic profile and the service needs, gaps in
services and barriers to care of this population, this Needs Assessment report is divided into four main
sections, as follows:
Section B: Methodology
This section provides background regarding the Needs Assessment Survey Tool, how survey
respondents were recruited, and how the survey was conducted throughout the Sacramento Region. In
addition, the data analysis procedures and processes are outlined.
Section C: Demographics
This section provides a demographic profile of the TGA’s general population; the HIV/AIDS
epidemiology in the TGA (by age, race, gender and mode of transmission); a demographic profile of
Ryan White clients; and a profile of the Needs Assessment respondents. A comparative analysis is
presented to more closely understand which subpopulations are under or overrepresented in each of
these categories. Other co-morbidities and complicating factors are examined, such as STIs, housing
status, income, insurance status and substance use. PLWH/A in rural counties of the TGA also are
analyzed in terms of their representation in the TGA, among RW clients and among survey respondents.
Section D: Service Needs, Gaps and Barriers to Care
This section presents the survey findings in terms of Service Needs, Need/Receive Gaps and Barriers
to Care. Services are organized by Core Medical Services and Support Services to correspond with the
organization of funding for the RW Program. These data are analyzed by client demographics such as
gender, race, mode of transmission and age. Other factors and co-morbidities that influence gaps in
services needed vs. services received also are examined, such as housing status, income status, substance
abuse history and mental health status. Barriers to Care also are analyzed by demographic cross
Sacramento Region FY13 HIV/AIDS Needs Assessment
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tabulations to find subpopulations with disproportionate service needs, gaps and/or barrier to care, such
as African American Women.
Section E: Summary of Findings and Implications
This section provides a summary of the highest ranked Service Need; Need/Receive Gaps; Barriers
to Care and largest demographic disparities among Needs Assessment respondents. Implications for the
RW priority setting and allocation processes also are presented by providing an overview of funding
sources in the TGA and analyzing trends in service utilization for Ryan White clients over the last
decade. Comparison of past trends in expenditures to the most recently reported Service Needs, Gaps
and Barriers to Care is presented to assist the RW Planning Council it making future Priorities and
Allocations decisions. Implications for developing improvements to the RW System of Care to address
Barriers also are presented.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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SECTION B: METHODOLOGY
B-1. NEEDS ASSESSMENT SURVEY TOOL
a. Consumer Survey
•
A total of 232 surveys were completed by PLWH/A with the assistance of a survey administrator,
between August 2013 and February 2014. This was a 28.9% increase over the number of surveys
conducted in FY11 (180 surveys).
•
Data were collected from several locations including Cares Community Health, Sierra Foothills
AIDS Foundation (SFAF) in El Dorado and Placer Counties, Colonia San Martin, Breaking Barriers,
Strategies for Change, Mexican American Addiction Program (MAAP), CommuniCare in West
Sacramento and Woodland (Yolo County), and at Sunburst Projects.
•
Ryan White HIV Health Services Council staff, RW service provider agency staff, and volunteers
conducted survey sessions, both in group and one-on-one settings.
•
The survey instrument was created in English, but was administered in Spanish during targeted
survey sessions at MAAP and Strategies for Change.
•
Surveys were completed anonymously.
The original Needs Assessment survey instrument for the Sacramento TGA was designed and
approved on March 14, 2003. The survey instrument has been modified periodically to capture needed
data, without changing the foundation of the original survey, in an attempt to be able to cross reference
and trend survey results over years. In some instances, minor language corrections were made to
improve the clarity of the questions asked, and to improve comprehension and consistency of responses.
The final consumer survey tool used for this Needs Assessment is in the Appendix, Attachment 2.
The initial part of the questionnaire captures key demographics, insurance and benefits, level of care,
stage of infection, medication and adherence, and quality of life. The survey then asks questions about
consumer services to measure awareness of services, current service need, demand for services, and
utilization of services. The list of services developed by the previous research team was derived from
the Sacramento TGA’s HIV/AIDS Continuum of Care and includes the service categories funded by
Ryan White, and sub-categories of services that were reviewed by the HHSPC as representing services
that were funded, or of interest to, the HHSPC. At the end of each major service category, survey
participants had an opportunity to say what problems they have had, if any, in obtaining each service.
Following the measurement of service need, people living with HIV/AIDS ranked different Barriers
to Care. The barriers examined are based on prior needs assessments as conducted by the initial
research team using a multidimensional schema discussed in the Barriers to Care Section later in this
report.
The final section of the survey measured issues such as substance abuse and residency status.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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b. Incentives
Participants of the consumer survey received a $20 grocery food certificate.
c. Recruitment
Every effort was made to select participants randomly from a wide variety of venues. The Ryan
White funded agencies were directly contacted through personal visits and various memoranda
describing the Needs Assessment project and underscoring the important need for their assistance.
Sunburst Projects was targeted due to their work with women living with HIV; AIDS Housing Alliance
assisted by providing space to conduct survey sessions at Colonia San Martin, Strategies for Change,
and Kaiser Permanente in the South Sacramento area; and Cares Community Health (formerly called the
Center for AIDS Research, Education and Services (CARES), and Breaking Barriers provided space in
mid-town Sacramento. Cares Community Health also provided survey session space on several
occasions to provide access to PLWH who frequent their facility for a variety of services, including
dental care, mental health care, substance abuse services, medical services and other social services.
In addition to recruitment of participants from Sacramento County, survey sessions were conducted
in the rural counties of the Transitional Grant Area, including El Dorado and Placer Counties to assist in
identifying needs and gaps in services for those in outlying regions of the TGA. Although Yolo County
(a neighboring county to the TGA) is not part of the RW Part A TGA, it is a recipient of RW Part B
funds and many of the PLWH/A in Yolo County receive medical care at Cares Community Health in
downtown Sacramento. Survey participants included 22 PLWH/A (9% of survey respondents) who
reside in Yolo County.
d. Quality Control
Surveys with incentives are vulnerable to duplicate respondents who would like additional
incentives. To assure complete and high quality data, staff checked each questionnaire before providing
the incentive. There also was a quality check for consistency and skip patterns before providing the
incentive.
To address the issue of duplicative surveys new procedures were implemented by staff for this FY13
Needs Assessment. Staff maintained a list of unique confidential identifiers which were created for each
survey participant using a combination of personal information. The intent of the client unique identifier
procedure was to allow the early identification of duplicate surveys. However, the confidential
identifiers were not consistently used across all needs assessment survey sessions and locations, so some
duplicate entries, although minimal, did occur. These duplicate surveys were identified and removed
from the completed surveys prior to data entry and analysis. The procedures for duplicate entries will
continue to be improved in future needs assessments and client unique identifiers will be more
consistently used across all survey sessions and locations.
Another quality control issue involves the accuracy of the information provided by survey
respondents as well as each respondent’s interpretation of the survey questions. While every effort was
made to ensure that individuals completing the surveys fully understood the intent of the questions,
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 8
responses were ultimately based on each respondent’s individual understanding and interpretation of
each question.
Data for all survey respondents have been analyzed and are presented in the charts and graphs
throughout this narrative report. In addition, to provide as complete a data set as possible for readers of
this Needs Assessment, all data can be found in the appendices.
B-2. NEEDS ASSESSMENT SURVEY ANALYSIS
a. Data Entry, Data Analysis and Confidence Intervals
Data from each completed survey was entered by staff of the HIV Health Services Planning Council
using Microsoft Access. All open-ended questions and survey comments were compiled. In addition,
data was checked for consistency and skip patterns.
Survey data were analyzed by Lili Carbone Consulting Services (LCJCS) using Microsoft Access.
Data were analyzed to identify meaningful findings in distributions of demographics, services needed,
services requested, services received, gaps in care and barriers to accessing services (as described more
completely below under Consumer Survey Analysis).
The Needs Assessment respondents are a sample of patients within the target population of all
PLWH in the Sacramento Region; and the data analysis compares results both within the Needs
Assessment sample, as well as to the full target population. The application of a confidence interval is
required to help identify disparities that are significant when using a sample group of a larger
population, as was done with this survey. Depending on the confidence interval estimation method
used, a result in the survey findings using this sample of 232 respondents should be interpreted as plus
or minus 3.3% to 6.6%.
For example, 41 respondents, or 17.7% of those in the sample surveyed, reported homelessness
either currently or in the past two years. Applying the narrowest confidence interval to this sampled
proportion, means that the actual percentage of those experiencing homelessness could be between
14.4% and 21.0%. Using the widest confidence interval, the estimated actual result could be between
11.1% and 24.3%.
For the purposes of this report, a plus-or-minus 5% threshold was used when comparing results
between proportions. In other words, differences between compared percentages are considered
significant if adding 5% to the smaller proportion and subtracting 5% from the large proportion resulted
in figures that did not overlap. This means that disparities are considered meaningful when there are
differences between proportions of greater than 10%. For example, if 29% of those surveyed are age
20-44, and 43% of respondents who indicate a need for residential substance abuse treatment are age 2044, this would mean that clients aged 20-44 have a significantly greater need for these service than
would be expected based on their overall representation in the survey.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 9
b. Consumer Survey Analysis
It is important to note that the responses provided in the charts and graphs throughout this report
correspond to the answers that survey respondents gave to three distinct questions that do not correlate
directly with one another:
 Did you need this service in this past year? (Service Need - “Need”)
 Did you ask for this service in this past year? (Service Demand - “Ask”)
 Did you receive this service this past year? (Service Utilization - “Receive”)
The response to each question is independent of the other. Although the questions are related, they
are distinct and the reader cannot make any assumptions about the receipt of services based on reported
need for that service or reported request for that service. Gaps are analyzed accordingly (e.g.,
Need/Receive Gaps and Need/Ask Gaps) to gain a better understanding of exactly where the gaps exist
and to plan for how to most effectively reduce these gaps.
In addition, the survey data permits the analysis of needs, unmet needs, service gaps and barriers to
care by different demographic characteristics such as race, age, gender, mode of transmission and
residency. Demographics were cross tabulated to target certain high risk special populations such as
African American Women, Injection Drug Users, the homeless population, the recently incarcerated
population, Hispanic Men Who Have Sex with Men (MSM), and the mentally ill population. The
survey also included measures of quality of life and adherence to medication to provide additional
information about outcomes of the Continuum of Care service delivery system.
c. Prior HIV/AIDS Needs Assessments
Findings from the Sacramento Region FY13 HIV/AIDS Needs Assessment are best understood
when considered in the context of other Needs Assessments that have been conducted for the HIV/AIDS
population in the region, and targeted for specific subpopulations and specific service needs. Although a
thorough comparative analysis is not provided in this report, the following Needs Assessments were
reviewed and comparisons were made as noted throughout this report:
•
Prior Sacramento TGA HIV/AIDS Needs Assessment Reports conducted by the region’s Ryan
White CARE Program and HIV Health Services Planning Council (2003 – 2011);
•
2010 Sacramento TGA Housing Mini Needs Assessment Report (conducted by RW CARE
Program and HIV Health Services Planning Council);
•
2012 Sacramento TGA Out of Care Needs Assessment Report (conducted by RW CARE
Program and HIV Health Services Planning Council);
•
2013 (Interim) Needs Assessment for HIV-positive Infants, Children and Youth in the
Sacramento Regional TGA (by Sunburst Projects, Sacramento).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 10
SECTION C: DEMOGRAPHICS
C-1. DEMOGRAPHICS: TGA, RW CLIENTS, NEEDS ASSESSMENT RESPONDENTS
a. Overall Demographics and Geography of TGA
The Sacramento Transitional Grant Area (TGA) is a large three-county area of 4,287 square miles,
with a geography that includes the primarily urban and suburban County of Sacramento, and the
primarily rural counties of El Dorado and Placer Counties. Based on the most recent 2012 US Census
Bureau Data, the TGA has a population of 1,992,364, and the HIV/AIDS epidemic affects all Counties
in the TGA. As of 12/31/12, Sacramento County accounted for 92% of people living with HIV and /or
AIDS (PLWH/A) in the TGA, while the rural counties of El Dorado and Placer Counties accounted for
8.0%.
In conducting this Needs Assessment, it was important to the HIV Health Services Planning Council
that PLWH/A from all areas of the TGA be represented in the survey process. Outreach efforts were
successful in ensuring that survey respondents included a representative sample of PLWH from all three
counties of the TGA, as follows: Sacramento County (77%), Placer County (6.5%) and El Dorado
County (6.0%). In addition, 9.5% of survey respondents were from Yolo County, a neighboring county
to the TGA. Although Yolo County is not part of the RW Part A TGA, it is a recipient of RW Part B
funds and many of the PLWH/A in Yolo County receive medical care at Cares Community Health in
downtown Sacramento. Therefore, inclusion of PLWH from Yolo County was important to the needs
assessment process.
b. Demographics of TGA, HIV/AIDS, RW Clients and Needs Assessment Respondents
Similar to geographic representation, it is important that Needs Assessment survey respondents be
representative of the demographics of the TGA’s HIV/AIDS epidemiology in terms of Race, Age,
Gender and Mode of HIV/AIDS Transmission. For comparative purposes, it is important to know the
demographics of the TGA’s general population to analyze which populations are over or under
represented in the TGA’s HIV/AIDS epidemic. As reported in the Fiscal Year 2014 Sacramento TGA
Ryan White Grant Application dated October 2013, the 2012 US Census Bureau data in the following
chart (Table 1) report demographic distributions within the TGA.
In comparison, data from California’s Statewide HIV/AIDS surveillance system, the Electronic
HIV/AIDS Reporting System (E-HARS), shows the demographic profile of the HIV/AIDS population in
the TGA as of 12/31/12. The Fiscal Year 2014 RW Grant Application documents 3,788 reported cases
of Persons Living with HIV/AIDS (PLWH/A) in the TGA as of 12/31/12.
Further, it is important to look at the demographics of the Ryan White Client population in
comparison to the TGA’s general population, HIV/AIDS Epidemiology and Needs Assessment Survey
respondents. During FY 2012, according to the Sacramento Eligible Metropolitan Area System
(SEMAS) database, 2,417 clients with HIV/AIDS were provided services through the Sacramento
TGA’s Ryan White (RW) Program.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 11
Table 1: HIV/AIDS DEMOGRAPHICS
TGA, RW CLIENTS, NEEDS ASSESSMENT RESPONDENTS
TGA*
General
Population
Race
Gender
Age
Population
African American
White
Asian/Pacific
Islander
Latino
Other
Male
Female
<19)
20-44
Needs
Assessment
Respondents
2013 ***
PLWA**
as of
12/31/12
PLWH**
as of
12/31/12
PLWH/A**
as of
12/31/12
RW
Clients
FY 2013
1,992,364
7.1%
61.4%
2,186
22.5%
58.0%
1,602
22.7%
55.8%
3,788
22.6%
57.1%
2,417
25.7%
50.1%
232
25.4%
45.7%
11.7%
14.1%
5.7%
49%
51%
30.2%
33.6%
3.1%
14.7%
1.7%
83.9%
16.1%
1.5%
71.6%
3.8%
15.7%
2.0%
83.0%
17.0%
4.3%
74.3%
3.4%
15.1%
1.8%
83.5%
16.5%
2.5%
72.9%
2.8%
18.9%
2.5%
79.2%
19.9%
1.5%
40.5%
1.3%
17.2%
10.6%
68.5%
28.4%
0.9%
28.9%
45+
36.1%
26.9%
21.3%
24.5%
58.0%
69.0%
Mode of
Transmission MSM
NA
54.4%
56.7%
55.0%
50.8%
46.6%
MSM/IDU
NA
10.1%
7.7%
9.0%
5.1%
1.7%
IDU
NA
11.4%
8.5%
10.1%
12.3%
10.3%
Heterosexual
NA
19.9%
20.3%
20%
22.8%
25.9%
Other /
Undetermined
NA
4.2%
6.8%
5.9%
9.0%
15.5%
*2012 US Census Data for the TGA: Sacramento, El Dorado and Placer Counties
**HIV / AIDS Prevalence: Persons Living with AIDS (PLWA), with HIV (PLWH); with HIV or AIDS (PLWH/A) in the TGA
*** Includes data for the three TGA Counties plus data for Yolo County PLWH/A who completed FY13 Needs Assessment survey
Table 1 above provides a basic demographic profile of the 232 PLWH living in the Sacramento
Region who completed the Needs Assessment Survey. Overall, the Needs Assessment Survey
Respondents are generally representative of the Ryan White CARE Program caseload in FY12. The data
do provide insight, however, as to what degree populations are over or underrepresented in the TGA’s
HIV/AIDS epidemic as compared to the TGA’s general population, in the RW Program and / or among
the Needs Assessment survey respondents. The following section provides an in-depth analysis, by the
demographic categories of race, gender, age and mode of transmission, for the TGA general population
as compared to the TGA’s HIVAIDS Epidemiology, the Ryan White (RW) client population, and the
Needs Assessment survey respondents.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 12
c. Comparative Analysis by Race, Age, Gender and HIV/AIDS Transmission
Figure 1: RACE (TGA, Epidemiology, RW, Needs Assessment)
70.00%
60.00%
50.00%
TGA
40.00%
PLWH/A
30.00%
RW Clients
20.00%
Needs Assessment
10.00%
0.00%
African
American
White
Latino
Other
African Americans. There is a disproportionate impact of HIV/AIDS among African Americans in
the TGA and among RW clients. Although African Americans make up only 7.1% of the TGA’s
general population, they were 22.6% of HIV/AIDS Prevalence, 19.0% of new RW clients and 25.7% of
the overall RW caseload in FY12. African Americans represented 28.3% of new AIDS Cases in 2010,
2011 and 2012 combined (up from 26.1% of new AIDS cases in 09-11). African Americans were
closely represented in the Needs Assessment survey when compared to their representation among RW
clients (25.4% vs. 25.7%).
Latinos. As can be seen in Figure 1 above, Latinos are slightly overrepresented among RW clients
(18.9%) as compared to the TGA general population (14.1%) and PLWH/A (15.1%), while well
represented among Needs Assessment survey respondents (17.2%).
Whites. Whites are underrepresented among Needs Assessment survey respondents (45.7%) as
compared to their representation among PLWH/A in the TGA (57.1%) and RW clients (50.1%).
Other Race. This category includes Asian/Pacific Islander, American Indian, Alaska Native, MultiRace or Not Specified. The “Other Race” category is well represented among Needs Assessment
Survey respondents (11.9%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 13
Comparative Analysis by Gender
Figure 2: GENDER (TGA, Epidemiology, RW, Needs Assessment)
90%
80%
70%
60%
TGA
50%
PLWH/A
40%
RW Clients
30%
Needs Assessment
20%
10%
0%
Male
Female
Females. Regarding gender, females are overrepresented in Needs Assessment Survey respondents
(28.4%) as compared to their representation among RW clients (19.9%) and PLWH/A (16.5%).
However, females are underrepresented among PLWH/A as compared to the TGA’s general population
(16.5% vs. 51.0%).
Males. The male population is overrepresented among PLWH/A as compared to their representation
in the TGA’s general population (83.5% vs. 49%); however, males are underrepresented in the Needs
Assessment survey respondents as compared to their representation among RW clients (68.5% vs.
79.2%). Among Latinos, males were disproportionately represented in the Needs Assessment: there
were 5 times as many Latino males than females.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 14
Comparative Analysis by Age
Figure 3: AGE (TGA, Epidemiology, RW, Needs Assessment)
80.00%
70.00%
60.00%
50.00%
TGA
PLWH/A
40.00%
RW Clients
30.00%
Needs Assessment
20.00%
10.00%
0.00%
<20
21-44
45+
Ages 19 years and younger. Children and youth are underrepresented in the TGA’s HIV/AIDS
epidemic, RW caseload and among current Needs Assessment survey respondents. However, among
teens (ages 13-19) there have been increases in the TGA’s HIV/AIDS epidemiology and among the RW
client population overtime. RW caseload for teens doubled between FY03 and FY04. It should be
noted that this was largely due to the aging of the children in the TGA’s HIV infected population, rather
than any significant new reported cases of HIV/AIDS. In FY12, total caseload for teens dropped, but
remains significantly higher than at the inception of the TGA’s RW Program in 1997.
Ages 20-44. This age group is significantly overrepresented among PLWH/A (72.9%) as compared
to their representation among the TGA’s general population (33.6%). However, people ages 21-44 are
underrepresented among the RW caseload (40.5%) as compared to their PLWH/A representation
(72.9%) and their representation among Needs Assessment respondents (28.9%).
Ages 45+. People ages 45+ are overrepresented among RW clients (58.0%) and Needs Assessment
respondents (69.0%) as compared to their representation among PLWH/A (24.5%) and the general
population of the TGA (36.1%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 15
Comparative Analysis by Mode of HIV/AIDS Transmission
Figure 4: MODE OF TRANSMISSION (TGA, Epidemiology, RW, Needs Assessment)
60.00%
50.00%
40.00%
30.00%
20.00%
PLWH/A
10.00%
RW Clients
0.00%
Needs Assessment
Men who Have Sex with Men (MSM). The MSM exposure category made up 55.0% of HIV/AIDS
Prevalence (2,083 cases) as of 12/31/12. MSMs are fairly well represented among RW clients (50.8%)
and Needs Assessment survey respondents (46.6%)
Men who Have Sex with Men and Inject Drugs (MSM/IDU). MSM/IDUs are underrepresented
among Needs Assessment respondents (1.7%) as compared to their representation among PLWH/A
(9.0%) and RW clients (5.1%).
Intravenous Drug Users (IDU). The IDU exposure category is closely represented among
PLWH/A (10.1%) RW clients (12.3%) and Needs Assessment survey respondents (10.3%)
Heterosexuals. This exposure category is closely represented among PLWH/A (20%) RW clients
(22.8%) and Needs Assessment survey respondents (25.9%)
d. HIV-Related Co-morbidities, Special Populations and Complicating Factors
Table 2 below provides data on a range of issues and comorbidities that add to the complexity of
care for PLWH/A across the TGA. Complicating factors such as homelessness, incarceration, STIs,
other HIV-related comorbidities, poverty, insurance status, and income level are compared below for the
TGA’s general population, Ryan White Clients, and Needs Assessment clients. In addition, Attachment
3 in the Appendix provides tables that provide a detailed analysis of the demographic “crosstabs” of
Needs Assessment respondents and of Ryan White clients (for example, gender by transmission or race
by age).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 16
Table 2: Co-Morbidities for TGA, RW Clients and Needs Assessment Respondents
Co-Morbidities, Poverty, Insurance Status, Housing Status, Incarceration Status
Condition
African American Women
TGA
General
Population
Ryan White
FY12
Needs
Assessment
2013
5.2%
9.1%
10.8%
Homeless / Unstable
Housing (Current)
0.1%
6.4%
10.8%
Recently Incarcerated
0.6%
2.6%
9.5%
TB (Active Treatment
Cases)
0.004%
0.1%
n/a
HCV All Cases
1.1%
20.5%
15.1%
HCV New Cases
0.01%
1.0%
n/a
Syphilis (New cases)
Gonorrhea (New Cases)
Chlamydia (New Cases)
0.01%
0.1%
0.5%
4.3%
2.1%
1.3%
4.7%
4.7%
4.3%
Uninsured
20.9%
21.8%
14.2%
Under 100% of Poverty
14.4%
57.1%
68.5%
Under 300% of Poverty
30.1%
82.2%
95.3%
Rural Counties in TGA
27.2%
8.2%
12.5%
Notes
TGA based on 2010
Census, Sac. Co. only
TGA based on 2011 El
Dorado County DHS; 2009
Placer County Consortium
on Homelessness; 2011
Sacramento County DHA
2010 US Census, 2010
California Department of
Corrections; NA based on
incarceration 2 years vs.12
month TGA and RW
TGA based on 2010
California DPH
TGA based on 2011 CDC
Prevention (National Rate)
TGA based on 2011 CDC
Prevention (National Rate)
TGA based on 2012 CDPH
TGA based on 2012 CDPH
TGA based on 2012 CDPH
TGA based on Center for
Health Policy Research,
2011
TGA based on 2010 US
Census
TGA based on 2010 US
Census
Based on 2010 Census (for
El Dorado and Placer)
In addition to the Co-Morbidities Table above, Attachment 3 in the Appendix provides an extensive
set of tables that shows a detailed analysis of the demographic “crosstabs” of Needs Assessment
respondents and of Ryan White clients (for example, gender by transmission, race by transmission, race
by age, transmission by age, etc.) These crosstab analyses show that HIV/AIDS has a disproportionate
impact on several “Special Populations” in the TGA. The following provides a description of several
co-morbidities, special populations and complicating factors within the HIV/AIDS population:
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 17
African American Women
HIV/AIDS has a disproportionately high impact on African American women across the TGA. In
FY12, 45.9% of the female RW clients were African American, vs. 20.5% of the male clients. Notably,
the 45.9% of females who were African American was much higher than the 25.7% of the total RW
population who were African American and the 7.1% of the TGA’s population who were African
American. Once again in the Needs Assessment population, women were overrepresented among the
African American population: 37.9% of females were African American, whereas 20.8% of males were
African American.
Homeless Population
PLWH/A in the FY13 Needs Assessment survey were asked about their current living arrangements:
18%, or 41 of 282 survey respondents, reported that they were currently homeless or had been homeless
(living on the street, in a car or in a shelter) at some point in the past two years. Trying to adhere to a
complex medical regimen is difficult at best, but even more complicated by the lack of stable housing.
Living in shelters, cars and being homeless with inconsistent access to food and proper nutrition
compounds the difficulty in adhering to medications and remaining in medical care.
Among RW clients in FY12, 6.4% reported themselves as either homeless (3.6%) or in unstable
housing (2.8%), as compared to a 2013 homelessness rate of .14% of the general population in the
Sacramento TGA. African Americans are significantly overrepresented among RW clients who were
homeless or in unstable housing: African Americans made up 34.4% of the homeless RW clients vs.
25.7% of the overall RW population in FY12.
Formerly Incarcerated Population
FY12 RW client level data show that 63 RW clients (2.6% of caseload) had been released from
Federal, State or local jails within the previous 12 months, as compared to the TGA’s recently released
incarceration rate of 0.7%. 22 of the FY13 Needs Assessment respondents (or nearly 10%) reported that
they had been incarcerated at some point within the past two years.
Sexually Transmitted Infections (STIs) and HIV Related Co-Morbidities
The co-morbidity of STIs is a big issue for the TGA and the RW program, especially when
considering that 89.3% of the FY12 RW caseload that reported a known HIV/AIDS exposure category
reported becoming infected with HIV through sexual contact. STIs noted in the FY13 Needs
Assessment were as follows:
Gonorrhea. In FY12, the Gonorrhea incidence rate among RW clients was over 22 times the
incidence rate of the TGA’s general population (2.1% vs. 0.095%) and Sacramento County had the third
highest ranking of Gonorrhea (out of 58 Counties) in California. An alarming 5% of the FY13 Needs
Assessment respondents reported having been diagnosed with Gonorrhea in the past year.
Chlamydia. In 2012, Sacramento County had the fourth highest ranking for Chlamydia (out of 58
counties in California), with a rate of 580/100,000 compared to the State rate of 449/100,000. Among
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 18
RW clients, the number of new cases of Chlamydia increased by 33.3% between FY11 and FY12 (from
24 to 32 cases). Among FY13 Needs Assessment respondents, 4% reported being diagnosed with
Chlamydia in the past year.
Syphilis. In 2012, Sacramento County had the fifth highest ranking in the State of California for
Syphilis (out of 58 counties). The number of new cases among RW clients in FY12 was 29.8% higher
than the number of new Syphilis cases among RW clients in FY10. Among FY13 Needs Assessment
respondents, 5% reported being diagnosed with Syphilis in the past year.
In addition to the STIs noted above, 36% of Needs Assessment respondents reported other STI
diagnoses in the past year, the most common of which were Hepatitis C (15%) and yeast infections
(9%).
Insurance Coverage
14% of FY13 Needs Assessment respondents reported that they did not have health insurance; 71%
of respondents had Medicare, Medi-Cal or both; and 15% (the remainder) had private insurance.
Income
Ryan White funded services are “payer of last resort.” In order to receive Ryan White benefits, the
client must have no other means of paying for and obtaining needed services. In FY12, 57.1% of RW
clients were at 100% of poverty. Follows are results from the Needs Assessment survey, demonstrating
the high rate of poverty among PLWH/A in the TGA, especially when compared to the TGA as a whole
(11.1% were at 100% of poverty in 2012):
• 68.5% of respondents reported annual incomes at 100% of poverty ($0 - $11,600)
• 26.6% reported annual incomes from 101% to 300% of poverty ($11,601-$35,000)
• 3.9% reported annual incomes over 300% of poverty (over $35,000)
Supplementary Income
Income supplements addressed in the Needs Assessment Survey include Supplemental Security
Income (SSI), Temporary Assistance to Needy Families (TANF), rental assistance, subsidized housing,
food stamps, and long-term and short-term disability payments. SSI and TANF are based on family
income and SSI also requires a status of disability. Those on SSI usually qualify for MediCal/Medicaid. Follows are the most frequently reported supplementary income sources reported by
Needs Assessment respondents:
• 37% are on SSI
• 34% are on SSDI
• 25% receive food stamps
• 24% are on long term disability (the survey tool provided the option for long term disability
as well as SSDI).
• 21% receive subsidized housing
• 6% reported that they were not eligible for any benefits
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 19
Due to reductions in Federal Funding over the last decade, Emergency Financial Assistance paid for
by Ryan White does not currently cover rental assistance, utilities assistance, or food, but does provide
assistance with medication reimbursements in Sacramento County. In the rural counties, Emergency
Financial Assistance may be used for these needs when there are minimal or no other sources of support
from community resources. All emergency financial assistance must be accessed through a RW
Medical Case Manager to verify need, income and payer of last resort documentation.
Employment Status
Only 16% of Needs Assessment survey respondents reported themselves as being employed, more
than half of whom work only part-time.
Educational Level
Nearly 20% of Needs Assessment respondents reported not having a high school diploma or General
Equivalent Development (GED) and 11% of survey respondents completed a 4-year college or graduate
school.
Substance Users
The co-morbidity of substance use and HIV includes drugs that are injected and non-injected
substances. Follows are several highlights regarding the percentage of PLWH/A in the Needs
Assessment regarding substance use issues:
• 81% of NA survey respondents reported past use of illegally obtained drugs (excluding
marijuana, because the FY13 Needs Assessment survey tool did not distinguish between
medically prescribed marijuana, which is legal in California, and illegally obtained
marijuana);
• 27% reported using such substances in the past 6 months;
• Methamphetamines (15%) were the most commonly used of such substances in the past 6
months;
• 41% reported using marijuana in the past 6 months (whether medically prescribed or illegally
obtained);
• 32% of survey respondents reported injecting prescribed substances in the past;
• 89% reported past use of alcohol; and
• 41% reported using alcohol in past six months.
Mental Illness
Mental health issues were reported in alarmingly high percentages among FY13 Needs Assessment
respondents, as follows:
• 78% of respondents reported receiving mental health services since they were diagnosed with
HIV/AIDS;
• 15% reported use of inpatient mental health services since they were diagnosed with
HIV/AIDs; and
• 70% reported being diagnosed with anxiety, bipolar disorder, dementia, depression or other
mental health conditions in the past two years.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 20
Out-of Care Population
For detailed information on the Out of Care population see the FY 2012 Out of Care Needs
Assessment Report prepared for the Sacramento TGA HIV Health Services Planning Council. Follows
are Out-of-Care findings for this FY13 Needs Assessment Report, which show that a large percentage of
PLWH/A in the Sacramento Region currently are, or have been, out of ongoing medical care:
•
31% of FY13 Needs Assessment survey respondents reported that they had experienced a
gap of more than six months without seeing a doctor or going to a clinic; and
•
21% of respondents reported not going to a doctor or clinic for more than a year at some
point since being diagnosed with HIV/AIDS.
e. Rural PLWH/A in TGA and Sacramento Region
As can be seen in Table 2, Co-Morbidities and Complicating Factors, the rural counties of the RW
Part A TGA (El Dorado and Placer Counties) account for 27.2.% of the TGA’s general population,
while Sacramento County accounts for the remaining 72.8%. Regarding PLWH/A in the TGA, 92%
reside in Sacramento County and 8% reside in the rural counties of the TGA. Rural PLWH/A are well
represented in the RW client population at 12.5% (vs. 8.2% of PLWH/A in TGA). In terms of Needs
Assessment respondents, 6.5% were from Placer County and 6.0% from El Dorado County.
In addition, 9.5% of survey respondents were from Yolo County, a neighboring rural county to the
TGA. Although Yolo County is not part of the RW Part A TGA, it receives RW Part B funds and many
PLWH/A receive medical care in Sacramento. Therefore, inclusion of Yolo County was important to
the needs assessment process.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 21
SECTION D: SERVICE NEEDS, GAPS AND BARREIRS TO CARE
D-1. CORE SERVICES NEEDS AND NEED/RECEIVE GAPS
a. Overview of Survey Questions
In efforts to get the most comprehensive understanding possible of the service needs and service
gaps of Needs Assessment survey respondents, three very distinct questions were asked across all
service categories (both core and support services), as follows:
 Did you need this service in this past year? (Service Need - “Need”)
 Did you ask for this service in this past year? (Service Request - “Ask”)
 Did you receive this service this past year? (Service Utilization - “Receive”)
The response to each question is independent of the other. Although the questions are related, they
are distinct from one another and no assumptions can be made about the receipt of services based on
reported need for that service, or based on the reported request (“ask”) for that service. Gaps are
analyzed accordingly, as described in the sections that follow under “Need/Receive Gap” and
“Need/Ask Gap.”
As is clear throughout the analysis that follows, perceived need, reported demand (asking for a
service), and reported utilization (receiving a service) follow a similar, but not identical pattern. With
most services, perceived need is higher than either the reported demand or utilization for each service.
Understanding the various gaps (need/ask and need/receive), as well as the overall reported need for a
service, is important in gaining a better understanding of exactly where the gaps exist and planning how
to most effectively reduce these gaps.
In addition, the survey data permits the analysis of needs, unmet needs, service gaps and barriers to
care by different demographic characteristics such as race, age, gender, mode of transmission and
residency. Demographics were cross tabulated to target certain high risk special populations such as
African American Women, Injection Drug Users, the homeless population, the recently incarcerated
population, Hispanic Men Who Have Sex with Men (MSM), and the mentally ill population. The
survey included measures of quality of life and adherence to medication to provide additional
information about outcomes of the Continuum of Care service delivery system.
b. Core Service Needs and Need/Receive Gaps Overall
The most important aspect in understanding how to best serve the respondents of the HIV/AIDS
Needs Assessment survey is to first find out what services they report to be most needed: Service Need.
It is equally important to find out if they were they able to receive those needed services (to determine if
there was a Need/Receive Gap). The Needs Assessment asked about Core Services (such as Outpatient
Medical Care, Oral Health Care, Medical Case Management) which are analyzed first in the tables and
then in the narrative that follows. In Section C, following Core Services, the Service Needs and
Need/Receive Gaps for Support Services are presented and analyzed (such as Child Care, Medical
Transportation, Social Service Case Management, etc.).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 22
Table 3 below shows the number and percentage of survey respondents that reported a Service Need
and Need/Receive Gap for each RW Core Service, as presented by service category and as forced
ranked by the Service Need percentage by service subcategory. In addition, the number and percentage
of survey respondents who reported Service Need, but did not receive that service (they have a
Need/Receive Gap for that service category or subcategory) are presented.
This table is presented in ranked order by Service Need by Subcategory. For example, Mental
Health Service as a category has five Subcategories (One-on-One Counseling, Group Counseling
Licensed Professional, Group Counseling non-Licensed Professional, Family Counseling and
Bereavement Counseling), each with has its own % Need and % Gap as follows:
Table 3: Core Service Needs and Need/Receive Gaps by Service Subcategory
CORE SERVICE NEEDS AND NEED/RECEIVE GAPS
BY SERVICE SUBCATEGORY
Core Service
Category
Subcategory
Doctor Prescribed Medications
Drug Reimbursement Assistance
Health Insurance Assistance
Medical Homecare Visit
Home Health Care
Specialized Home Healthcare Visit
Medical Case Management Session
Medical Case
Management
Treatment Adherence Services
Medical Nutrition Therapy
One-on-One Counseling
Group Counseling with Licensed
Professional
Mental Health
Group Counseling with NonServices
Licensed Professional
Family Counseling
Bereavement Counseling
Oral Health Care
HIV Medical Visit
Outpatient Medical
Non HIV Medical Visit
Care
Medical Specialist Visit
Outpatient Substance Abuse
Outpatient Treatment or Counseling
Substance Abuse Group Counseling
Substance Abuse
Substance Abuse one-on-one
Outpatient Care
psychological or psychiatric
counseling
Substance Abuse Peer Counseling
Medications
Sacramento Region FY13 HIV/AIDS Needs Assessment
# Need
%
Need
# Need /
Receive
Gap
% Need /
Receive
Gap
206
91
90
40
13
158
92
115
142
89%
39%
39%
17%
6%
68%
40%
50%
61%
7
24
20
8
5
18
18
20
16
3%
26%
22%
20%
38%
11%
20%
17%
11%
105
45%
21
20%
100
43%
17
17%
44
39
179
201
172
162
19%
17%
77%
87%
74%
70%
19
9
46
9
10
15
43%
23%
26%
4%
6%
9%
62
27%
8
13%
61
26%
9
15%
55
24%
9
16%
51
22%
12
24%
Page 23
To provide a ranking by highest overall Need by Service Category, rather than by Service
Subcategory as shown in Table 3 above, each subcategory was collapsed into their respective Service
Category (for example Mental Health Services has one overall Service Category Need (70%), rather
than 5 Subcategory Needs). These findings by Service Category are shown below in Table 4.
Table 4: Core Service Categories Ranked by Level of Need
CORE SERVICES CATEGORIES
RANKED BY LEVEL OF NEED
Rank
1
2
3
4
5
6
7
8
9
#
Need
220
211
179
169
162
115
90
80
43
Core Service Category Needs
Outpatient Medical Care
Medications
Oral Health Care
Medical Case Management
Mental Health Services
Medical Nutrition Therapy
Health Insurance Assistance
Substance Abuse Outpatient Care
Home Health Care
%
Need
95%
91%
77%
73%
70%
50%
39%
34%
19%
As important as it is to analyze Service Need, it is equally important to analyze the gap between
services needed and services received (Need/Receive Gap). Again, the following are analyzed by
Services Category, by collapsing all service subcategories into their respective Service Category. In
addition, in Table 5 below, the Service Categories are ranked by level of Need/Receive Gap:
Table 5: Core Service Categories Ranked by Level of Need/Receive Gap
CORE SERVICES CATEGORIES
RANKED BY LEVEL OF NEED/RECEIVE GAP
Rank
1
2
3
4
5
6
7
8
9
Core Service Category Need/Receive Gap
Mental Health Services
Oral Health Care
Health Insurance Assistance
Substance Abuse Outpatient Care
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Outpatient Medical Care
# Need
162
179
90
80
43
169
115
211
220
#
Did Not
Receive
43
46
20
15
8
31
20
25
26
% Need/
Receive
Gap
27%
26%
22%
19%
19%
18%
17%
12%
12%
There are services for which the Service Need is ranked significantly higher than the Need/Receive
Gap, meaning that although services are highly needed, those services are being received and the service
demand is mostly being met for the majority of clients with a need for that service. By comparing Tables
4 and 5 above, it is clear that the Service Need ranking for several services is higher than Need/Receive
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 24
Gap rank for that service. What follows is a list of core services in which the Service Need is ranked
higher than the Need/Receive Gap.
Core Services Need Rank Greater Than Need/Receive Gap Rank
As can be noted by comparing Tables 4 and 5 above, there are several Service Categories in which
the Service Need is ranked higher than the Need/Receive Gap. What this means is that, although this
service is highly needed among respondents, most of those in need are able to receive the service, and
there is a relatively low Need/Receive Gap. Examples of these include:
•
•
•
Outpatient Medical Care Ranked #1 in Service Need, but #9 in Need/Receive Gap
Prescription Medications Ranked #2 in Service Need, but #8 in Need/Receive Gap
Medical Case Management Ranked #4 in Service Need, But #6 in Need/Receive Gap
Core Services Need/Receive Gap Rank Greater than Need Rank
On the other side of the spectrum, there are services for which the Need/Receive Gap is greater than
the Service Need, meaning that although the service is not ranked as one of the highest needed service, a
high proportion of clients that do need that service are not receiving the service. Examples of these
include:
•
•
•
•
Mental Health Services ranked #1 for Need/Receive Gap, but #4 for Service Need
Health Insurance Assistance ranked #3 for Need/Receive Gap, but #7 for Need
Substance Abuse Outpatient Care ranked #4 for Need/Receive Gap, but #8 Need
Home Health Care ranked #5 Need/Receive Gap, but #9 Need
These disparities in Service Needs as compared to Need/Receive Gaps are discussed further in the
section that follows under each Service Category.
c. Core Service Needs, Gaps and Demographics by Service Category
Follows is a look at each of the Top 5 Core Service Categories, listed in order of those services with
the highest needs to those with the lowest needs. The Need/Receive Gap, showing the percentage of
clients that needed each service who reported that they were not able to receive that service, also is
provided. In addition, Service Needs and Need/Receive Gaps are analyzed by Demographic categories,
such as age, race, gender, mode of transmission, and other characteristics, to highlight subpopulations
that have higher or lower needs and/or gaps in each service category. As applicable, various
subcategories within each core service are analyzed.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 25
Outpatient Medical Care (#1 Ranked Core Service Need)
Need
Outpatient Medical Care
Needs and Need/Receive Gaps by Demographics
N/R Gap
120%
100%
80%
60%
40%
20%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need. The core service category that had the highest reported Need among Needs
Assessment survey respondents was Outpatient Medical Care. 95% of survey respondents reported a
need for at least one of the subcategories of Outpatient Medical Care. An analysis by each subcategory
of Outpatient Medical Care shows the following: 87% of survey respondents reported a need for nonHIV medical visits; 74% for HIV medical visits; and 70% for medical specialty visits.
Need/Receive Gap. Thankfully, the high number of survey respondents who reported a Service
Need for Outpatient Medical Care (95%) reported that they are able to receive those services and the
Service Need/Receive Gap was at 12%. This comparison shows that, overall, the service need for
Outpatient Medical Care is being met for those in need, most of the time. However, because Outpatient
Medical is the primary mandate of the Ryan White CARE Program, it is important to examine further
which subpopulations of PLWH/A are in the 12% with a Need/Receive Gap, and what Barriers to Care
they are confronting.
Demographic Disparities. Analysis of Service Needs and Need/Receive Gaps by demographic
categories (race, age, gender, mode of transmission) did not show any disparities for Outpatient Medical
Care for any demographic category, with the exception of African American women, who were greatly
overrepresented with regard to Need/Receive Gap. While 12% of respondents overall reported a
Need/Receive gap for Outpatient Medical Care, the service gap for African American women was 29%.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 26
Additional Findings. The Needs Assessment survey asked “Where do you receive your medical
care most often?” Of the 232 survey respondents, all but 2 (1%) noted a place where they receive their
care most often. Survey respondents could indicate more than one type of facility, so the categories are
not mutually exclusive and 21% of respondents indicated receiving services in several places (with some
respondents receiving services in as many of four different types of facilities), as follows: 77% of
respondents stated they often receive their care at a community or neighborhood clinic, such as Cares
Community Health or a County Clinic; 32% of respondents indicated that they most often receive care
in the hospital or in an emergency room; 7% at Private Doctors Office; 5% at Alternative treatment
facilities (such as holistic health center); 3% at “Other” (such as Urgent Care Center and Tribal Health
Clinic); 1% at Veteran’s Administration Medical Center.
In terms of frequency of receiving Outpatient Medical Care, the Needs Assessment survey asked
“When did you first see a doctor after receiving HIV+ diagnosis?” 68% of survey respondents reported
seeing a doctor within a month of being diagnosed. 15% reported seeing a doctor within 1-3 months of
initial diagnosis; 3% within 4-6 months; and 4% between 7 months and a year. 9% reported that they
did not see a doctor until over a year after their initial diagnosis. All but one survey respondent reported
having seen a doctor since being diagnosed with HIV.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 27
Prescription Medication Assistance (#2 Ranked Core Service Need)
Need
Medications
Needs and Need/Receive Gaps by Demographics
N/R Gap
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need. The core service category with the second highest reported need among survey
respondents was Prescription Medications at 91%, with the subcategories “Doctor Prescribed
Medications” and “Drug Reimbursement” reporting Services Needs of 89% and 39%, respectively.
Need/Receive Gap. Thankfully, although 91% of survey respondents overall reported a need for
Prescription Medication Services, 12% reported that they had a Need/Receive Gap, and were not able to
receive the prescription services they needed.
Demographic Disparities. An analysis of service needs and service gaps by demographic categories
(race, age, gender, mode of transmission) showed no demographic disparities between subpopulations,
meaning there was less than a 10% disparity between the proportion of respondents within each
demographic group and the respondents overall in terms of service needs or service need/receive gaps
for prescription medications.
Other Findings. Regarding Medication Adherence, 44% of Needs Assessment respondents reported
having never skipped taking their medications. 51% reported not having taken their medications at least
one or twice a month. In terms of reasons why respondents skipped taking their medications at least one
or twice a month, 70% reported that it was because they forgot and 23% reported that it was due to side
effects of the medication.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 28
Oral Health Care (#3 Ranked Core Service Need)
Need
Oral Health Care
Needs and Need/Receive Gaps by Demographics
N/R Gap
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need. The core service category with the third highest reported need among survey
respondents was Oral Health Care at 77%.
Need/Receive Gap. Unlike Outpatient Medical Care and Prescription Medications, which are both
ranked high among Core Service Needs, but ranked low among Need/Receive Gaps, Oral Health ranks
high in both Service Need (#3) and Service Need/Receive Gap (#2). Given these findings, it is clear that
efforts need to be addressed to understand why the high service need for Oral Health Care is not being
well met in the TGA. 77% of Needs Assessment survey respondents reported a Need for Oral Health
Care, and 26% of those with a service need reported that they were not able to receive Oral Health Care
Services (26% Need/Receive Gap).
Demographic Disparities. Among demographic groups reporting Need/Receive Gaps, African
American Women (38%) and people ages 20-44 (37%) were overrepresented when compared to
respondents overall (26%), and the following were underrepresented: females (12%) and IDUs (11%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 29
Medical Case Management (#4 Ranked Core Service Need)
Need
Medical Case Management
Needs and Need/Receive Gaps by Demographics
N/R Gap
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. Medical Case Management was ranked #4 Service Need at
73%, with 18% of those reporting a Need stating that they were unable to receive the service and had a
Need/Receive Gap
Demographic Disparities. For Service Needs, all demographic groups were proportionally
represented with the following exceptions: Injection Drug Users were slightly overrepresented at 83%
of those with a Need for Medical Case Management vs. 73% of respondents overall. For Service
Need/Receive Gaps, however, there were demographic disparities within all demographic categories
(race, age, gender and transmission) as follows:
•
Latinos were over-represented among those with a Need Receive Gap in Medical Case Management:
41% of Latinos who needed the service reported a Need/Receive Gap vs. 18% of respondents
overall.
•
Females are underrepresented among those with a Need Receive Gap (at 8% vs. 21% for males).
•
Persons aged 20-44 are overrepresented among those with Need/Receive Gap (33% vs. 13% for
those ages 45+).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 30
Mental Health Care (#5 Ranked Core Service Need)
Need
Mental Health Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 70% of survey respondents reported a Service Need for Mental
Health Care. 27% of those who reported a Service Need for Mental Health Services also reported a
Need /Receive Gap.
Demographic Disparities. The Homeless population was the only demographic group that was
overrepresented among respondents with a Service Need for Mental Health Care: 88% reported a need
for Mental Health Care vs. 70% of respondents overall. The rural population reported a lower Service
Need for Mental Health Care (53%) than respondents overall (70%). Regarding Need/Receive Gaps,
African American women reported a higher gap (44%) than respondents overall (27%). In terms of
other Need/Receive Gap disparities, African Americans were overrepresented: 38% reported
Need/Receive Gap vs. 27% overall.
Other Findings. Analyzed by Mental Health Subcategories, it is clear that although one-on-one
counseling is the highest need (68%), it has the lowest need/receive gap (11%). The opposite is true for
Family Counseling, which has one of the lowest needs (19%), it has the highest need/receive gap (43%).
Mental Health Service as a category includes five Subcategories: One-on-One Counseling, Group
Counseling Licensed Professional, Group Counseling non-Licensed Professional, Family Counseling
and Bereavement Counseling.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 31
Medical Nutrition Therapy (#6 Ranked Core Service Need)
Need
Medical Nutrition Therapy
Needs and Need/Receive Gaps by Demographics
N/R Gap
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 50% of survey respondents reported a Service Need for
Medical Nutrition Therapy and of those, 17% reported Need /Receive Gap.
Demographic Disparities. The Homeless population was overrepresented among those with a
Service Need for Medical Nutrition Therapy: 71% of homeless vs. 50% overall. Regarding Service
Need/Receive Gaps, Latinos were overrepresented (33% vs. 17% overall), as well as IDUs (29% vs.
17% overall) and Females as compared to Males (38% vs. 21%). Rural PLWH/A, however, reported
lower Service Needs (39%) and Need/Receive Gaps (0%) than respondents overall (17%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 32
Health Insurance Assistance (#7 Ranked Core Service Need)
Need
Health Insurance Assistance
Needs and Need/Receive Gaps by Demographics
N/R Gap
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 39% of survey respondents reported a Service Need for Health
Insurance Assistance and of those, 22% reported Need/Receive Gap.
Demographic Disparities. IDUs reported a lower Service Need than respondents overall (25% vs.
39%). Regarding Need/Receive Gaps, Latinos (35%) and Females (58%) reported a higher gap than
respondents overall (22%), while Rural PLWH/A reported a lower service gap (11%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 33
Substance Abuse Outpatient Care (#8 Ranked Core Service Need)
Need
Substance Abuse Outpatient Care
Needs and Need/Receive Gaps by Demographics
N/R Gap
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs Need/Receive Gap. 34% of survey respondents reported a Service Need for
Substance Abuse Outpatient Care and, of those who reported a Service Need, 19% reported
Need/Receive Gap.
Demographic Disparities. Higher Service Needs were reported for Latinos (45%), IDUs (50%) and
the Homeless population (63%), than survey respondents overall (34%); while Rural PLWH/A reported
lower Service Needs (16%). Regarding Need/Receive Gaps, Females reported a much higher gap (42%)
than males (23%) and survey respondents overall (19%). Rural PLWH/A reported a higher
Need/Receive Gap than respondents overall (38% vs. 19%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 34
Home Health Care
Need
Home Health Care
Needs and Need/Receive Gaps by Demographics
N/R Gap
45%
40%
35%
30%
25%
20%
15%
10%
5%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 19% of survey respondents reported a Service Need for Home
Health Care and, of those, 19% reported a Need/Receive Gap.
Demographic Disparities. Latinos reported a higher Service Need than respondents overall (30%
vs. 19%).
D-2. SUPPORT SERVICES NEEDS AND NEED/RECEIVE GAPS
a. Support Services Needs and Need/Receive Gaps Overall
Table 6 below shows the number and percentage of survey respondents that reported a Need and
Need/Receive Gap for each Ryan White Support Service, as presented by service category and as forced
ranked by the Service Need percentage by service subcategory. In addition, the number and percentage
of survey respondents who reported Service Need, but did not receive that service (they have a
Need/Receive Gap for that service category or subcategory) are presented.
Please note that this table, similar to the table presented in Section C-2 for Core Services, is
presented in ranked order by Service Need by Subcategory. For example, Social Service Case
Management has 4 subcategories (Benefits Counseling Session, Intake Session, Client Advocacy and
Referral to Clinical Research) and each has its own % Need and % Need/Receive Gap as shown in Table
6 below.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 35
Table 6: Support Service Needs and Need/Receive Gaps by Service Subcategory
SUPPORT SERVICE NEEDS AND NEED/RECEIVE GAPS
BY SERVICE SUBCATEGORY
Support Service Category
Child Care Services
Emergency Financial
Assistance
Food Bank /
Home Delivered Meals
Health Education /
Risk Reduction
Housing Services
Legal Services
Subcategory
Child Care
Childhood Development / Early
Intervention
Child Welfare
Permanency Planning
Food Voucher Assistance
Housing / Rental Assistance
Utilities Assistance
Short-term / Emergency
Housing Assistance
Food Bank
Home Delivery Food
HIV Health Education
Housing Information Assistance
Bus/light Rail Passes for
Appointments
Medical Transportation
Volunteer Drivers for
Services
Appointments
Taxi Services for Appointments
Complementary Therapies
Recreational Activities
Non-medical Home Care
Other Support Services
Buddy / Companion Services
Physical and Occupational
Therapy
Day or Respite Care
Risk Reduction Items
Safer Sex Practices Support
HIV Prevention Information
Prevention for Positives
Counseling for HIV+ and
Partner(s)
Disclosure of HIV Status
Benefits Counseling Session
Intake Session
Social Service Case
Management
Client Advocacy
Referral to Clinical Research
Substance Abuse Residential Care
Sacramento Region FY13 HIV/AIDS Needs Assessment
# Need
13
%
Need
6%
# Need /
Receive
Gap
1
% Need /
Receive
Gap
8%
12
8
6
130
115
111
5%
3%
3%
56%
50%
48%
1
1
3
48
34
49
8%
13%
50%
37%
30%
44%
52
155
53
22%
67%
23%
22
24
23
42%
15%
43%
93
85
64
40%
37%
28%
9
30
38
10%
35%
59%
117
50%
26
22%
79
54
73
68
51
49
34%
23%
31%
29%
22%
21%
27
32
40
35
18
20
34%
59%
55%
51%
35%
41%
45
17
146
84
78
19%
7%
63%
36%
34%
16
7
8
9
8
36%
41%
5%
11%
10%
48
42
140
130
103
74
21
21%
18%
60%
56%
44%
32%
9%
6
10
25
15
13
23
8
13%
24%
18%
12%
13%
31%
38%
Page 36
To provide a ranking by highest overall Need by service Category, rather than by service
Subcategory as shown in Table 6, each subcategory was collapsed into their respective Service Category
(e.g., Social Service Case Management has one overall Service Category Need (79%), rather than 4
Subcategory Needs). Findings by Support Service Category are shown below.
Table 7: Support Service Categories Ranked by Level of Need
SUPPORT SERVICES CATEGORIES
RANKED BY LEVEL OF NEED
Rank
1
2
3
4
5
6
7
8
9
10
11
#
Need
184
180
160
159
135
127
93
85
64
21
19
Support Service Category Needs
Social Service Case Management
Emergency Financial Assistance
Prevention for Positives
Food Bank / Home Delivered Meals
Other Support Services
Medical Transportation Services
Health Education / Risk Reduction
Housing Services
Legal Services
Substance Abuse Residential Care
Child Care Services
%
Need
79%
78%
69%
69%
58%
55%
40%
37%
28%
9%
8%
As important as it is to analyze Service Need, it is equally important to analyze the gap between
services needed and services received (Need/Receive Gap). Again, the following are analyzed by
Services Category, by collapsing all service subcategories into their respective Service Category. In
Table 8 below, Service Categories are ranked by Need/Receive Gap:
Table 8: Support Service Categories Ranked by Level of Need/Receive Gap
SUPPORT SERVICES CATEGORIES
RANKED BY LEVEL OF NEED/RECEIVE GAPS
Rank
1
2
3
4
5
6
7
8
9
10
11
Support Service Category Need/Receive Gap
Legal Services
Other Support Services
Emergency Financial Assistance
Substance Abuse Residential Care
Medical Transportation Services
Housing Services
Child Care Services
Social Service Case Management
Food Bank / Home Delivered Meals
Prevention for Positives
Health Education / Risk Reduction
Sacramento Region FY13 HIV/AIDS Needs Assessment
#
Needed
64
135
180
21
127
85
19
184
159
160
93
# Did
Not
Receive
38
68
84
8
46
30
6
46
38
19
9
%
Need /
Receive
Gap
59%
50%
47%
38%
36%
35%
32%
25%
24%
12%
10%
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Support Services Need Ranked Higher than Need/Receive Gap Rank
There are services for which the Service Need is ranked significantly higher than the Need/Receive
Gap, meaning that although services are highly needed, those services are being received and the service
demand is mostly being met for the majority of clients with a need for that service. By comparing Tables
7 and 8 above, it is clear that the Service Need ranking for several services is higher than Need/Receive
Gap rank for that service. For example:
•
•
Social Service Case Management ranks #1 Need, but #8 Need/Receive Gap
Prevention for Positives ranks #3 Need, but #8 Need/Receive Gap
Support Services Need/Receive Gap Ranked Higher than Need
On the other side of the spectrum, there are services for which the Need/Receive Gap is greater than
the Service Need, meaning that although the service is not ranked as one of the highest needed service, a
high proportion of clients that do need that service are not receiving the service. For example:
•
•
Legal Services Ranked #1 for Need/Receive Gap, but #9 for Service Need
Substance Abuse Residential Care Ranked #4 for Need/Receive Gap, but #10 for Need
These disparities in Service Needs as compared to Need/Receive Gaps are discussed further in the
section that follows under each Support Service Category.
b. Support Service Needs, Gaps and Demographics by Service Category
What follows is a look at each service category, listed in order of those services with the highest
needs to those with the lowest needs, analyzed by Service Needs, Need/Receive Gaps and
Demographics. This section highlights each support service category that Needs Assessment survey
respondents were asked about in terms of whether or not they needed that service (% Need) and whether
or not they received that service (% Need/Receive Gap). A variety of differences were found between
what services are reported as needed by PLWH/A, and what services are received (the Need/Receive
Gap). Further, Service Needs and Need/Receive Gaps are analyzed in detail by client demographics
such as age, race, gender and mode of HIV transmission.
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Social Service Case Management (#1 Ranked Support Service Need)
Need
Social Service Case Management
Needs and Need/Receive Gaps by Demographics
N/R Gap
Homeless (n=41)
African American Female (n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Service Need. The Support Service category that had the highest reported Need among survey
respondents was Social Service Case Management. 79% of survey respondents reported a need for at
least one of the subcategories of Social Service Case Management as follows: 87% for Benefits
Counseling Session; 56% for Intake Session; 44% for Client Advocacy and 32% for Referral to Clinical
Research.
Need/Receive Gap. Thankfully, although the Service Need is high for Social Service Case
Management (79%), the Need/Receive Gap was not as high (25%).
Demographic Disparities. The Homeless population was disproportionately represented among
those with a Service Need for Social Service Case Management as compared to respondents overall
(90% vs. 79%). Latinos were the only demographic subpopulation that reported a significantly higher
Need/Receive Gap than respondents overall (42% vs. 25%), while Rural PLWH/A reported a lower Gap
(10%).
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Emergency Financial Assistance (#2 Ranked Support Service Need)
Need
Emergency Financial Assistance
Needs and Need/Receive Gaps by Demographics
N/R Gap
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 78% of respondents reported a Service Need for Emergency
Financial Assistance, and of those who reported a Need, 47% reported a Need/Receive Gap.
Demographic Disparities. The following subpopulations reported a 10% or greater higher
Need/Receive Gap than respondents overall: African Americans (60%), Females (58%), PLWH/A ages
20-44 (58%) and African American Females (62%).
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Prevention for Positives (#3 Ranked Support Service Need)
Need
Prevention for Positives
Needs and Need/Receive Gaps by Demographics
N/R Gap
Rural (n=51)
Homeless (n=41)
African American Female (n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Service Need. 69% of survey respondents reported a need for Prevention for Positives services,
which includes the subcategories of Risk Reduction Items (60% reported need); Safer Sex Practices
Support (36%); HIV Prevention Information (34%); Counseling for HIV+ and Partners (21%); and
Assistance with Disclosure of HIV Status (18%).
Need/Receive Gap. 12% of respondents with a need for Prevention for Positives services were not
able to receive those services and reported a Need/Receive Gap. “Assistance with Disclosure of HIV
Status” was the subcategory with the highest Need/Receive Gap (24%).
Demographic Disparities. Latinos reported a higher service need than respondents overall (90% vs.
69%), while Whites reported a lower need (55%). The Homeless population also reported a higher
service need at 85%. Regarding Need/Receive Gaps, no respondents in the IDU population reported a
Need/Receive Gap.
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Food Bank / Home Delivered Meals (#4 Ranked Support Service Need)
Need
Food Bank / Home Delivered Meals
Needs and Need/Receive Gaps by Demographics
N/R Gap
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 67% of overall respondents reported Service Need for Food
Bank services and 22% for Home Delivered Meals. Of those reporting a need, 15% reported
Need/Receive Gap for Food Bank, and 43% reported gap for Home Delivered Meals.
Demographic Disparities. A higher percentage of IDUs and Homeless reported need for Food
Services than respondents overall (83% and 90%, respectively, vs. 69% overall).
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Other Support Services (#5 Ranked Support Service Need)
Need
Other Support Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female (n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 58% of respondents overall reported need for other support
services, such as complementary therapies, recreational activities, buddy/companion services, etc., while
50% reported that they had a Need/Receive Gap for those services.
Demographic Disparities. IDUs and the Homeless population had disproportionately higher service
needs (75% and 85%) than respondents overall (58%), but lower Need/Receive Gap (33% and 40%)
than overall respondents (50%). Rural PLWH/A had a lower Service Gap than respondents overall
(39% vs. 58%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Medical Transportation Services (#6 Ranked Support Service Need)
Need
Medical Transportation Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 55% of respondents reported a Service Need for Medical
Transportation, and of those, 36% reported a Need/Receive Gap.
Demographic Disparities. Regarding Service Need, African Americans (73%), Latinos (68%)
African American Women (76%), IDUs (79%) and the Homeless (90%) were higher, while Whites
(41%) and Rural PLWH/A (41%) reported a lower service need, than respondents overall (55%).
Regarding Need/Receive Gap, IDUs were the only demographic group with a lower gap than
respondents overall (21% vs. 36%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Health Education / Risk Reduction (#7 Ranked Support Service Need)
Need
Health Education / Risk Reduction
Needs and Need/Receive Gaps by Demographics
N/R Gap
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 40% of respondents reported a Service Need for Health
Education / Risk Reduction, and of those, 10% reported a Need/Receive Gap.
Demographic Disparities. For Service Need, Latinos (63%) and the Homeless population (66%)
were higher, while Whites (28%) were lower, than respondents overall (40%). For Need/Receive Gaps,
Latinos (20%) and African American Women (20%) were higher than respondents overall (10%).
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Housing Services (#8 Ranked Support Service Need)
Need
Housing Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 37% of respondents reported a Service Need for Housing, and
of those who reported a need, 35% reported a Need/Receive Gap.
Demographic Disparities. African Americans (51%) and the Homeless Population (76%) reported
higher Service Needs for Housing than respondents overall (37%), while Rural PLWH/A reported lower
Service Needs (22%).
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Legal Services (#9 Ranked Support Service Need)
Need
Legal Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
80%
70%
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 28% of respondents reported a Need for Legal Services, and of
those, 59% reported a Need/Receive Gap.
Demographic Disparities. Latinos (75%) and MSMs (76%) reported a higher Need/Receive Gap
than respondents overall (59%).
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Residential Substance Abuse Care (#10 Ranked Support Service Need)
Need
Substance Abuse Residential Care
Needs and Need/Receive Gaps by Demographics
N/R Gap
Rural (n=51)
Homeless (n=41)
African American Female (n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Service Need vs. Need/Receive Gap. Although Residential Substance Abuse Care is ranked #10 in
terms of reported Need (9% of respondents), it is ranked #4 for Need/Receive Gap, as 38% of those who
are in need are not receiving the service.
Demographic Disparities. The Homeless Population reported higher Service Needs for Residential
Substance Abuse Care than respondents overall (32% vs. 9%). Rural PLWH/A reported a lower
Need/Receive Gap than overall respondents (0% vs. 38%). The IDU population is clearly
underreporting Service Need. No respondents from the IDU population reported a Service Need or
Need/Receive Gap for Residential Substance Abuse Treatment.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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Child Care Services (#11 Ranked Support Service Need)
Need
Child Care Services
Needs and Need/Receive Gaps by Demographics
N/R Gap
60%
50%
40%
30%
20%
10%
Rural (n=51)
Homeless (n=41)
African American Female
(n=25)
Heterosexual (n=60)
IDU (n=24)
MSM (n=108)
Age 45+ (n=160)
Age 20-44 (n=67)
Female (n=66)
Male (n=159)
White (n=106)
Latino (n=40)
African American (n=59)
Overall (n=232)
0%
Service Need vs. Need/Receive Gap. 8% of survey respondents reported a Service Need for Child
Care and, of those, 32% reported Need/Receive Gap.
Demographic Disparities. Latinos reported a higher Service Need than respondents overall (20%
vs. 8%). Regarding Need/Receive Gaps, Whites (50%), African Americans (43%) and African
American Females (50%) had higher gaps than respondents overall (32%).
D-3. BARRIERS TO CARE
a. Description of Categories of Barriers to Care and Overall Rankings
To understand the variety of issues that each person living with HIV/AIDS feels is limiting them
from getting the services that they need, the Needs Assessment survey allocates an entire section to
questions about Barriers to Care. Each person surveyed was asked to examine thirty-two (32) different
issues, or potential problems that they may have faced, to indicate whether they agree/yes that it has
been a barrier to services for them, or disagree/no if they do not think it has been a barrier to services for
them. These barriers are not linked to a particular service category, but are described as potential
barriers applicable to any or all services.
As shown in Table 9 below, the 32 potential barriers have been classified into three general
categories of “Structural,” “Organizational,” and “Individual” Barriers to Care. To help the TGA gain a
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 49
better understanding about which level of the service system the barriers to care exist, these categories
go from examining broad-based TGA-wide “Structural” issues; to service provider-based
“Organizational” issues; to client-based “Individual” issues. To further breakdown the analysis, each of
the three general categories is subcategorized into two separate subcategories. The following provides a
description of the categories and subcategories of Barriers to Care.
•
Structural Barriers include issues regarding the overall structure of the TGA’s Continuum of Care
and is subcategorized into “Rules and Regulations” and “Access to Care,” as follows:
 Rules and Regulations include issues such as challenges navigating the system of care;
lapsed time between scheduling and getting an appointment; excessive red tape and
paperwork; excessive wait time in waiting room; lack of service eligibility; and lack of or
inadequate insurance coverage. On average, 31% of survey respondents indicated that
Barriers to Care in the Rules and Regulations category were a barrier for them. This was the
2nd highest ranking subcategory (2 of 6) of Barriers to Care, just under “Individual /
Knowledge which ranked #1 at 33%.
 Access to Care is the other subcategory of Structural Barriers and includes issues such as
lack of transportation; lack of access to specialists; termination or suspension from seeking
services; denial of services in the past; denial of services due to a criminal justice matter; and
lack of childcare. On average, 18% of survey respondents indicated that Barriers to Care in
the Access to Care category were a barrier for them. This was the lowest ranking
subcategory of Barriers to Care (ranked 6 of 6 categories).
•
Organizational Barriers include issues at the service provider level, and is subcategorized into
“Provider Sensitivity” and “Provider Expertise,” as follows:
 Provider Sensitivity Barriers to Care include issues such as the client or patient’s perception
of the provider’s response to their issues and concerns. For example, whether the provider
makes the client “feel like a number.” Issues such as fear of HIV or AIDS status being found
out by others (client confidentiality); or whether the patient felt there were issues such as the
discrimination by the provider, also are included in the “Provider Sensitivity” subcategory.
On average, 23% of survey respondents indicated that Barriers to Care in the Provider
Sensitivity category were a barrier for them. This category was the 2nd to lowest ranking
subcategory of the Barriers to Care (ranked 5 of 6 categories).
 Provider Expertise, the other subcategory under “Organizational Barriers,” includes issues
such as the perceived experience of providers; the ability of providers to provide the correct
referrals to clients; and the ability of providers to get along with clients. On average, 27% of
survey respondents indicated that Barriers to Care in the Provider Sensitivity category were a
barrier for them. This category was the 2nd to lowest ranking subcategory of the Barriers to
Care (ranked 4 of 6 categories).
•
Individual Barriers category is aimed at understanding Barriers to Care that exist at the client level
of care, and is subcategorized into “Knowledge” and “Well-Being,” as follows:
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 Individual Knowledge Barriers to Care include issues such as lack of knowledge that a
service or treatment was available; lack of knowledge regarding the location of the service;
not knowing who to ask for help; or not understanding the instructions for obtaining the
service or treatment. On average, 33% of survey respondents indicated that Barriers to Care
in the Individual Knowledge category were a barrier for them. This was the highest ranking
subcategory of Barriers to Care (ranked 1 of 6).
 Individual Well-Being is the other subcategory for Individual Barriers to Care and includes
issues such as state of mind or mental ability to deal with the treatment, denial issues, and
challenges with physical issues to get to the service location. On average, 29% of survey
respondents indicated that Barriers to Care in the Individual Well-Being category were a
barrier for them. This was the 3rd highest ranking subcategory (ranked 3 of 6) of Barriers to
Care, just under “Rules and Regulations” which ranked #2 at 31%.
b. Analysis of Barriers to Care by Category
To provide a more thorough analysis of each Barrier to Care, Table 9 below provides data for all
Barriers to Care, ranked from highest to lowest within each subcategory as described above, by noting
the percentage of PLWH/A who agreed it was a Barrier of Care for them in FY 2013. A narrative
analysis, by Category of Barrier to Care (Structural, Organizational or Individual) follows the table.
Table 9: Barriers to Care by Category and Subcategory
BARRIERS TO CARE
By Category and Subcategory
STRUCTURAL
Rules and Regulations
1. The amount of time I had to wait between scheduling an appointment and
the actual day of the appointment.
2. My ability to find my way through the system.
3. The amount of time I had to wait in the waiting room prior to my
appointment.
4. There was too much paperwork or red tape.
5. There are too many rules and regulations.
6. I was not eligible for the service.
7. My lack of or inadequate, insurance coverage.
8. I can’t afford one or more of the services.
Category Average
Access to Care
1. No transportation.
2. I have been denied a service in the past.
3. There was no specialist who could provide the care I needed.
4. I have been denied or have been afraid to seek services due to a criminal
justice matter.
5. I have been terminated or suspended from seeking services.
6. No childcare.
Category Average
Sacramento Region FY13 HIV/AIDS Needs Assessment
%
Agree
Barrier
39%
38%
36%
30%
28%
26%
26%
25%
31%
34%
26%
15%
13%
12%
10%
18%
Page 51
BARRIERS TO CARE
By Category and Subcategory
ORGANIZATIONAL
Provider Sensitivity
1. Sensitivity of the organization and person providing services to me
regarding my issues and concerns.
2. Fear of my HIV or AIDS status being found out by others – lack of
confidentiality.
3. The organization providing the service made me feel like a number.
4. Discrimination I experienced by the persons or organization providing the
services.
5. The people providing services to me are not helpful.
6. Fear that I would be reported to immigration or other authorities.
Category Average
Provider Expertise
1. Experience or expertise of the person providing services to me.
2. The organization did not provide the right referrals to the services I need.
3. I do not get along with the people providing services.
Category Average
INDIVIDUAL
Knowledge
1. Not knowing that a service or treatment was available to me.
2. Not knowing the location of the service(s).
3. Not knowing who to ask for help.
4. My ability to communicate or interact with the service provider.
5. Not understanding instructions for obtaining service or treatment.
6. Not knowing what medical services I need to treat my HIV infection or
AIDS.
Category Average
Well-Being
1. My state of mind or mental ability to deal with the treatment.
2. I do not believe HIV/AIDS is a problem for me that requires assistance
(denial).
3. My physical health has not allowed me to get to the place where the
service is provided.
Category Average
%
Agree
Barrier
39%
26%
22%
21%
17%
10%
23%
43%
19%
15%
27%
49%
40%
35%
31%
26%
19%
33%
45%
23%
20%
29%
Structural Rules and Regulations
As can be seen from Table 9 above, the highest ranked Barrier to Care under the Structural Category
“Rules and Regulations” subcategory is regarding appointment wait time, as 39% of PLWH/A
completing this section of the survey agreed that “the amount of time I had to wait between scheduling
an appointment and the actual day of the appointment” had been a barrier to care for them.
Challenges navigating the system of care ranked as the second largest identified “Rules and
Regulations” barrier, as 38% agreed that “my ability to find my way through the system” had been a
barrier to care for them. The third highest ranking barrier to care regarding rules and regulations was
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Page 52
“the amount of time I had to wait in the waiting room prior to my appointment,” as 36% agreed that this
was a barrier to care for them. As compared to the FY 2011 Needs Assessment, the Barrier to Care of
waiting room time increased from ranking 8 in Structural “Rules and Regulations” Barriers to Care (at
32%) to ranking 3 in this subcategory in the FY 2013 Assessment (at 36%).
Structural Access to Care
The greatest identified barrier under the Structural “Access to Care” subcategory was lack of
transportation, as 34% of survey respondents agreed that it was a barrier. The second highest Access to
Care barrier, for which 26% PLWH/A agreed it was a barrier, was “I have been denied a service in the
past.” As compared to the FY 2011 Needs Assessment, the Barrier to Care of “denial of service”
increased from ranking 6 in “Access to Care” (at 21%) to ranking 2 in the FY 2013 Assessment (at
26%).
Organizational Provider Sensitivity
Within the Organizational category, the “Provider Sensitivity” subcategory Barrier to Care with the
highest percentage of PLWH/A who thought it was a barrier (39%) was “Sensitivity of the organization
and person providing services to me regarding my issues and concerns.” The second highest Provider
Sensitivity barrier was “Fear of my HIV or AIDS status being found out by others – lack of
confidentiality.” This barrier of “confidentiality” was ranked higher in 2013 than it was in the 2011
Needs Assessment survey.
Organizational Provider Expertise
The highest Organizational Barriers in the Provider Expertise category was “Experience or expertise
of the person providing services to me,” as 43% of PLWH/A who completed this part of the survey
agreed it has been a barrier for them. The other two organizational barriers, “the organization did not
provide the right referrals to the services I need,” and “I do not get along with the people providing
services,” were ranked much lower, at 19% and 15%, respectively.
Individual Knowledge
The highest ranked “Individual Knowledge” Barrier to Care for services was the consumers’ lack of
knowledge that a needed service may have existed, as 49% agreed that they did “not know that a service
or treatment was available to me.” The second highest Individual Knowledge barrier was “not knowing
the location of the service(s),” for which 40% of survey respondents agreed that this was a barrier to
care for them. The third highest Individual Knowledge barrier was “not knowing who to ask for help” at
35%. Ranked fourth was the Individual Knowledge barrier to care of “my ability to communicate or
interact with the service provider” at 31%. Interestingly, it should be noted that out of all Barriers to
Care, this “Communication” barrier is the barrier to care that increased the most between the FY 2011
and FY 2013 Needs Assessments, from 20% to 31%, respectively.
Individual Well Being
The highest ranked “Well-Being” barrier, for which 45% of PLWH/A who completed this section of
survey agreed it was a barrier, was “my state of mind or mental ability to deal with the treatment.” The
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next highest barrier regarding individual well-being was regarding denial, as 23% of survey respondents
agreed that “I do not believe HIV/AIDS is a problem for me that requires assistance.”
c. Highest Ranked Barriers to Care Overall FY 13 and FY11
A look at Barriers to Care overall, rather than ranked by category (Structural, Organizational and
Individual) as in the previous section, also is helpful for planning purposes. Follows are the top 10
Barriers to Care overall in FY13. Additionally, comparing the top 10 Barriers to Care in FY13 to FY11
is helpful for planning purposes and is provided below in Table 10. By comparing the top 10 Barriers to
Care in FY13 to the % of respondents that agreed that each was a Barrier to Care in FY11, program
planners and service providers can gain a better understanding of the Barriers to Care that are
consistently remaining most in need of being addressed.
Table 10: Top 10 Barriers to Care FY 2013 Compared to FY11
BARRIERS TO CARE
Not knowing that a service or treatment was available to me.
My state of mind or mental ability to deal with the treatment.
Experience or expertise of the person providing the services to
me.
Not knowing the location of the service(s).
The amount of time I had to wait between scheduling an
appointment and the actual day of the appointment.
Sensitivity of the organization and person providing services to me
regarding my issues and concerns.
My ability to find my way through the system.
The amount of time I had to wait in the waiting room prior to my
appointment.
Not knowing who to ask for help.
No transportation.
%
Agree
FY13
49%
45%
43%
Rank
FY13
Rank
FY11
1
2
3
%
Agree
FY11
50%
43%
38%
40%
39%
4
5
39%
34%
3
7
39%
6
31%
12
38%
36%
7
8
41%
32%
4
8
35%
34%
9
10
39%
30%
5
9
1
2
6
This analysis shows that all top 10 Barriers to Care in FY11 remained in the top 10 for FY13, with
one exception (“my lack of or inadequate insurance”). The Individual Knowledge barrier, “Not
knowing that a service or treatment was available to me,” was the #1 Barrier to Care in both FY13 and
FY11. Interestingly, the average percentage of clients who agreed that each issue was a barrier of care
for them remained the same (at 37%) for both Needs Assessments. The only difference was that the
ranking order changed slightly between the findings of both Needs Assessments.
For example, the biggest shift was that “Not knowing who to ask for help,” lowered from a rank of 5
in FY11 to 9 in FY13. “My ability to find my way through the system,” also decreased between FY11
and FY13, from a rank of 4 to 7.
A barrier that moved up in ranking between FY11 and FY13 was the “Experience or expertise of the
person providing the services to me,” which increased from a rank of 6 in FY11 to 3 in FY13. There
was one barrier, “Sensitivity of the organization and person providing services to me regarding my
issues and concerns,” that was ranked 6 in FY13, but was not ranked in the top 10 barriers in FY11.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 54
d. Lowest Ranked Barriers to Care
In contrast to looking at the top 10 Barriers to Care, a look at the lowest ranked barriers can help to
better understand what policies and procedures are working and should continue to be implemented.
The following are the lowest ranked barriers in FY13:
•
•
•
•
•
Fear that I would be reported to immigration or other authorities (10%)
No childcare (10%)
I have been terminated or suspended from seeking services (12%)
I have been denied or have been afraid to seek services due to a criminal justice matter (13%)
There was no specialist who could provide the care I needed (15%)
Interestingly, the four lowest Barriers to Care in FY13 were also the four lowest Barriers to Care in
FY11. The average percentage of PLWH/A who agreed each issue was a barrier to care, however, was
higher in FY13 (at 11%) than in FY11 (at 5%). It should be noted that 3 of the 4 lowest Barriers to Care
in both FY13 and FY11 were in the “Structural” category under “Access to Care.”
e. Barriers to Care by Demographics
To gain a more thorough analysis of the impact of each Barrier to Care on the various demographic
groups of Needs Assessment Survey respondents, each barrier was analyzed separately for race, age,
gender and mode of transmission. In addition, the subpopulations of African American Women, the
homeless population, and the rural PLWH/A were analyzed and are described below. A detailed set of
spreadsheets that show each Barrier to Care by demographic group can be found in the Appendix.
Race:
•
Latinos more commonly reported Barriers to Care than did all other racial groups.
•
For half of all Barriers, Latinos reported barriers at rates 10% or higher than overall respondents.
•
Latinos reported the following Barriers to Care at rates 20% higher than the overall respondent
group: provider expertise; wait time to schedule an appointment; and deportation fears.
•
African Americans reported facing Barriers to Care because of concerns about confidentiality at a
higher rate than respondents overall (39% vs. 26%). Confidentiality concerns were African
Americans’ 8th greatest barrier, compared to the 15th among respondents overall.
•
African Americans reported travel constraints due to health issues as a barrier at higher percentages
than respondents overall (37% vs 20%). This barrier is ranked 11th for African Americans as
compared to 23rd among survey respondents overall.
•
Whites reported less concerns about confidentiality (15%) than African Americans (39%) and
Latinos (40%).
Gender:
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 55
•
Males reported paperwork to be a Barrier to Care more commonly than females (35% vs. 18%).
•
Male respondents were more likely to report having been denied services in the past than females
(30% vs. 15%).
Age:
• Respondents age 20-44 were more likely than those 45 and older to have experienced barriers
regarding transportation (48% vs. 28%) and service eligibility (36% vs. 21%).
•
Younger respondents (ages 20-44) reported higher rates of Barriers to Care related to provider
sensitivity (52% vs. 33%); communication (42% vs. 25%); confidentiality (40% vs. 20%); and
discrimination (33% vs. 15%).
Mode of Transmission:
• IDU respondents were less likely to identify Barriers to Care than other respondents.
•
The most significant exception was that health-related travel restrictions were more commonly a
barrier for IDUs (33%) than for MSMs (16%) or Heterosexuals (22%).
African American Women:
• The number one barrier to care for African American female respondents was transportation: 52%
identified this as a barrier vs. 34% overall. This barrier was ranked 10th among all respondents.
•
African American Women also reported health-related travel restrictions as a more common barrier
than survey respondents overall: 36% of African American Women vs. 20% of overall respondents.
Homeless Population:
• Homeless respondents more commonly indicated the presence of Barriers to Care than did overall
respondents.
•
For 27% of all Barriers, Homeless respondents reported barriers at rates 10% or higher than the
overall respondent group.
•
The number one Barrier to Care for homeless respondents was transportation: 55% identified this as
a barrier vs. 34% overall. This barrier was ranked 10th among all respondents.
•
Waiting room time was the number two barrier to care for homeless respondents vs. number eight in
the overall group. 54% of the homeless population reported waiting room time was a barrier vs.
39% in the overall group.
•
Homeless respondents were more likely than the overall population to claim barriers related to
provider sensitivity (54% vs. 39%) and getting along with a provider (30% vs. 15%).
Rural Population:
• Rural respondents were less likely to identify Barriers to Care than other respondents. For all but one
barrier, they reported barriers at rates less than the overall respondent group.
Sacramento Region FY13 HIV/AIDS Needs Assessment
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•
For the one barrier that Rural respondents reported having at a higher rate than respondents overall
(HIV Specialist not available) the difference was minimal (16% vs. 15%).
f.
Need/Ask Gap as Barrier to Care
To understand whether PLWH/A are requesting the services that they need, survey participants were
instructed to indicate whether they needed a service and whether they had asked for that service. If
clients do not ask for services that they need, this Need/Ask Gap becomes a Barrier to Care. Overall, the
request for services follow reported need, as would be expected.
There are several service categories (all of which are Support Services with the exception of one
service category) where PLWH/A were considerably less likely to ask for a service that they needed,
therefore having a higher Need/Ask Gap, as shown in Table 12 below. Within Core Services, the only
service subcategory that had a Need/Ask Gap of 25% or higher was Medical Case Management Session.
Within Support Services, there were seven subcategories with a Need/Ask Gap of 25% or higher as
follows: Child Care Permanency Planning (50%); Recreational Activities (41%); Taxi Services for
Appointments (39%); Complementary Services (36%); Buddy/Companion Services (27%); Legal
Services (27%); and Prevention for Positives – Disclosure (26%).
Table 11: Need/Ask Gap Barrier to Care
CORE Service Category
AIDS Drug Assistance
Program
AIDS Pharmaceutical
Assistance
Health Insurance Assistance
Home Health Care
Medical Case Management
Subcategory
Medical Homecare Visit
Specialized Home Healthcare Visit
Medical Case Management Session
Treatment Adherence Services
Medical Nutrition Therapy
Mental Health Services
One-on-One Counseling
Group Counseling with Licensed
Professional
Group Counseling with Non-Licensed
Professional
Family Counseling
Bereavement Counseling
Oral Health Care
Outpatient Medical
Substance Abuse Outpatient
Care
HIV Medical Visit
Non HIV Medical Visit
Medical Specialist Visit
Outpatient Substance Abuse
Outpatient Treatment or Counseling
Sacramento Region FY13 HIV/AIDS Needs Assessment
#
Need
#
Ask
% Need /
Ask Gap
206
195
5%
91
90
40
13
158
92
115
142
71
80
34
14
119
92
101
135
22%
11%
15%
-8%
25%
0%
12%
5%
105
99
6%
100
44
39
179
201
172
162
91
35
34
166
183
158
139
9%
20%
13%
7%
9%
8%
14%
62
57
8%
Page 57
CORE Service Category
SUPPORT Service Category
Child Care Services
Emergency Financial
Assistance
Food Bank / Home Delivered
Meals
Health Education / Risk
Reduction
Housing Services
Legal Services
Medical Transportation
Services
Other Support Services
Prevention for Positives
Social Service Case
Management
#
Need
61
#
Ask
51
% Need /
Ask Gap
16%
55
51
48
40
#
Need
13
#
Ask
13
13%
22%
% Need /
Ask Gap
0%
12
8
6
130
115
111
11
8
3
105
102
88
8%
0%
50%
19%
11%
21%
52
50
4%
Home Delivery Food
53
40
25%
HIV Health Education
Housing Information Assistance
93
85
64
81
73
47
13%
14%
27%
117
79
54
73
68
51
49
45
17
103
68
33
47
40
41
36
37
13
12%
14%
39%
36%
41%
20%
27%
18%
24%
146
124
15%
84
78
70
66
17%
15%
48
42
140
130
103
74
37
31
107
100
96
60
23%
26%
24%
23%
7%
19%
21
16
24%
Subcategory
Substance Abuse Group Counseling
Substance Abuse one-on-one
psychological or psychiatric counseling
Substance Abuse Peer Counseling
Subcategory
Child Care
Childhood Development / Early
Intervention
Child Welfare
Permanency Planning
Food Voucher Assistance
Housing / Rental Assistance
Utilities Assistance
Short-term / Emergency Housing
Assistance
Bus/light Rail Passes for
Appointments
Volunteer Drivers for Appointments
Taxi Services for Appointments
Complementary Therapies
Recreational Activities
Non-medical Home Care
Buddy / Companion Services
Physical and Occupational Therapy
Day or Respite Care
Access to Free Condoms and Risk
Reduction Items
Support for other HIV+ Peers in Safer
Sex Practices
Information on HIV Prevention
Counseling for HIV+ Person and
Partner(s)
Disclosing HIV Status with Partner(s)
Benefits Counseling Session
Intake Session
Client Advocacy
Referral to Clinical Research
Substance Abuse Residential
Care
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 58
SECTION E: SUMMARY OF FINDINGS AND IMPLICATIONS
E-1. SUMMARY OF NEEDS ASSESSMENT FINDINGS
a. Core Services: Largest Needs and Need/Receive Gaps
As is clear from the content of this Needs Assessment Report, it is equally important to understand
both Service Needs and Need/Receive Gaps to gain a clear picture of what services PLWH/A are most
in need of, and which services they are having the most difficulty obtaining. Therefore, the RW
Planning Council must prioritize those services with a high need and a high gap to use its funds most
effectively. The following chart summarizes % Need and % Need/Receive Gaps for Core Services:
Table 12: CORE SERVICE CATEGORIES SUMMARY
% Need and % Need/Receive Gap
Core Service Category
% Need
% Need/Receive Gap
Outpatient Medical Care
95%
12%
Medications
91%
12%
Oral Health Care
77%
26%
Medical Case Management
73%
18%
Mental Health Services
70%
27%
Medical Nutrition Therapy
50%
17%
Health Insurance Assistance
39%
22%
Substance Abuse Outpatient Care
34%
19%
Home Health Care
19%
19%
b. Support Services: Largest Needs and Need/Receive Gaps
Because the RW Planning Council has a legal mandate to allocate no more than 25% of its Part A
annual allocation from HRSA on Support Services, those services have been analyzed separately from
Core Services throughout this Needs Assessment report. Below is a summary of % Need and %
Need/Receive Gaps for Support Services:
Table 13: SUPPORT SERVICES CATEGORIES SUMMARY
% Need and % Need/Receive Gap
Support Service Category
% Need
% Need/Receive Gap
Social Service Case Management
79%
25%
Emergency Financial Assistance
78%
47%
Prevention for Positives
69%
12%
Food Bank / Home Delivered Meals
69%
24%
Other Support Services
58%
50%
Medical Transportation Services
55%
36%
Health Education / Risk Reduction
40%
10%
Housing Services
37%
35%
Legal Services
28%
59%
Substance Abuse Residential Care
9%
38%
Child Care Services
8%
32%
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 59
E-2. IMPLICATIONS FOR RW PRIORITY SETTING AND ALLOCATIONS
a. FY13 Ryan White Funding Sources and TGA Direct Service Allocations
To use the data from the Needs Assessment Survey to assist the Planning Council in Setting
Priorities and Allocations, it is important to understand Ryan White funding in the context of other
funding sources in the TGA for PLWH/A.
Based on the 2014 Part A application, Attachment 5: Sources of Other Funding, the Sacramento
TGA has $37.4 million in public funding for HIV/AIDS care in FY13 (down from $42.3 million in
FY11). That includes about $2.5 million in Ryan White Part A and MAI funds, which is 6.8% of all
funding. The majority of other Federal funds ($5.9 million, or 15.7%) are for Medi-Cal and Medicare,
and includes RW Parts B, C and D. State funds ($24.2 million, or 64.8%) include the ADAP program
and home and community based support services. The remainder includes slightly under $4.7 million
(12.7%) in local funds. The distribution of funds is shown in Figure 5.
Figure 5: FY13 Sacramento TGA Distribution of HIV/AIDS Funding
12.70%
6.80%
15.70%
Ryan White (Part A and
Part A MAI)
Other Federal (Medicaid,
Medicare, RW B, C, D)
Other State ADAP, Home,
Community Based
Other Local
64.80%
Ryan White CARE Act strives for 100% access to care for all persons living with HIV/AIDS,
regardless of ability to pay, and the RW Program is to use its funds as “payer of last resort.” Within the
Sacramento TGA, the planned FY13 allocation of the projected $3.9 million in Federal Ryan White Part
A, RW Part A Minority AIDS Initiative (MAI) funds, and RW Part B State funds, for each direct service
category is shown in Figure 6 below. By far, Ambulatory/Outpatient Medical Care has the largest
allocation, 40.1%, with Medical Case Management being the second largest allocation at 23.3%.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 60
Figure 6: FY13 RW CARE Program (Part A, Part A MAI and RW Part B Funds) Direct Services
Allocations
Ambulatory/Outpatient Medical Care (40.1%)
$1,339,297
Core
Medical Case Management Services (23.3%)
Oral Health Care (12.3%)
$411,153
Mental Health Services (9.7%)
Substance Abuse Services - Outpatient (4.3%)
Medical Nutritional Therapy (0.9%)
Support
$778,092
$324,915
$143,800
$31,698
Outreach MAI / Part B (2.6%)
$86,154
Social Services Case Management (2.0%)
$66,388
Substance Abuse Services – Residential (1.2%)
$40,403
Health Education Risk Reduction (1.2%)
$38,697
Emergency Financial Assistance (0.8%)
$27,991
Medical Transportation Services (0.7%)
$22,063
Pediatric Treatment Adherence - WICY (0.6%)
$18,580
Child Care Services (0.3%)
$11,264
b. RW Part A, RW Part A MAI and RW Part B Direct Service Expenditures in Rural Counties
of TGA
An analysis of RW direct service expenditures for (Part A, MAI and Part B) in the rural counties of
the TGA (El Dorado,Placer and Yolo Counties), as a percentage of total rural expenditures by service
category, show that 89.5% of funds were spent on Core Services (84.3% Medical Case Mangement,
1.3% Outpatient Medical Care, 1.2% Mental Health Care, 2.7% Oral Health Care); and 10.6% was spent
on Support Services (3.9% Transportation; and 6.7% Emergency Financial Assistance).
c. Analysis of RW Client Service Expenditure Trends
To assist the RW Planning Council in making future decisions for Priorities and Allocations, RW
expenditures on Core Services and Support Services were analyzed from FY 1999 to FY 2012 to gain a
better understanding of the trends in service utlization for RW clients over time. As is clear from Figure
7 below, expenditures for support services have dropped significantly since FY2001, when they were at
their highest of $876,269, to their lowest of $203,832 in FY 2008.
Following Figure 7 is a bullet point analysis that provides a more thorough look at trends in RW
client support service expenditures in various service categories over time.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 61
Figure 7: Support Services as a Percentage of RW Expenditures: FY1999-FY2012
30%
25%
20%
15%
10%
5%
0%
FY1999- FY2000- FY2001- FY2002- FY2003- FY2004- FY2005- FY2006- FY2007- FY2008- FY2009- FY2010- FY2011- FY20122000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
As is clear from Figure 7 above, there have been significant changes in the amount and proportion of
RW funds that have been spent on Support Services as compared to Core Services overtime, as follows:
Core Service RW Expenditures
•
Funding for Ambulatory Care has more than doubled since FY1999 and now tops $1.3m
annually.
•
Oral Health Care funding has more than tripled in the past few years: It was $133K in FY2009
and $411K in the latest year.
•
At $749K, Medical Case Management spending currently is at approximately the same level as it
was in FY2000. It peaked at over $1M/year in FY2004.
•
Spending for Mental Health currently is about $325K annually and at its lowest in FY2003 was
about one-third less.
•
From FY1999-FY2002, Outpatient Substance Abuse Treatment expenditures averaged about
$75K annually. Between FY2003 and FY2006, the average annual spend went down to $24K.
Since FY2007, annual average expenditures have increased to $144K.
Support Service RW Expenditures
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 62
•
Support services expenditures dropped from over 25% of budget during the period FY1999FY2001 to 7-10% of budget during the period FY2007-FY2012. It must be noted that Social
Service Case Management expenditures for FY2012 include only 5 months of funding.
•
Since FY2007, Emergency Financial Assistance expenditures have been near or under $50K per
year. Prior to that time, they were funded at $150-200K annually.
•
Expenditures on Medical Transportation Services have dropped in half since FY2005. RW
funding on transportation was approximately $22K over each of the last 2 years compared to
over $75K at around turn of the millennium. While transportation is a service category with an
increasingly high need/receive gap, the TGA experienced the loss of a provider who operated a
volunteer-based transportation program. No new providers applied for this service during the
most recent RFP. Therefore, funds are currently only being used for public transit. The HHSPC
will allocate increased funds to this service need as capacity issues are resolved.
•
Outreach Services were funded little if at all prior to FY2009. Annual expenditures reached
$86K last year.
•
Funding for Housing Services dropped 10-fold since FY2000 and in FY2012 account for about
$5K in expenditures per year.
•
Food Bank, Buddy Services, and Client Advocacy stopped being funded in the early 2000’s – all
of these categories previously were funded in the tens-of-thousands per year.
•
Residential Substance Abuse Treatment expenditures have steadily declined: in FY2013 costs
were about half what they were in FY1999.
d. Trends in Service Needs and Gaps
The trends in RW funding on Core and Support Services over time, as highlighted above, should be
considered by the RW Planning Council, in conjunction with the findings from the FY13 Needs
Assessment, to determine priorities and allocations for the Sacramento Region. It becomes clear that as
funding on Support Services has declined overtime, Service Gaps for those services have increased.
Follows are the highlights of the analysis of trends in Need/Receive Gaps between 2003 and 2013.
Need/Receive Gaps that widened are as follows:
• The Need/Receive Gap for Transportation has widened. Depending on the type of transportation
needed, the various gaps grew from 28-37% in 2003 to as high as 59% in 2013.
•
Gap for Food vouchers widened from 20% to 37%.
•
Gap for Complementary Care widened from 39% to 55%.
•
Gap for Medication Reimbursement widened from 13% to 26%.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 63
Need/Receive Gaps that narrowed are as follows:
• The Need/Receive Gap for Mental Health group therapy dropped from 40% to 17%.
•
Gap for Client Advocacy dropped from 34% to 13%.
•
Gap for Rental assistance dropped from 45% to 30%.
•
Gap for Food Bank dropped from 31% to 15%.
•
Gap for Housing information assistance dropped from 53% to 35%
•
Gap for Delivered Meals dropped from 63% to 43%
e. Demographic Disparities in Service Needs and Gaps
While determining Priorities and Allocations, it is important that the Planning Council target the
demographic populations in the Sacramento Region that have the most disparate Service Needs and
Need/Receive Gaps. Follow is a more detailed look at demographic disparities by demographic group
and by service categories:
RACE:
• Latinos reported highest Service Needs and Need/Receive Gaps, followed by African Americans,
followed by Whites.
•
For 30% of service categories, Latinos reported Service Needs at rates 10% or higher than the
overall respondent group (Health Education / Risk Reduction, Child Care, Transportation, Home
Health Care and Substance Abuse Outpatient Care).
•
For 25% of services, Latinos reported Service Gaps at rates 10% or higher than respondents overall
(Social Service Case Management, Legal Services, Health Education, Medical Nutrition Therapy
and Health Insurance Assistance).
•
For two service categories, African Americans reported Service Needs at rates 10% or higher than
overall respondents (Legal and Transportation).
•
For three services, African American reported Need/Receive Gaps at rates 10% or higher than
respondents overall (Mental Health Care, Child Care and Emergency Financial Assistance).
•
The only service category for which Whites had a Need/Receive Gap at a rate 10% or higher than
respondents overall was Child Care services (50% gap vs. 32% overall).
GENDER:
• There were no significant disparities between men and women regarding Service Needs.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 64
•
For Service Gaps, females reported Service Gaps at rates 10% or higher than men in 30% of service
categories (Health Insurance Assistance, Medical Nutrition Therapy, Outpatient Substance Abuse,
Child Care, Emergency Financial Assistance and Housing Services).
•
Men reported a higher Gap than women in only one service category: Residential Substance Abuse
Services (44% vs. 20%).
AGE:
• There were no significant disparities between age groups regarding Service Needs.
•
For Service Gaps, respondents ages 20-44 reported Service Gaps at rates 10% or higher than those
ages 45+ in two services (Medical Case Management, Oral Health Care and Emergency Financial
Assistance).
MODE OF TRANSMISSION:
•
IDUs reported Service Gaps of 10% or lower than respondents overall in 40% of service categories
(Home Health Care, Oral Health Care, Health Education/Risk Reduction, Medical Transportation,
Legal Services, Other Support Services, Prevention for Positives and Social Service Case
Management).
•
IDUs reported Service Needs of 10% or higher than overall respondents in four service categories
(Medical Case Management, Outpatient Substance Abuse, Food Bank, Transportation, and Other
Support Services).
•
MSMs did not have any disparate findings in terms of Service Needs or Gaps.
•
Heterosexuals reported only one service, Legal Services, at a rate higher than 10% of respondents
overall (76% vs. 59%).
OTHER TARGET POPULATIONS:
African American Women:
• African American Women reported only two Service Needs (Housing and Transportation) at rates of
10% or higher than respondents overall.
•
African American Women reported Service Gaps of 10% or higher than overall respondents in 35%
of services (Mental Health, Outpatient Medical Care, Outpatient Substance Abuse, Emergency
Financial Assistance, Childcare, Food Bank and Health Education).
•
In only two services, did African American Women report Service Gaps at rates 10% or lower than
overall respondents (Health Insurance Assistance and Residential Substance Abuse).
Homeless:
• Homeless respondents reported Service Needs for 55% of services at rates of 10% or higher than
respondents overall (Medical Nutrition, Mental Health, Outpatient Substance Abuse, Food Bank,
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 65
Health Education / Risk Reduction, Housing, Transportation, Other Support Services, Social Service
Case Management and Residential Substance Abuse).
•
For Service Gaps, however, the Homeless reported rates at 10% or lower than respondents overall
for several services (Health Insurance Assistance, Housing, and Residential Substance Abuse).
Rural PLWH/A:
•
Rural survey respondents had equal or lower Service Needs and Service Gaps than respondents
overall across all service categories.
•
Rural survey respondents reported Service Needs at rates lower than 10% than respondents overall
for 30% of services (Medical Nutrition, Mental Health, Outpatient Substance Abuse, Housing,
Transportation and Other Support Services).
•
For Service Gaps, Rural survey respondents reported rates at 10% or lower than respondents overall
for 40% of services (Health Insurance Assistance, Medical Nutrition Therapy, Outpatient Substance
Abuse, Childcare, Emergency Financial Assistance, Food Bank, social Service Case Management
and Residential Substance Abuse).
f. Implications for Priorities and Allocation Decisions
Follows are examples of funding decisions that can be considered by the Planning Council to
address the services that had the most highly reported Service Need and Need/Receive Gaps, as well as
to address the largest demographic disparities among PLWH/A in the Sacramento Region:
•
Latinos, African American Women and PLWH/A experiencing homelessness reported higher Needs
and Need/Receive Gaps than respondents overall. The Council should consider funding outreach
and other targeted services for these vulnerable populations.
•
Rural survey respondents reported equal or lower Service Needs and Gaps than overall respondents
across all service categories. The Council should continue to allocate funding to the RW Part A
TGA’s rural Counties to allow for local control and contract flexibility to meet the local service
demand when no other funding sources are available.
•
Current trends in medication reimbursement service gap have widened since earlier needs
assessments. While the AIDS Drug Assistance Program (ADAP) supports compensation for some
medications, PLWH/A may need assistance paying for drugs not covered by ADAP.
•
The Council should monitor the impact of Affordable Care Act (ACA) on PLWH/A. While many
RW patients may receive subsidies for insurance premiums, many may need help with expenses not
covered under their out-of-pocket maximum (e.g., deductibles, copayments).
•
Over three-quarters of survey respondents reported needing Medical and Social Service Case
Management, but over one-quarter of those did not receive it. Given how imperative retention in
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 66
ongoing medical care is, the Council should continue to monitor the utilization of Medical and
Social Service Case Management and allocate funds proportionate to current needs.
•
Over three-quarters of survey respondents need Oral Health Care, but over one-quarter of those did
not receive it, even with recent increases in dental care funding. The Council should consider further
funding enhancements to support improved access to Oral Health Care.
•
Over two-thirds of respondents reported needing Mental Health Services, but one-quarter of those
did not receive it. The Council should investigate ways to improve access to, and funding for,
Mental Health Services.
•
Needs, Gaps and Barriers for Transportation Services have worsened since earlier needs
assessments, and RW funding for transportation has dropped significantly over time. The Council
should continue to explore alternate transportation delivery systems and increased allocations to
transport patients to appointments.
•
Over a third of respondents need Treatment Adherence Services; and one-fifth of patients needing
these services do not receive them. This is an area for the Council to consider for increased funding
and program development.
•
Services for food banks, food vouchers, food delivery and medical nutrition therapy had high
Service Needs and Gaps. Current trends worsened since past assessments, while funding decreased.
The Council should consider funding improved access to nutritious food and nutrition services.
•
Latinos, African Americans and African American Women reported higher Service Needs and Gaps
than respondents overall for Childcare, and the Council should consider increased Childcare funding
for these special populations.
E-3. IMPLICATIONS FOR SERVICE SYSTEM IMPROVEMENTS
a. Top Barriers to Care
Nearly one-third of survey respondents reported a gap of more than six months without seeing a
medical provider. A fifth of respondents reported being out of care more than a year at some point.
One-third of respondents said that the most common care setting was in the hospital or emergency room.
Follows are the top 10 Barriers to Care reported by survey respondents:
Rank
1
2
3
4
5
6
7
Table 14: TOP 10 BARRIERS TO CARE
Not knowing that a service or treatment was available to me.
My state of mind or mental ability to deal with the treatment.
Experience or expertise of the person providing the services to me.
Not knowing the location of the service(s).
The amount of time I had to wait between scheduling an appointment
and the actual day of the appointment.
Sensitivity of the organization and person providing services to me
regarding my issues and concerns.
My ability to find my way through the system.
Sacramento Region FY13 HIV/AIDS Needs Assessment
% Agree
Barrier
49%
45%
43%
40%
39%
39%
38%
Page 67
Rank
8
9
10
Table 14: TOP 10 BARRIERS TO CARE
The amount of time I had to wait in the waiting room prior to my
appointment.
Not knowing who to ask for help.
No transportation.
% Agree
Barrier
36%
35%
34%
b. Service System Improvements to Address Barriers to Care and Demographic Disparities
Although not meant to be an exhaustive list of possible strategies, follows are examples of service
system improvements for the Council to consider while addressing the most highly reported Barriers to
Care, and largest demographic disparities, to retain patients in ongoing medical care:
•
Wait times, both before and during the appointment, are reported as Barriers to Care for over a third
of survey respondents. Further research is required to understand the actual extent of the issue and
possible remediation activities that could address patient wait times, and to determine where these
wait times are occurring. The Needs Assessment Survey Tool should be more specific in terms of
“wait times.” Cares Community Health Clinic performs confirmatory lab tests prior to a client’s
initial visit to verify HIV status, and the survey tool should distinguish between wait times for initial
lab work and subsequent medical visits.
•
Sensitivity to patient needs, both by the organizations providing care as well as individual
employees, is among the greatest reported barriers. The Council may consider funding technical
assistance to providers with the goal of increasing sensitivity to the unique needs of PLWH/A and
the various demographic subgroups (i.e., African American Women, Latinos, and the homeless
population – see finding above).
•
Lack of patient awareness also is among those barriers most commonly identified by survey
respondents. Improved outreach to, and case management for, PLWH/A should be a priority for the
Planning Council. For example, Service Providers should work to improve awareness of available
services through direct client contact and broader marketing and social media campaigns. Case
Managers and other support staff should inquire about and work with each client to ensure that
support services are provided to stabilize the person’s life situation (i.e., housing, food,
transportation).
•
To support retention in ongoing medical care, Case Managers and other support staff should make
contact with patients and inquire about and encourage re-entry into medical care. Primary Care
providers should continue to make appointment reminder calls; improve and expand transportation
assistance; and continue to implement/maintain “no-show” tracking and follow up protocols.
•
Service Providers should consider the use of peer advocates to provide outreach to specific
populations and locations to get and retain PLWH/A in ongoing medical care.
•
The Council should consider technical assistance, capacity building and networking with current
organizations throughout the region to educate them about findings and implications of the Needs
Assessment, and to improve the overall system of care for PLWH/A.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 68
•
The Council should network with other organizations throughout the Sacramento Region to
maximize other funding opportunities and services for PLWH/A.
E-4. IMPLICATIONS FOR FUTURE NEEDS ASSESSMENTS
It is important that the Sacramento Region’s Needs Assessment survey tool remain consistent so that
findings can be trended over time; however, a few adjustments need to be made to the survey tool prior
to the next cycle. Follows are several changes that the Needs Assessment Committee members may
wish to consider among any others they see fit:
•
PLWH/A aged between 20 and 44 were significantly under-represented in the FY13 Needs
Assessment, and this should be remediated in the next survey cycle.
•
Survey methods should address the under-representation of youth (ages 19 and under), Whites, and
male PLWH/A in the next survey cycle, or conduct a targeted Needs Assessment for these
subpopulations.
•
Survey methods should continue efforts to reach communities of color, including monolingual
Latinos and Asians.
•
Survey methods should continue efforts to reach the homeless population.
•
Question #35 should also ask if person has been diagnosed with tuberculosis (TB).
•
Question #45 should add a service category for the support service of “pediatric treatment
adherence” under “health services.”
•
Question #46 regarding Barriers to Care, should only ask “Agree/Yes” and delete the option to
answer “Disagree/No.”
•
Barriers to Care regarding waiting times - Question #46 (l) and (m) - should be specific in terms of
timeframes for acceptable “wait times.” For example, “the amount of time I had to wait between
scheduling an appointment and the actual day of the appointment was more than 2 weeks.” Or, “the
amount of time I had to wait in the waiting room was more than an hour prior to being called in on
the day of the appointment.” In addition, the survey tool should distinguish between wait times for
initial lab work appointment and subsequent medical visits.
•
Question #47 about substance use should ask about medically prescribed marijuana separately from
illegally obtained marijuana.
Sacramento Region FY13 HIV/AIDS Needs Assessment
Page 69
APPENDIX
FY 2013 SACRAMENTO REGION
HIV/AIDS NEEDS ASSESSMENT
Attachment 1: Needs Assessment Committee
Attachment 2: Demographic Crosstabs of Needs Assessment Respondents
Attachment 3: Service Needs by Service Category and Demographics
Attachment 4: Service Gaps by Service Category and Demographics
Attachment 5: Barriers to Care by Demographics
Attachment 6: Detailed Survey Results
Attachment 7: FY13 Needs Assessment Survey Tool
70
Attachment 1
HIV Health Services Planning Council
Needs Assessment Committee 2014-2015 Roster
Name
Mahara Leong*
Celina Martinez – Co Chair
Gail Brosnan
Ronnie Miranda
Paula Gammell – Staff
Email
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
* Denotes Committee Chair
3/20/14
71
ATTACHMENT 2
Demographic Crosstabs of Needs Assessment Respondents
Age & Gender
0-19
20-44
45+
Unknown
TOTAL
M
1
46
109
3
159
F
1
19
46
0
66
T
0
2
5
0
7
TOTAL
2
67
160
3
232
0-19
20-44
45+
Unknown
TOTAL
M
0.4%
19.8%
47.0%
1.3%
68.5%
F
0.4%
8.2%
19.8%
0.0%
28.4%
T
0.0%
0.9%
2.2%
0.0%
3.0%
TOTAL
0.9%
28.9%
69.0%
1.3%
100.0%
0-19
20-44
45+
Unknown
TOTAL
M
0.6%
28.9%
68.6%
1.9%
100.0%
F
1.5%
28.8%
69.7%
0.0%
100.0%
T
0.0%
28.6%
71.4%
0.0%
100.0%
TOTAL
0.9%
28.9%
69.0%
1.3%
100.0%
0-19
20-44
45+
Unknown
TOTAL
M
50.0%
68.7%
68.1%
100.0%
68.5%
F
50.0%
28.4%
28.8%
0.0%
28.4%
T
0.0%
3.0%
3.1%
0.0%
3.0%
TOTAL
100.0%
100.0%
100.0%
100.0%
100.0%
72
Age & Transmission
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
0-19
0
0
1
0
0
0
1
2
20-44
35
3
21
1
1
4
2
67
45+
73
20
38
3
9
16
1
160
Unknown
0
1
0
0
0
0
2
3
TOTAL
108
24
60
4
10
20
6
232
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
0-19
0.0%
0.0%
0.4%
0.0%
0.0%
0.0%
0.4%
0.9%
20-44
15.1%
1.3%
9.1%
0.4%
0.4%
1.7%
0.9%
28.9%
45+
31.5%
8.6%
16.4%
1.3%
3.9%
6.9%
0.4%
69.0%
Unknown
0.0%
0.4%
0.0%
0.0%
0.0%
0.0%
0.9%
1.3%
TOTAL
46.6%
10.3%
25.9%
1.7%
4.3%
8.6%
2.6%
100.0%
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
0-19
0.0%
0.0%
50.0%
0.0%
0.0%
0.0%
50.0%
100.0%
20-44
52.2%
4.5%
31.3%
1.5%
1.5%
6.0%
3.0%
100.0%
45+
45.6%
12.5%
23.8%
1.9%
5.6%
10.0%
0.6%
100.0%
Unknown
0.0%
33.3%
0.0%
0.0%
0.0%
0.0%
66.7%
100.0%
TOTAL
46.6%
10.3%
25.9%
1.7%
4.3%
8.6%
2.6%
100.0%
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
0-20
0.0%
0.0%
1.7%
0.0%
0.0%
0.0%
16.7%
0.9%
21-44
32.4%
12.5%
35.0%
25.0%
10.0%
20.0%
33.3%
28.9%
45+
67.6%
83.3%
63.3%
75.0%
90.0%
80.0%
16.7%
69.0%
Unknown
0.0%
4.2%
0.0%
0.0%
0.0%
0.0%
33.3%
1.3%
TOTAL
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
73
Transmission & Gender
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
M
104
12
16
4
5
15
3
159
F
1
12
42
0
4
5
2
66
T
3
0
2
0
1
0
1
7
TOTAL
108
24
60
4
10
20
6
232
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
M
44.8%
5.2%
6.9%
1.7%
2.2%
6.5%
1.3%
68.5%
F
0.4%
5.2%
18.1%
0.0%
1.7%
2.2%
0.9%
28.4%
T
1.3%
0.0%
0.9%
0.0%
0.4%
0.0%
0.4%
3.0%
TOTAL
46.6%
10.3%
25.9%
1.7%
4.3%
8.6%
2.6%
100.0%
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
M
65.4%
7.5%
10.1%
2.5%
3.1%
9.4%
1.9%
100.0%
F
1.5%
18.2%
63.6%
0.0%
6.1%
7.6%
3.0%
100.0%
T
42.9%
0.0%
28.6%
0.0%
14.3%
0.0%
14.3%
100.0%
TOTAL
46.6%
10.3%
25.9%
1.7%
4.3%
8.6%
2.6%
100.0%
MSM
IDU
Heterosexual Transmission
MSM/IDU
Adult Hemophiliac/blood products
Don’t Know
Unknown
TOTAL
M
96.3%
50.0%
26.7%
100.0%
50.0%
75.0%
50.0%
68.5%
F
0.9%
50.0%
70.0%
0.0%
40.0%
25.0%
33.3%
28.4%
T
2.8%
0.0%
3.3%
0.0%
10.0%
0.0%
16.7%
3.0%
TOTAL
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
74
Age & Race
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
0-20
1
0
1
0
0
0
0
2
21-44
17
1
15
1
23
9
1
67
45+
39
2
24
4
82
8
1
160
Unknown
2
0
0
0
1
0
0
3
TOTAL
59
3
40
5
106
17
2
232
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
0-20
0.4%
0.0%
0.4%
0.0%
0.0%
0.0%
0.0%
0.9%
21-44
7.3%
0.4%
6.5%
0.4%
9.9%
3.9%
0.4%
28.9%
45+
16.8%
0.9%
10.3%
1.7%
35.3%
3.4%
0.4%
69.0%
Unknown
0.9%
0.0%
0.0%
0.0%
0.4%
0.0%
0.0%
1.3%
TOTAL
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
0-20
50.0%
0.0%
50.0%
0.0%
0.0%
0.0%
0.0%
100.0%
21-44
25.4%
1.5%
22.4%
1.5%
34.3%
13.4%
1.5%
100.0%
45+
24.4%
1.3%
15.0%
2.5%
51.3%
5.0%
0.6%
100.0%
Unknown
66.7%
0.0%
0.0%
0.0%
33.3%
0.0%
0.0%
100.0%
TOTAL
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
0-20
1.7%
0.0%
2.5%
0.0%
0.0%
0.0%
0.0%
0.9%
21-44
28.8%
33.3%
37.5%
20.0%
21.7%
52.9%
50.0%
28.9%
45+
66.1%
66.7%
60.0%
80.0%
77.4%
47.1%
50.0%
69.0%
Unknown
3.4%
0.0%
0.0%
0.0%
0.9%
0.0%
0.0%
1.3%
TOTAL
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
75
Race & Gender
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
M
33
3
32
3
75
12
1
159
F
25
0
6
1
29
5
0
66
T
1
0
2
1
2
0
1
7
TOTAL
59
3
40
5
106
17
2
232
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
M
14.2%
1.3%
13.8%
1.3%
32.3%
5.2%
0.4%
68.5%
F
10.8%
0.0%
2.6%
0.4%
12.5%
2.2%
0.0%
28.4%
T
0.4%
0.0%
0.9%
0.4%
0.9%
0.0%
0.4%
3.0%
TOTAL
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
M
20.8%
1.9%
20.1%
1.9%
47.2%
7.5%
0.6%
100.0%
F
37.9%
0.0%
9.1%
1.5%
43.9%
7.6%
0.0%
100.0%
T
14.3%
0.0%
28.6%
14.3%
28.6%
0.0%
14.3%
100.0%
TOTAL
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
African American
Asian / Pacific Islander
Latino
Native American
White
More than one
Unknown
TOTAL
M
55.9%
100.0%
80.0%
60.0%
70.8%
70.6%
50.0%
68.5%
F
42.4%
0.0%
15.0%
20.0%
27.4%
29.4%
0.0%
28.4%
T
1.7%
0.0%
5.0%
20.0%
1.9%
0.0%
50.0%
3.0%
TOTAL
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
76
Race & Transmission
MSM
IDU
Heterosexual
Transmission
African
American
Asian / Pacific
Islander
Latino
Native
American
White
More than
one
Unknown
14
2
23
1
59
9
0
108
8
0
4
1
9
2
0
24
TOTAL
27
0
6
0
25
2
0
60
MSM/IDU
Adult Hemophiliac /
blood products
1
0
2
0
1
0
0
4
1
0
0
1
7
1
0
10
Don’t Know
4
1
5
2
5
3
0
20
Unknown
4
0
0
0
0
0
2
6
59
3
40
5
106
17
2
232
African
American
Asian / Pacific
Islander
Latino
Native
American
White
More than
one
Unknown
MSM
6.0%
0.9%
9.9%
0.4%
25.4%
3.9%
0.0%
46.6%
IDU
Heterosexual
Transmission
3.4%
0.0%
1.7%
0.4%
3.9%
0.9%
0.0%
10.3%
TOTAL
TOTAL
11.6%
0.0%
2.6%
0.0%
10.8%
0.9%
0.0%
25.9%
MSM/IDU
Adult Hemophiliac /
blood products
0.4%
0.0%
0.9%
0.0%
0.4%
0.0%
0.0%
1.7%
0.4%
0.0%
0.0%
0.4%
3.0%
0.4%
0.0%
4.3%
Don’t Know
1.7%
0.4%
2.2%
0.9%
2.2%
1.3%
0.0%
8.6%
Unknown
1.7%
0.0%
0.0%
0.0%
0.0%
0.0%
0.9%
2.6%
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
African
American
Asian / Pacific
Islander
Latino
Native
American
White
More than
one
Unknown
MSM
23.7%
66.7%
57.5%
20.0%
55.7%
52.9%
0.0%
46.6%
IDU
Heterosexual
Transmission
13.6%
0.0%
10.0%
20.0%
8.5%
11.8%
0.0%
10.3%
TOTAL
TOTAL
45.8%
0.0%
15.0%
0.0%
23.6%
11.8%
0.0%
25.9%
MSM/IDU
Adult Hemophiliac /
blood products
1.7%
0.0%
5.0%
0.0%
0.9%
0.0%
0.0%
1.7%
1.7%
0.0%
0.0%
20.0%
6.6%
5.9%
0.0%
4.3%
Don’t Know
6.8%
33.3%
12.5%
40.0%
4.7%
17.6%
0.0%
8.6%
Unknown
6.8%
0.0%
0.0%
0.0%
0.0%
0.0%
100.0%
2.6%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
African
American
Asian / Pacific
Islander
Latino
Native
American
White
More than
one
Unknown
TOTAL
MSM
13.0%
1.9%
21.3%
0.9%
54.6%
8.3%
0.0%
100.0%
IDU
Heterosexual
Transmission
33.3%
0.0%
16.7%
4.2%
37.5%
8.3%
0.0%
100.0%
45.0%
0.0%
10.0%
0.0%
41.7%
3.3%
0.0%
100.0%
MSM/IDU
Adult Hemophiliac /
blood products
25.0%
0.0%
50.0%
0.0%
25.0%
0.0%
0.0%
100.0%
10.0%
0.0%
0.0%
10.0%
70.0%
10.0%
0.0%
100.0%
Don’t Know
20.0%
5.0%
25.0%
10.0%
25.0%
15.0%
0.0%
100.0%
8_DK
66.7%
0.0%
0.0%
0.0%
0.0%
0.0%
33.3%
100.0%
Unknown
25.4%
1.3%
17.2%
2.2%
45.7%
7.3%
0.9%
100.0%
TOTAL
77
ATTACHMENT 3
Service Needs by Service Category and Demographics
Overall
Core Service Category Needs: All Respondents (232)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
90
43
169
115
211
162
179
220
80
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Rank
7
9
4
6
2
5
3
1
8
Support Service Category Needs: All Respondents (232)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
19
180
159
93
85
64
127
135
160
184
21
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Rank
11
2
4
7
8
9
6
5
3
1
10
78
African American
Core Service Category Needs: African Americans (59)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
24
14
47
33
55
40
47
56
26
%
41%
24%
80%
56%
93%
68%
80%
95%
44%
Rank
8
9
3
6
2
5
4
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/+2%
+5%
+7%
+6%
+2%
-2%
+3%
+0%
+10%
Support Service Category Needs: African Americans (59)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
12%
85%
71%
47%
51%
34%
73%
66%
78%
85%
8%
Rank
10
1
5
8
7
9
4
6
3
2
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+4%
+7%
+3%
+7%
+14%
+6%
+18%
+8%
+9%
+5%
-1%
7
50
42
28
30
20
43
39
46
50
5
79
Latino
Core Service Category Needs: Latinos (40)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
17
12
29
18
36
30
33
37
18
%
43%
30%
73%
45%
90%
75%
83%
93%
45%
Rank
8
9
5
6
2
4
3
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/+4%
+11%
-0%
-5%
-1%
+5%
+5%
-2%
+11%
Support Service Category Needs: Latinos (40)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
20%
78%
73%
63%
45%
20%
65%
68%
90%
78%
18%
Rank
9
2
4
7
8
10
6
5
1
3
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+12%
-0%
+4%
+22%
+8%
-8%
+10%
+9%
+21%
-2%
+8%
8
31
29
25
18
8
26
27
36
31
7
80
White
Core Service Category Needs: Whites (106)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
39
12
73
50
95
73
82
102
27
%
37%
11%
69%
47%
90%
69%
77%
96%
25%
Rank
7
9
4
6
2
5
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-2%
-7%
-4%
-2%
-1%
-1%
+0%
+1%
-9%
Support Service Category Needs: Whites (106)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
2%
74%
63%
28%
28%
25%
41%
51%
55%
76%
8%
Rank
11
2
3
7
8
9
6
5
4
1
10
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-6%
-4%
-5%
-12%
-8%
-2%
-14%
-7%
-14%
-3%
-2%
2
78
67
30
30
27
43
54
58
81
8
81
Male
Core Service Category Needs: Male (159)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
60
30
112
73
144
108
121
149
53
%
38%
19%
70%
46%
91%
68%
76%
94%
33%
Rank
7
9
4
6
2
5
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-1%
+0%
-2%
-4%
-0%
-2%
-1%
-1%
-1%
Support Service Category Needs: Male (159)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
4%
75%
65%
40%
36%
23%
50%
53%
67%
78%
10%
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-4%
-3%
-4%
+0%
-1%
-4%
-4%
-5%
-2%
-1%
+1%
6
119
103
64
57
37
80
85
107
124
16
82
Female
Core Service Category Needs: Female (66)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
24
11
51
39
60
49
52
64
24
%
36%
17%
77%
59%
91%
74%
79%
97%
36%
Rank
7
9
4
6
2
5
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-2%
-2%
+4%
+10%
-0%
+4%
+2%
+2%
+2%
Support Service Category Needs: Female (66)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
12
55
50
26
25
25
43
45
46
55
5
%
18%
83%
76%
39%
38%
38%
65%
68%
70%
83%
8%
Rank
10
1
3
7
8
9
6
5
4
2
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+10%
+6%
+7%
-1%
+1%
+10%
+10%
+10%
+1%
+4%
-1%
83
Age 20-44
Core Service Category Needs: Age 20-44 (67)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
28
13
49
30
59
47
49
62
27
%
42%
19%
73%
45%
88%
70%
73%
93%
40%
Rank
7
9
3
6
2
5
4
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/+3%
+1%
+0%
-5%
-3%
+0%
-4%
-2%
+6%
Support Service Category Needs: Age 20-44 (67)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
12
55
44
29
32
25
43
43
54
54
9
%
18%
82%
66%
43%
48%
37%
64%
64%
81%
81%
13%
Rank
10
1
4
8
7
9
5
6
2
3
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+10%
+5%
-3%
+3%
+11%
+10%
+9%
+6%
+12%
+1%
+4%
84
Age 45+
Core Service Category Needs: Age 45+ (160)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
59
29
116
80
148
110
125
153
52
%
37%
18%
73%
50%
93%
69%
78%
96%
33%
Rank
7
9
4
6
2
5
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-2%
-0%
-0%
+0%
+2%
-1%
+1%
+1%
-2%
Support Service Category Needs: Age 45+ (160)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
4%
76%
69%
38%
31%
24%
49%
56%
64%
78%
7%
Rank
11
2
3
7
8
9
6
5
4
1
10
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-4%
-2%
+1%
-3%
-5%
-3%
-5%
-3%
-5%
-1%
-2%
6
121
111
60
50
39
79
89
102
125
11
85
MSM
Core Service Category Needs: MSM (108)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
41
20
70
46
99
72
81
101
35
%
38%
19%
65%
43%
92%
67%
75%
94%
32%
Rank
7
9
5
6
2
4
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-1%
-0%
-8%
-7%
+1%
-3%
-2%
-1%
-2%
Support Service Category Needs: MSM (108)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
3%
73%
59%
33%
35%
23%
46%
54%
65%
71%
10%
Rank
11
1
4
8
7
9
6
5
3
2
10
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-5%
-4%
-9%
-7%
-1%
-4%
-8%
-4%
-4%
-8%
+1%
3
79
64
36
38
25
50
58
70
77
11
86
IDU
Core Service Category Needs: IDU (24)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
Support Service Category Needs: IDU (24)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
6
6
20
14
19
17
19
24
12
4
19
20
10
7
4
19
18
17
20
0
%
25%
25%
83%
58%
79%
71%
79%
100%
50%
Rank
8
9
2
6
4
5
3
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-14%
+6%
+10%
+9%
-12%
+1%
+2%
+5%
+16%
%
17%
79%
83%
42%
29%
17%
79%
75%
71%
83%
0%
Rank
9
3
1
7
8
10
4
5
6
2
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+8%
+2%
+15%
+2%
-7%
-11%
+24%
+17%
+2%
+4%
-9%
87
Heterosexual
Core Service Category Needs: Heterosexual (60)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
21
8
46
32
54
41
48
57
22
%
35%
13%
77%
53%
90%
68%
80%
95%
37%
Rank
8
9
4
6
2
5
3
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-4%
-5%
+4%
+4%
-1%
-1%
+3%
+0%
+2%
Support Service Category Needs: Heterosexual (60)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
12%
82%
77%
48%
43%
32%
62%
60%
73%
85%
10%
Rank
10
2
3
7
8
9
5
6
4
1
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+3%
+4%
+8%
+8%
+7%
+4%
+7%
+2%
+4%
+6%
+1%
7
49
46
29
26
19
37
36
44
51
6
88
African American Female
Core Service Category Needs: African-American Female (25)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Needs: African-American Female
(25)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
10
6
19
12
24
16
21
24
10
%
40%
24%
76%
48%
96%
64%
84%
96%
40%
Rank
7
9
4
6
1
5
3
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/+1%
+5%
+3%
-2%
+5%
-6%
+7%
+1%
+6%
#
%
16%
84%
68%
40%
48%
36%
76%
68%
68%
76%
4%
Rank
10
1
4
8
7
9
2
4
4
2
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/+8%
+6%
-1%
-0%
+11%
+8%
+21%
+10%
-1%
-3%
-5%
4
21
17
10
12
9
19
17
17
19
1
89
Homeless
Core Service Category Needs: Homeless (41)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
19
10
31
29
37
36
30
38
26
%
46%
24%
76%
71%
90%
88%
73%
93%
63%
Rank
8
9
4
6
2
3
5
1
7
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/+8%
+6%
+3%
+21%
-1%
+18%
-4%
-2%
+29%
Support Service Category Needs: Homeless (41)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
7%
85%
90%
66%
76%
34%
90%
73%
85%
90%
32%
Rank
11
4
1
8
6
9
1
7
4
1
10
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-1%
+8%
+22%
+26%
+39%
+7%
+36%
+15%
+16%
+11%
+23%
3
35
37
27
31
14
37
30
35
37
13
90
Rural
Core Service Category Needs: Rural (51)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
#
19
5
36
20
47
27
38
48
8
%
37%
10%
71%
39%
92%
53%
75%
94%
16%
Rank
7
9
4
6
2
5
3
1
8
Overall
Rank
7
9
4
6
2
5
3
1
8
Overall
%
39%
19%
73%
50%
91%
70%
77%
95%
34%
Overall
+/-2%
-9%
-2%
-10%
+1%
-17%
-3%
-1%
-19%
Support Service Category Needs: Rural (51)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
#
%
6%
78%
73%
31%
22%
18%
41%
39%
65%
80%
4%
Rank
10
2
3
7
8
9
5
6
4
1
11
Overall
Rank
11
2
4
7
8
9
6
5
3
1
10
Overall
%
8%
78%
69%
40%
37%
28%
55%
58%
69%
79%
9%
Overall
+/-2%
+1%
+4%
-9%
-15%
-10%
-14%
-19%
-4%
+1%
-5%
3
40
37
16
11
9
21
20
33
41
2
91
ATTACHMENT 4
Service Gaps by Service Category and Demographics
Overall
Core Service Category Need/Receive Gap: All Respondents (232)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: All Respondents (232)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
90
43
169
115
211
162
179
220
80
Did Not
Receive
20
8
31
20
25
43
46
26
15
Need /
Receive
Gap%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Needed
19
180
159
93
85
64
127
135
160
184
21
Did Not
Receive
6
84
38
9
30
38
46
68
19
46
8
Need /
Receive
Gap%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Gap
Rank
3
5
6
7
8
1
2
9
4
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
92
African American
Core Service Category Need/Receive Gap: African Americans (59)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: African Americans
(59)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
24
14
47
33
55
40
47
56
26
Did Not
Receive
4
3
8
4
10
15
14
12
4
Need /
Receive
Gap%
17%
21%
17%
12%
18%
38%
30%
21%
15%
Needed
7
50
42
28
30
20
43
39
46
50
5
Did Not
Receive
3
30
13
4
10
13
15
18
3
16
2
Need /
Receive
Gap%
43%
60%
31%
14%
33%
65%
35%
46%
7%
32%
40%
7
3
6
9
5
1
2
3
8
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-6%
+3%
-1%
-5%
+6%
+11%
+4%
+10%
-3%
4
2
9
10
7
1
6
3
11
8
5
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+11%
+13%
+7%
+5%
-2%
+6%
-1%
-4%
-5%
+7%
+2%
Gap
Rank
Gap
Rank
93
Latino
Core Service Category Need/Receive Gap: Latinos (40)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Latinos (40)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
17
12
29
18
36
30
33
37
18
Did Not
Receive
6
3
12
6
7
5
9
6
5
Need /
Receive
Gap%
35%
25%
41%
33%
19%
17%
27%
16%
28%
Needed
8
31
29
25
18
8
26
27
36
31
7
Did Not
Receive
2
12
8
5
8
6
9
15
7
13
3
Need /
Receive
Gap%
25%
39%
28%
20%
44%
75%
35%
56%
19%
42%
43%
2
6
1
3
7
8
5
9
4
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/+13%
+6%
+23%
+16%
+8%
-10%
+2%
+4%
+9%
9
6
8
10
3
1
7
2
11
5
4
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/-7%
-8%
+4%
+10%
+9%
+16%
-2%
+5%
+8%
+17%
+5%
Gap
Rank
Gap
Rank
94
White
Core Service Category Need/Receive Gap: Whites (106)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Whites (106)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
39
12
73
50
95
73
82
102
27
Did Not
Receive
9
1
9
8
5
18
20
5
5
Need /
Receive
Gap%
23%
8%
12%
16%
5%
25%
24%
5%
19%
Needed
2
78
67
30
30
27
43
54
58
81
8
Did Not
Receive
1
32
12
0
9
15
18
28
8
14
2
Need /
Receive
Gap%
50%
41%
18%
0%
30%
56%
42%
52%
14%
17%
25%
3
7
6
5
8
1
2
9
4
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/+1%
-10%
-6%
-1%
-7%
-2%
-1%
-7%
-0%
3
5
8
11
6
1
4
2
10
9
7
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+18%
-6%
-6%
-10%
-5%
-4%
+6%
+1%
+2%
-8%
-13%
Gap
Rank
Gap
Rank
95
Male
Core Service Category Need/Receive Gap: Male (159)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Male (159)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
60
30
112
73
144
108
121
149
53
Did Not
Receive
12
6
24
15
18
28
30
16
12
Need /
Receive
Gap%
20%
20%
21%
21%
13%
26%
25%
11%
23%
Needed
6
119
103
64
57
37
80
85
107
124
16
Did Not
Receive
1
51
24
7
19
23
31
47
11
32
7
Need /
Receive
Gap%
17%
43%
23%
11%
33%
62%
39%
55%
10%
26%
44%
6
6
4
5
8
1
2
9
3
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-2%
+1%
+3%
+3%
+1%
-1%
-1%
-1%
+4%
9
4
8
10
6
1
5
2
11
7
3
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/-15%
-4%
-1%
+1%
-2%
+3%
+3%
+5%
-2%
+1%
+6%
Gap
Rank
Gap
Rank
96
Female
Core Service Category Need/Receive Gap: Female (66)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Female (66)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
24
11
51
39
60
49
52
64
24
Did Not
Receive
14
3
4
15
1
6
6
6
10
Need /
Receive
Gap%
58%
27%
8%
38%
2%
12%
12%
9%
42%
Needed
12
55
50
26
25
25
43
45
46
55
5
Did Not
Receive
4
32
13
2
10
14
14
19
7
12
1
Need /
Receive
Gap%
33%
58%
26%
8%
40%
56%
33%
42%
15%
22%
20%
1
4
8
3
9
5
6
7
2
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/+36%
+9%
-11%
+21%
-10%
-14%
-14%
-2%
+23%
5
1
7
11
4
2
6
3
10
8
9
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+2%
+12%
+2%
-2%
+5%
-3%
-4%
-8%
+3%
-3%
-18%
Gap
Rank
Gap
Rank
97
Age 20-44
Core Service Category Need/Receive Gap: Age 20-44 (67)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Age 20-44 (67)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
28
13
49
30
59
47
49
62
27
Did Not
Receive
6
5
16
7
10
16
18
8
3
Need /
Receive
Gap%
21%
38%
33%
23%
17%
34%
37%
13%
11%
Needed
12
55
44
29
32
25
43
43
54
54
9
Did Not
Receive
4
32
13
5
11
17
17
22
6
17
3
Need /
Receive
Gap%
33%
58%
30%
17%
34%
68%
40%
51%
11%
31%
33%
6
1
4
5
7
3
2
8
9
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-1%
+20%
+14%
+6%
+5%
+7%
+11%
+1%
-8%
6
2
9
10
5
1
4
3
11
8
6
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+2%
+12%
+6%
+8%
-1%
+9%
+3%
+1%
-1%
+6%
-5%
Gap
Rank
Gap
Rank
98
Age 45+
Core Service Category Need/Receive Gap: Age 45+ (160)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Age 45+ (160)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
59
29
116
80
148
110
125
153
52
Did Not
Receive
14
3
15
12
15
26
26
16
12
Need /
Receive
Gap%
24%
10%
13%
15%
10%
24%
21%
10%
23%
Needed
6
121
111
60
50
39
79
89
102
125
11
Did Not
Receive
2
51
23
4
19
21
27
44
13
28
5
Need /
Receive
Gap%
33%
42%
21%
7%
38%
54%
34%
49%
13%
22%
45%
1
8
6
5
9
2
4
7
3
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/+2%
-8%
-5%
-2%
-2%
-3%
-5%
-1%
+4%
7
4
9
11
5
1
6
2
10
8
3
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+2%
-5%
-3%
-3%
+3%
-6%
-2%
-1%
+1%
-3%
+7%
Gap
Rank
Gap
Rank
99
MSM
Core Service Category Need/Receive Gap: MSM (108)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: MSM (108)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
41
20
70
46
99
72
81
101
35
Did Not
Receive
9
6
17
9
12
19
23
10
9
Need /
Receive
Gap%
22%
30%
24%
20%
12%
26%
28%
10%
26%
Needed
3
79
64
36
38
25
50
58
70
77
11
Did Not
Receive
1
33
18
5
14
19
22
31
8
22
5
Need /
Receive
Gap%
33%
42%
28%
14%
37%
76%
44%
53%
11%
29%
45%
6
1
5
7
8
3
2
9
4
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-0%
+11%
+6%
+2%
+0%
-0%
+3%
-2%
+7%
7
5
9
10
6
1
4
2
11
8
3
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+2%
-5%
+4%
+4%
+2%
+17%
+8%
+3%
-0%
+4%
+7%
Gap
Rank
Gap
Rank
100
IDU
Core Service Category Need/Receive Gap: IDU (24)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: IDU (24)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
6
6
20
14
19
17
19
24
12
Did Not
Receive
1
0
3
4
3
4
2
4
2
Need /
Receive
Gap%
17%
0%
15%
29%
16%
24%
11%
17%
17%
Needed
4
19
20
10
7
4
19
18
17
20
0
Did Not
Receive
1
8
3
0
2
0
4
6
0
3
0
Need /
Receive
Gap%
25%
42%
15%
0%
29%
0%
21%
33%
0%
15%
NA
3
9
7
1
6
2
8
3
3
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-6%
-19%
-3%
+11%
+4%
-3%
-15%
+5%
-2%
4
1
6
8
3
8
5
2
8
6
NA
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/-7%
-5%
-9%
-10%
-7%
-59%
-15%
-17%
-12%
-10%
NA
Gap
Rank
Gap
Rank
101
Heterosexual
Core Service Category Need/Receive Gap: Heterosexual (60)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Heterosexual (60)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
21
8
46
32
54
41
48
57
22
Did Not
Receive
3
1
7
3
5
14
12
6
2
Need /
Receive
Gap%
14%
13%
15%
9%
9%
34%
25%
11%
9%
Needed
7
49
46
29
26
19
37
36
44
51
6
Did Not
Receive
3
26
14
3
11
11
10
17
8
13
2
Need /
Receive
Gap%
43%
53%
30%
10%
42%
58%
27%
47%
18%
25%
33%
4
5
3
7
8
1
2
6
9
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-8%
-6%
-3%
-8%
-3%
+8%
-1%
-1%
-10%
4
2
7
11
5
1
8
3
10
9
6
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+11%
+6%
+7%
+1%
+7%
-1%
-9%
-3%
+6%
+0%
-5%
Gap
Rank
Gap
Rank
102
African American Female
Core Service Category Need/Receive Gap: African-American Female (25)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: African-American Female (25)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
10
6
19
12
24
16
21
24
10
Did Not
Receive
1
1
2
1
3
7
8
7
1
Need /
Receive
Gap%
10%
17%
11%
8%
13%
44%
38%
29%
10%
Needed
4
21
17
10
12
9
19
17
17
19
1
Did Not
Receive
2
13
7
2
5
6
7
7
2
6
0
Need /
Receive
Gap%
50%
62%
41%
20%
42%
67%
37%
41%
12%
32%
0%
7
4
6
9
5
1
2
3
7
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-12%
-2%
-8%
-9%
+1%
+17%
+12%
+17%
-9%
3
2
5
9
4
1
7
5
10
8
11
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+18%
+15%
+17%
+10%
+6%
+7%
+1%
-9%
-0%
+7%
-38%
Gap
Rank
Gap
Rank
103
Homeless
Core Service Category Need/Receive Gap: Homeless (41)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Homeless (41)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
19
10
31
29
37
36
30
38
26
Did Not
Receive
2
1
6
6
4
11
10
6
4
Need /
Receive
Gap%
11%
10%
19%
21%
11%
31%
33%
16%
15%
Needed
3
35
37
27
31
14
37
30
35
37
13
Did Not
Receive
1
18
9
3
7
8
15
12
3
11
3
Need /
Receive
Gap%
33%
51%
24%
11%
23%
57%
41%
40%
9%
30%
23%
8
9
4
3
7
2
1
5
6
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-12%
-9%
+1%
+3%
-1%
+4%
+8%
+4%
-3%
5
2
7
10
9
1
3
4
11
6
8
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/+2%
+5%
+0%
+1%
-13%
-2%
+4%
-10%
-3%
+5%
-15%
Gap
Rank
Gap
Rank
104
Rural
Core Service Category Need/Receive Gap: Rural (51)
Health Insurance Assistance
Home Health Care
Medical Case Management
Medical Nutrition Therapy
Medications
Mental Health Services
Oral Health Care
Outpatient Medical Care
Substance Abuse Outpatient Care
Support Service Category Need/Receive Gap: Rural (51)
Child Care Services
Emergency Financial Assistance
Food Bank / Home Delivered Meals
Health Education / Risk Reduction
Housing Services
Legal Services
Medical Transportation Services
Other Support Services
Prevention for Positives
Social Service Case Management
Substance Abuse Residential Care
Needed
19
5
36
20
47
27
38
48
8
Did Not
Receive
2
1
6
0
1
6
8
3
3
Need /
Receive
Gap%
11%
20%
17%
0%
2%
22%
21%
6%
38%
Needed
3
40
37
16
11
9
21
20
33
41
2
Did Not
Receive
0
10
4
1
4
6
8
10
3
4
0
Need /
Receive
Gap%
0%
25%
11%
6%
36%
67%
38%
50%
9%
10%
0%
6
4
5
9
8
2
3
7
1
Overall
Gap
Rank
3
5
6
7
8
1
2
9
4
Overall
Gap
%
22%
19%
18%
17%
12%
27%
26%
12%
19%
Overall
+/-12%
+1%
-2%
-17%
-10%
-4%
-5%
-6%
+19%
Gap
Rank
10
5
6
9
4
1
3
2
8
7
10
Overall
Gap
Rank
7
3
9
11
6
1
5
2
10
8
4
Overall
Gap
%
32%
47%
24%
10%
35%
59%
36%
50%
12%
25%
38%
Overall
+/-32%
-22%
-13%
-3%
+1%
+7%
+2%
-0%
-3%
-15%
-38%
Gap
Rank
105
ATTACHMENT 5
Barriers to Care by Demographics
Overall
Barriers: Overall
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
106
African American
Barriers: African-Americans
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
47%
41%
46%
38%
41%
41%
39%
39%
34%
42%
37%
29%
23%
32%
39%
21%
24%
22%
21%
25%
22%
25%
37%
22%
25%
17%
24%
17%
12%
19%
8%
14%
4%
Rank
1
5
2
10
5
4
7
8
13
3
11
15
21
14
8
25
19
22
26
16
22
16
11
22
16
28
20
28
31
27
32
30
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-2%
-4%
+3%
-2%
+1%
+2%
+2%
+3%
-1%
+8%
+6%
-1%
-5%
+6%
+13%
-5%
-2%
-4%
-5%
+2%
-0%
+4%
+18%
+3%
+6%
-0%
+9%
+2%
-1%
+6%
-1%
+4%
-6%
107
Latino
Barriers: Latino
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
53%
59%
70%
53%
63%
48%
43%
43%
45%
50%
49%
45%
45%
33%
40%
30%
35%
36%
38%
30%
40%
35%
18%
28%
28%
26%
21%
15%
26%
11%
30%
23%
8%
Rank
4
3
1
4
2
8
12
12
9
6
7
9
9
20
14
21
18
17
16
21
14
18
30
24
25
26
29
31
26
32
21
28
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+3%
+14%
+27%
+13%
+24%
+9%
+5%
+7%
+10%
+16%
+18%
+15%
+17%
+6%
+14%
+4%
+9%
+10%
+13%
+7%
+18%
+14%
-2%
+9%
+8%
+8%
+5%
+0%
+13%
-2%
+20%
+13%
-1%
108
White
Barriers: White
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
50%
43%
35%
35%
33%
34%
37%
34%
35%
26%
23%
29%
27%
22%
15%
28%
25%
25%
25%
20%
15%
15%
15%
15%
14%
15%
9%
16%
9%
11%
6%
3%
9%
Rank
1
2
5
4
9
8
3
7
5
13
17
10
12
18
23
11
15
14
15
19
26
23
21
21
27
23
29
20
29
28
32
33
31
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+1%
-2%
-8%
-4%
-6%
-5%
-1%
-2%
-0%
-8%
-9%
-2%
-1%
-4%
-11%
+2%
-1%
-0%
-1%
-3%
-7%
-6%
-4%
-4%
-5%
-2%
-6%
+1%
-3%
-2%
-4%
-7%
-1%
109
Male
Barriers: Male
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
49%
47%
45%
41%
39%
40%
39%
37%
38%
34%
30%
35%
30%
25%
25%
27%
25%
30%
27%
25%
26%
20%
18%
22%
22%
18%
15%
17%
15%
12%
9%
7%
10%
Rank
1
2
3
4
6
5
7
9
8
11
12
10
13
21
19
15
18
14
16
20
17
24
26
22
23
25
29
27
28
30
32
33
31
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+0%
+3%
+2%
+2%
-0%
+1%
+1%
+1%
+2%
-0%
-1%
+5%
+2%
-1%
-1%
+2%
-0%
+4%
+2%
+2%
+4%
-1%
-2%
+3%
+2%
+1%
-1%
+2%
+3%
-0%
-1%
-3%
+0%
110
Female
Barriers: Female
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
48%
40%
36%
35%
39%
34%
33%
35%
32%
36%
32%
18%
22%
29%
27%
22%
24%
15%
18%
18%
14%
24%
23%
12%
15%
14%
18%
11%
5%
12%
12%
14%
6%
Rank
1
2
4
6
3
8
9
6
10
4
10
20
17
12
13
17
14
23
20
20
25
14
16
28
23
25
19
31
33
28
28
25
32
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-1%
-5%
-6%
-5%
+0%
-5%
-4%
-1%
-4%
+2%
+1%
-12%
-6%
+3%
+1%
-4%
-1%
-10%
-7%
-5%
-9%
+3%
+3%
-7%
-4%
-4%
+3%
-4%
-8%
-0%
+2%
+4%
-3%
111
Age 20-44
Barriers: 20-44
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
55%
45%
51%
42%
43%
52%
45%
45%
39%
48%
42%
30%
30%
37%
40%
33%
36%
28%
27%
25%
31%
33%
21%
26%
28%
22%
24%
14%
13%
11%
18%
13%
11%
Rank
1
5
3
9
8
2
6
7
12
4
9
19
18
13
11
15
14
20
22
24
17
16
27
23
20
26
25
29
30
32
28
30
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+6%
+1%
+8%
+2%
+4%
+13%
+8%
+9%
+3%
+14%
+11%
-0%
+2%
+11%
+14%
+8%
+10%
+3%
+2%
+2%
+9%
+12%
+2%
+7%
+9%
+5%
+9%
-1%
+1%
-1%
+8%
+4%
+1%
112
Age 45+
Barriers: 45+
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
47%
44%
38%
39%
36%
33%
34%
32%
33%
28%
25%
30%
27%
21%
20%
23%
21%
24%
24%
22%
19%
15%
18%
16%
15%
15%
11%
15%
11%
13%
6%
8%
9%
Rank
1
2
4
3
5
7
6
9
7
11
13
10
12
19
20
16
18
15
14
17
21
24
22
23
24
27
29
24
29
28
33
32
31
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-3%
-1%
-5%
-1%
-3%
-6%
-4%
-4%
-2%
-6%
-6%
-0%
-1%
-5%
-6%
-3%
-4%
-2%
-1%
-1%
-4%
-6%
-1%
-3%
-4%
-3%
-4%
+0%
-1%
+0%
-4%
-1%
-1%
113
MSM
Barriers: MSM
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
50%
46%
41%
38%
34%
44%
38%
40%
34%
35%
26%
31%
29%
23%
19%
25%
26%
29%
30%
23%
26%
19%
16%
21%
19%
18%
13%
17%
14%
11%
9%
8%
5%
Rank
1
2
4
7
9
3
6
5
10
8
15
11
13
20
22
18
15
13
12
19
15
23
27
21
23
25
29
26
28
30
31
32
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+0%
+1%
-2%
-1%
-5%
+5%
+1%
+4%
-1%
+1%
-5%
+0%
+1%
-3%
-7%
-1%
+0%
+3%
+5%
-0%
+4%
-3%
-3%
+1%
-0%
+0%
-2%
+2%
+1%
-1%
-1%
-1%
-5%
114
IDU
Barriers: IDU
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
50%
42%
29%
42%
25%
33%
32%
38%
42%
35%
17%
26%
13%
29%
22%
17%
9%
17%
13%
17%
8%
17%
33%
26%
13%
22%
17%
9%
13%
4%
4%
17%
0%
Rank
1
2
10
2
14
7
9
5
2
6
17
12
24
10
15
17
29
17
24
22
30
22
7
12
27
15
17
28
24
31
31
17
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+1%
-3%
-14%
+2%
-14%
-6%
-6%
+2%
+6%
+1%
-14%
-4%
-15%
+3%
-4%
-8%
-17%
-8%
-12%
-7%
-14%
-5%
+14%
+7%
-7%
+4%
+2%
-6%
+0%
-8%
-6%
+8%
-9%
115
Heterosexual
Barriers: Heterosexual
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
40%
42%
42%
35%
45%
32%
32%
28%
30%
32%
35%
23%
20%
23%
33%
25%
27%
17%
22%
20%
15%
22%
22%
13%
15%
13%
15%
12%
7%
17%
13%
8%
6%
Rank
4
2
2
5
1
8
9
12
11
10
5
15
20
15
7
14
13
23
17
21
25
17
17
27
25
27
24
30
32
22
27
31
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-9%
-3%
-1%
-5%
+6%
-7%
-6%
-8%
-5%
-3%
+4%
-7%
-8%
-3%
+7%
-1%
+1%
-9%
-4%
-3%
-7%
+0%
+2%
-6%
-4%
-4%
+0%
-3%
-6%
+5%
+3%
-1%
-3%
116
African American Female
Barriers: African American Female
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
48%
32%
36%
36%
36%
42%
43%
44%
32%
52%
40%
12%
17%
36%
28%
13%
28%
20%
20%
28%
16%
32%
36%
16%
28%
12%
28%
20%
4%
20%
12%
12%
0%
Rank
2
12
7
7
7
5
4
3
12
1
6
28
24
7
15
27
15
20
20
15
25
12
7
25
15
28
15
20
32
20
28
28
33
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-1%
-13%
-7%
-4%
-3%
+3%
+6%
+8%
-3%
+18%
+9%
-18%
-11%
+10%
+2%
-13%
+2%
-6%
-5%
+5%
-6%
+11%
+16%
-3%
+9%
-5%
+13%
+5%
-9%
+8%
+2%
+2%
-9%
117
Homeless
Barriers: Homeless
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
51%
51%
41%
46%
43%
54%
46%
54%
37%
55%
37%
23%
38%
24%
23%
38%
25%
39%
31%
29%
27%
34%
33%
27%
22%
22%
30%
13%
20%
8%
10%
5%
17%
Rank
4
4
9
6
8
2
7
2
13
1
13
24
11
23
24
12
22
10
17
19
20
15
16
20
26
26
18
30
28
32
31
33
29
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/+2%
+6%
-1%
+7%
+3%
+15%
+8%
+18%
+1%
+21%
+5%
-8%
+11%
-2%
-3%
+12%
-1%
+13%
+5%
+6%
+4%
+13%
+13%
+8%
+3%
+5%
+15%
-2%
+7%
-5%
+0%
-5%
+7%
118
Rural
Barriers: Rural
Unaware of Service
State of Mind
Provider Expertise
Not Knowing Service Location
Scheduling Wait Time
Lack of Provider Sensitivity
Inability to Navigate the System
Waiting Room Time
Not Knowing Who to Ask
Lack of Transportation
Inability to Communicate
Too Much Paperwork
Too Many Rules
Not Understanding Instructions
Lack of Confidentiality
Inadequate Insurance
Ineligible for Service
Denied Service in Past
Unable to Afford Service
Help Not Needed for HIV/AIDS
Felt Like a Number
Experienced Discrimination
Health Prevents Travel
Referrals Not Provided
Not Knowing Service Needs
Provider Not Helpful
Do Not Get Along with Provider
Specialist Not Available
Criminal Justice Barrier
Suspended from Getting Service
Deportation Fear
No Childcare
Other Barriers
% Agree
45%
35%
31%
39%
25%
25%
24%
24%
29%
25%
14%
22%
20%
18%
16%
24%
20%
24%
22%
16%
18%
10%
8%
8%
12%
10%
4%
16%
8%
6%
2%
4%
13%
Rank
1
3
4
2
6
6
9
11
5
6
22
13
15
17
19
11
15
10
13
19
18
26
29
27
24
25
31
19
27
30
33
32
23
Overall
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Overall
%
49%
45%
43%
40%
39%
39%
38%
36%
35%
34%
31%
30%
28%
26%
26%
26%
26%
26%
25%
23%
22%
21%
20%
19%
19%
17%
15%
15%
13%
12%
10%
10%
9%
Overall
+/-4%
-9%
-11%
-0%
-14%
-13%
-13%
-12%
-6%
-9%
-17%
-9%
-8%
-8%
-10%
-2%
-6%
-2%
-4%
-8%
-5%
-11%
-12%
-11%
-7%
-7%
-11%
+1%
-5%
-6%
-8%
-6%
+3%
119
ATTACHMENT 6
DETAILED SURVEY RESULTS
1. Are you currently...
Status
HIV+ with symptoms
HIV+ with no symptoms
HIV negative
N/A
TOTAL
#
107
124
0
1
232
%
46%
53%
0%
0.4%
100%
2. When were you born? (based on year of birth)
Age Group
0-19
20-44
45+
UNK
TOTAL
#
2
67
160
3
232
%
1%
29%
69%
1%
100%
3. Are you...
Gender
Male
Female
Transgender – Male to Female (MTF)
Transgender – Female to Male (FTM)
Intersex
TOTAL
#
159
66
5
1
1
232
%
69%
28%
2%
0%
0%
100%
4. What do you consider your ethnic background?
Ethnicity
African American / Black
Asian Pacific Islander
Hispanic / Latino
Native American
White / Caucasian (non-Hispanic)
More Than One
N/A
TOTAL
#
59
3
40
5
106
17
2
232
%
25%
1%
17%
2%
46%
7%
1%
100%
120
4a. What language(s) do you speak most frequently at home?
Language
English
Spanish
Other
TOTAL
#
216
14
2
232
%
93%
6%
1%
100%
5. Do you consider yourself...
Sexual Orientation
Heterosexual/Straight
Homosexual - Gay male
Homosexual - Lesbian
Bisexual
Other
N/A
TOTAL
#
98
101
3
17
11
2
232
%
42%
44%
1%
7%
5%
1%
100%
6. What is the highest level of education you completed?
Education
Grade school or less
Some high school
Graduated High School/GED/trade school
Some College / 2 year college degree
Completed 4 year College
Graduate School
N/A
TOTAL
#
11
35
79
81
16
9
1
232
%
5%
15%
34%
35%
7%
4%
0.4%
100%
7. What is the zip code and city and/or neighborhood where you live? (based on zip code)
County
El Dorado
Placer
Sacramento
Yolo
4Other
TOTAL
#
14
15
178
22
3
232
%
6%
6%
77%
9%
1%
100%
121
8. Where do you currently live?
Place of Residence
In my own apartment/house I own
In my own apartment/house I rent
At my parent's/relative's apt./house
Living/crashing with someone and not paying rent
Single Room Occupancy (SRO) with tenancy
Single Room Occupancy (SRO) without tenancy
In a "supportive living" facility (Assisted Living Facility)
In a group home or residence including residential drug therapy
In a half-way house or transitional housing
Skilled Nursing Home
Homeless (on the street/in car)
Homeless shelter
Jail or Correctional Facility
Hospital/Institution
Residential Hospice Facility
Other
N/A
TOTAL
#
37
128
22
8
4
0
4
4
5
0
6
5
0
0
0
6
3
232
%
16%
55%
9%
3%
2%
0%
2%
2%
2%
0%
3%
2%
0%
0%
0%
3%
1%
100%
9. How much do you pay monthly for housing?
Amount (of those responding)
Average
Minimum
Maximum
Total Respondents
$
447
0
2,120
215
10a. Is your living situation safe?
Response
Yes
No
N/A
TOTAL
#
206
14
12
232
%
89%
6%
5%
100%
10b. Is your living situation habitable (clean and livable)?
Response
Yes
No
N/A
TOTAL
#
191
7
34
232
%
82%
3%
15%
100%
122
10c. Is your living situation stable?
Response
Yes
No
N/A
TOTAL
#
187
18
27
232
%
81%
8%
12%
100%
11. Are you on a waiting list to get into housing?
Response
Yes
No
N/A
TOTAL
#
%
47
157
28
232
20%
68%
12%
100%
11a. Have you even been on a waiting list for housing?
Response
Yes
No
TOTAL
#
108
124
232
%
47%
53%
100%
11b. If not placed, why not?
Reason
Substance Abuse
Pets
Incarceration
Criminal Record
Significant Other’s Rental History
Rental History
Significant Other’s Rental History
Not enough money
Housing Location
Mental Health
Physical Health
Lack of transportation where housing available
Other
#
9
3
4
6
0
4
0
11
5
4
3
4
22
%
4%
1%
2%
3%
0%
2%
0%
5%
2%
2%
1%
2%
9%
123
12. Have you ever received a referral for housing?
Response
Yes
No
TOTAL
#
81
151
232
%
35%
65%
100%
12a. If you received a referral for housing, did it result in a housing placement?
Response
Yes
No
TOTAL
#
66
166
232
%
28%
72%
100%
13. In your household, how many…
…Other adults are living with you?
People
0
1
2
3
4
5
9
11
12
N/A
TOTAL
#
74
70
35
12
4
3
1
2
2
29
232
%
32%
30%
15%
5%
2%
1%
0.4%
1%
1%
13%
100%
…Children and teens are living with you?
People
0
1
2
3
4
5
N/A
TOTAL
#
134
22
8
6
5
1
56
232
%
58%
9%
3%
3%
2%
0%
24%
100%
124
13a. Is anyone else in your household HIV positive?
Response
Partner/wife/husband
Adult family member/relative
Other adults
Children
Yes
28
5
24
3
No
101
98
94
101
Don’t Know
4
3
7
4
N/A
99
126
107
124
TOTAL
232
232
232
232
% Yes
12%
2%
10%
1%
14. Over the last two years, have you lived in each of the places listed below?
Place
In a half-way house or transitional housing
In a treatment facility (drug or psychiatric)
Homeless (on the street/in car)
Homeless shelter
Jail or correctional facility
Other
#
27
16
31
22
22
8
%
12%
7%
13%
9%
9%
3%
15. What best describes your current job (work) situation?
Work Situation
Employed full-time
Employed part-time
Not working - looking for work
Not working - student/homemaker/other
Not working - not looking for work
Retired
Other
N/A
TOTAL
#
17
21
26
21
98
28
19
2
232
%
7.3%
9.1%
11.2%
9.1%
42.2%
12.1%
8.2%
0.9%
100.0%
16. What is your reported estimated yearly income from all sources and before taxes?
Income
$8,600 or less (up to $713 a month)
$8,601 - $11,600 ($717 - $967 a month)
$11,601 - $16,500 ($968 - $1375 a month)
$16,501 - $23,200 ($1376 - $1933 a month)
$23,201 - $26,000 ($1934 - $2167 a month)
$26,001 - $35,000 ($2168 - $2917 a month)
Greater than $35,001 ($2918 or more a month)
N/A
TOTAL
#
74
85
37
13
4
8
9
2
232
%
32%
37%
16%
6%
2%
3%
4%
1%
100%
125
17. Do you have any health insurance?
Response
Yes
No
N/A
TOTAL
#
199
31
2
232
$
86%
13%
1%
100%
17a. What kind of health insurance do you have?
Type
Insurance through work
COBRA or OBRA (insurance through my last employer)
Private insurance, not through work
Medicare
Medical
Other Insurance
#
12
2
11
91
143
45
%
5%
1%
5%
39%
62%
19%
18. Which of the following benefits do you receive?
Benefit
Food Stamps
Long Term Disability
Short Term Disability
Supplemental Security Income (SSI)
Public Health Service, Bureau of Indian Affairs (BIA)
State Disability Insurance (SDI)
Social Security Disability Insurance (SSDI)
Veteran’s Benefits (VA)
CHAMPUS (VA Assistance for non-military personnel)
Worker’s Compensation
Annuity/Life insurance payments
Retirement
Rent Supplement
Subsidized housing (HOPWA Subsidy, Section 8 certificate or Shelter Plus Care)
General Assistance
Other Financial Assistance
Emergency Financial Assistance
WIC
TANF/CalWORKS – formerly AFDC
Other
Not eligible for benefits
#
58
55
4
86
0
12
79
2
0
1
3
8
15
49
14
5
3
7
10
11
14
%
25%
24%
2%
37%
0%
5%
34%
1%
0%
0.4%
1%
3%
6%
21%
6%
2%
1%
3%
4%
5%
6%
126
19. In the past year, how many agencies have provided medical/case management to you at the same
time?
Agencies
0
1
2
3
4
6
9
N/A
TOTAL
#
24
102
47
19
6
2
1
31
232
%
10%
44%
20%
8%
3%
1%
0%
13%
100%
127
20. What was the ... year that you first tested positive for HIV?
Year
1980
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
N/A
TOTAL
#
1
2
2
8
8
10
4
9
10
13
5
5
7
8
6
4
7
5
11
8
4
5
6
6
10
7
14
11
8
4
11
7
6
232
%
0.4%
1%
1%
3%
3%
4%
2%
4%
4%
6%
2%
2%
3%
3%
3%
2%
3%
2%
5%
3%
2%
2%
3%
3%
4%
3%
6%
5%
3%
2%
5%
3%
3%
100%
128
21. After receiving your HIV diagnosis, when did you have your first visit with a doctor for your
HIV/AIDS?
First Doctor Visit after HIV Diagnosis
Unknown
Within a month after diagnosis
1-3 months after diagnosis
4-6 months after diagnosis
7 months to a year after diagnosis
More than a year after diagnosis
I haven't seen a doctor for my HIV
TOTAL
#
1
158
35
8
9
20
1
232
%
0.4%
68.1%
15.1%
3.4%
3.9%
8.6%
0.4%
100.0%
22. What is the most likely way you were infected by HIV?
Mode
Having sex with a man
Having sex with a woman
Having sex with a transgender
Sharing needles
Blood products/Transfusion (blood or tissue recipient)
Hemophilia
Acquired at birth
Other
N/A
TOTAL
#
108
24
60
4
10
0
0
20
6
232
%
47%
10%
26%
2%
4%
0%
0%
9%
3%
100%
23. Have you ever been told by your doctor, nurse, or other health care team member that you have
AIDS?
Prognosis
Yes
No
N/A
TOTAL
#
103
126
3
232
%
44%
54%
1%
100%
129
23a. If yes to Q.23, when were you told that you had AIDS?
Year of Diagnosis (of those responding)
1982
1984
1985
1986
1987
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
TOTAL
#
1
1
1
1
2
1
5
4
2
5
7
2
3
1
6
3
8
4
2
2
4
3
6
2
5
4
4
4
6
2
101
%
1%
1%
1%
1%
2%
1%
5%
4%
2%
5%
7%
2%
3%
1%
6%
3%
8%
4%
2%
2%
4%
3%
6%
2%
5%
4%
4%
4%
6%
2%
100%
130
23b. Where were you diagnosed with AIDS?
State
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
CA
AZ
MA
MN
NE
NJ
NV
NV
OR
OR
OR
TX
City (of those responding)
Auburn
Burbank
Folsom
Fresno
Garden Grove
Grass Valley
Hemet
Lodi
Los Angeles
Merced
Oakland
Oroville
Palo Alto
Pasadena
Redwood City
Rocklin
Sacramento
San Diego
San Francisco
Santa Ana
Santa Barbara
Stockton
Tracy
Vacaville
Vallejo
Walnut Creek
Woodland
Phoenix
Boston
Minneapolis
Omaha
New Jersey
Las Vegas
Reno
Klamath Falls
Medford
Portland
Houston
TOTAL
#
3
1
1
1
1
1
1
1
5
1
3
1
1
1
1
1
50
2
5
1
1
2
1
1
1
1
4
1
1
1
1
1
1
1
1
1
1
1
104
%
3%
1%
1%
1%
1%
1%
1%
1%
5%
1%
3%
1%
1%
1%
1%
1%
48%
2%
5%
1%
1%
2%
1%
1%
1%
1%
4%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
100%
131
24. At this time, do you think that your HIV status is presenting you with a problem that requires
assistance (health, financial, social, etc.)?
Response
1_Yes
2_No
TOTAL
#
164
68
232
%
71%
29%
100%
25. How would you rate your physical health now as compared to when you first sought treatment for
your HIV infection?
Rating
Much worse
A little worse
About the same
A little better
Much better
TOTAL
#
25
32
37
31
107
232
%
11%
14%
16%
13%
46%
100%
26. How would you rate your emotional health now as compared to when you first sought treatment for
your HIV infection?
Rating
Much worse
A little worse
About the same
A little better
Much better
N/A
TOTAL
#
33
24
36
49
89
1
232
%
14%
10%
16%
21%
38%
0.4%
100%
27. Has your T-Cell count...
Amount
Ever dropped below 500 cells/UL
Ever dropped below 350 cells/UL
Ever dropped below 200 cells/UL
Now dropped below 350 cells/UL
Now dropped below 200 cells/UL
#
178
149
99
62
35
%
77%
64%
43%
27%
15%
132
28. Has your viral load...
Amount
Ever rose above 30,000 copies
Ever rose about 10,000 copies
Currently above 10,000 copies
#
99
126
32
%
43%
54%
14%
29. What was the date of the last visit you had with a doctor for your HIV infection?
Months Since Last Visit
0
1
2
3
4
5
6
7
8
9
11
12
13
14
16
N/A
TOTAL
#
52
75
41
24
12
9
2
1
1
1
1
1
1
1
1
9
232
%
22%
32%
18%
10%
5%
4%
1%
0%
0.4%
0.4%
0.4%
0.4%
0.4%
0.4%
0.4%
4%
100%
30. Since you found out you were HIV positive...
Has there ever been a period of time of more than a year (12 months) when you didn’t see a doctor or go
to a clinic?
Twelve-Month Gap
Yes
No
N/A
TOTAL
#
48
179
5
232
%
21%
77%
2%
100%
Has there ever been a period of time of more than six months when you didn’t see a doctor or go to a
clinic?
Six-Month Gap
Yes
No
N/A
TOTAL
#
43
148
41
232
%
19%
64%
18%
100%
133
30a. Since that time have you gone back to see a doctor?
Response (of those responding)
Yes
No
TOTAL
#
89
3
92
%
97%
3%
100%
30b. If yes to Q.30a, what happened to make you seek medical care after not seeing a doctor or clinic
professional for more than six months?
Reason
I got sicker
Change in my income
Change in my insurance status
Heard about new doctor/clinic
There was a change in my doctors or clinic’s attitudes
There were different drugs or treatments available
I had stable housing
Other
#
39
14
15
11
16
23
32
17
%
44%
16%
17%
12%
18%
26%
36%
19%
31. Where do you receive your medical care most often?
Place
Alternative treatment/medical facility (such as holistic health centers)
Community/Neighborhood Clinic (CARE, Maap, Inc. Community Clinic, County Clinics, etc.)
Veteran’s Administration Medical Center
Emergency Room
Hospital (Kaiser Permanente, Mercy, Sutter, UC Davis Medical Center, etc.)
Private Doctor’s Office/Clinic
Other
Emergency Room or Hospital
More Than One Location
N/A
#
12
179
2
29
62
16
6
75
49
2
%
5%
77%
1%
13%
27%
7%
3%
32%
21%
1%
32. Thinking about the past year, how often did you get medical care from any physician or clinician
that can prescribe medications from a pharmacy?
Frequency
Never
Only when you were sick
On a regular on-going basis
N/A
TOTAL
#
14
23
194
1
232
%
6%
10%
84%
0.4%
100%
134
33. Have you had the same doctor or gone to the same clinic for your HIV infection?
Same Doctor Since Infected
Since I found out I was HIV+
For two or more years
Since last year
N/A
Total
#
110
89
28
5
232
%
47%
38%
12%
2%
100%
34. Did you miss any medical appointments in the last year?
Response
Yes
No
N/A
TOTAL
#
97
129
6
232
%
42%
56%
3%
100%
34a. If missed, did you reschedule for the next available appointment?
Response (of those responding)
Yes
No
TOTAL
#
100
18
118
%
85%
15%
100%
34b. If rescheduled, did you make it to the rescheduled appointment?
Response (of those responding)
Yes
No
TOTAL
#
90
12
102
%
88%
12%
100%
135
35. At any time in the last year, have you been diagnosed with any of the following diseases listed
below?
Disease
Hepatitis A or B
Hepatitis C
Syphilis
Herpes (genital)
Gonorrhea
Chlamydia
Genital Warts
Yeast infections
Other
Any of the above
#
15
35
11
13
11
10
13
21
12
83
%
6%
15%
5%
6%
5%
4%
6%
9%
5%
36%
36. Since you found out you were HIV positive, have you ever had any opportunistic infections?
Response
Yes
No
N/A
TOTAL
#
116
114
2
232
%
50%
49%
1%
100%
36a. What types of infections or symptoms?
Infection Type
Candidiasis
Lymphoma (including Burkitts, immunoblastic or the brain)
Mycobacterium avium complex
Pneumonia or pneumoncystis carinii pneumonia (PCP)
Salmonella
Shingles
Toxoplasmosis
Tuberculosis
Wasting syndrome
Cryptococcosis
Cryptosporidiosis (chronic intestinal)
Cytomegalovirus (usually of the retina)
HIV encephalopathy
Herpes
Isoporiasis
Kaposi's Sarcoma
Histoplasmosis
#
25
8
8
69
5
36
1
3
20
6
4
6
7
34
1
4
0
%
22%
7%
7%
59%
4%
31%
1%
3%
17%
5%
3%
5%
6%
29%
1%
3%
0%
136
37. Have you ever taken any medicines for your HIV infection?
Response
Yes
No
N/A
TOTAL
#
217
14
1
232
%
94%
6%
0.4%
100%
38. How many prescription drugs are you currently taking?
Number
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
19
20
N/A
TOTAL
#
7
22
22
31
24
25
7
8
7
11
21
2
8
5
3
3
2
2
1
1
20
232
%
3%
9%
9%
13%
10%
11%
3%
3%
3%
5%
9%
1%
3%
2%
1%
1%
1%
1%
0.4%
0.4%
9%
100%
38a. How many of your prescription drugs are paid for or reimbursed by each of the following sources?
Source
ADAP
Medi-Cal / Medicare
Private insurance
Veterans benefits
Out-of-pocket
Other
#
74
106
17
3
15
4
%
34%
49%
8%
1%
7%
2%
137
39. Are you taking any of the following?
Drug
Anti-retrovirals and/or protease inhibitors
Antibiotics (such as Bactrim) that fight off infections
Antifungal (such as Diflucan) that are for body rashes or thrush
Steroids which help you with your appetite or build weight
Antidepressants for depression or anxiety
Herbal and/or other supplements
#
183
52
30
24
126
55
%
84%
24%
14%
11%
58%
25%
40. How often have you skipped taking your HIV/ AIDS medication as prescribed by your doctor in the
last two (2) years?
Frequency
Never/ Have not skipped
Once or twice a month
Once or twice a week
More than twice a week
I have stopped taking my medicine
NA
TOTAL
#
102
68
13
29
8
12
232
%
44%
29%
6%
13%
3%
5%
100%
41. If skipped or stopped taking your HIV/AIDS medication, why?
Reason (of those responding)
Side effects
Difficult schedule and requirements
Didn’t want others to see the medications
Didn’t understand the directions
Felt that the medication didn’t work
Could not afford medication
Forgot to take medication
Hard to coordinate with food
Just did not want to take them
Homeless
Medication made me feel good so I felt I didn’t need them anymore
My doctor advised me to stop taking my medications
Other
TOTAL
#
27
24
12
0
5
8
83
16
28
14
8
6
14
118
%
23%
20%
10%
0%
4%
7%
70%
14%
24%
12%
7%
5%
12%
100%
138
42. Since you were infected with HIV have you received mental health counseling or treatments?
Response
Yes
No
N/A
TOTAL
#
182
49
1
232
%
78%
21%
0.4%
100%
43. Which of the following mental health counseling or treatments did you receive?
Treatment
Inpatient (in a hospital at least overnight)
Individual counseling/therapy
Group counseling/therapy
Medication for psychological or behavioral problems
#
34
159
114
107
%
15%
69%
49%
46%
44. At any time in the last two years have you been diagnosed with any of the following mental health
problems?
Diagnosis
Anxiety
Bipolar Disorder
Dementia
Depression
Other
Any of the above
#
114
55
12
141
20
163
%
49%
24%
5%
61%
9%
70%
139
45. For each of the services below:
Under column A, circle “yes” if you needed the service in the past year or circle “no” if you didn’t need
the service.
Under column B, circle “yes” if you asked for the service in the past year or circle “no” if you didn’t ask
for the service.
Under column C circle “yes” if you received the service in the past year or circle “no” if you didn’t
receive the service.
Service
Medical case management session(s)
with a medical case manager to help
you coordinate your HIV/AIDS care
and help access benefits.
Benefits counseling session(s) with a
medical case manager or benefits
counselor to help you access benefits.
Education and referral to clinical
research opportunities available to
clients.
Intake session when you first come to
an agency and a staff member
assesses your care needs.
Client advocacy where a counselor
assists you to work through a
particular problem in obtaining a
service, or in a complaint against a
service provider.
Child care for your child while you
attended a medical or social service
appointment.
Child welfare services to aid in family
preservation/unification, foster care,
parenting education, or other child
welfare services.
Childhood developmental assessment
and early intervention services to aid
in your child’s psychosocial and
intellectual development.
Permanency planning to help you or
your family determine what will be
done with your children if you become
unable to care for them.
Food Voucher assistance to help you
pay for food.
Food Bank services that provide you
with access to food banks/closets to
obtain food, meals and nutritional
supplements.
Home Delivery of food, meals, and
nutritional supplements to your home
because you were unable to leave
your home due to illness.
Nutritional counseling and education.
Need
#
Need
%
Ask
#
Ask
%
Receive
#
Receive
%
158
68%
119
51%
140
60%
140
60%
107
46%
115
50%
74
32%
60
26%
51
22%
130
56%
100
43%
115
50%
103
44%
96
41%
90
39%
13
6%
13
6%
12
5%
8
3%
8
3%
7
3%
12
5%
11
5%
11
5%
6
3%
3
1%
3
1%
130
56%
105
45%
82
35%
155
67%
127
55%
131
56%
53
115
23%
50%
40
101
17%
44%
30
95
13%
41%
140
Service
Visits with a doctor, nurse, or
assistant to take care of your HIV
Outpatient medical care.
Visit to a medical specialist based on
a referral from your doctor.
Visit with a doctor, nurse, or assistant
to examine or treat non-HIV health
conditions.
Education or counseling about HIV,
HIV transmission, and how to reduce
the risk of HIV transmission.
In home visits from health care
workers because your illness
prevented you from leaving the
house.
In home specialized health care
requiring intravenous (IV) treatment or
other high tech treatments.
Health Insurance assistance to help
you pay for health insurance
premiums or co-pays.
Doctor prescribed medications.
Drug reimbursement assistance to
help you pay for medications and
prescriptions.
Treatment adherence services to
provide you with education and
counseling on ways to help you
routinely take HIV/AIDS medications
and follow through on HIV/AIDS
treatments.
Complementary therapies, such as
acupuncture, chiropractic, and
massage services.
Dental visits with a dentist, hygienist,
or assistant to take care of oral health
problems.
Utilities assistance to help you pay for
essential utilities (such as gas,
electricity, phone, etc.)
Housing/Rental assistance to help
you pay for permanent housing.
Housing/Rental assistance to help
you pay for short-term/emergency
housing.
Housing information services from a
housing specialist to assist you in
finding or getting housing, or
qualifying for housing programs.
Mental health services through oneon-one psychological or psychiatric
counseling (NOT FOR SUBSTANCE
ABUSE).
Need
#
Need
%
Ask
#
Ask
%
Receive
#
Receive
%
201
87%
183
79%
192
83%
162
70%
139
60%
147
63%
172
74%
158
68%
162
70%
93
40%
81
35%
84
36%
40
17%
34
15%
32
14%
13
6%
14
6%
8
3%
90
206
39%
89%
80
195
34%
84%
70
199
30%
86%
91
39%
71
31%
67
29%
92
40%
92
40%
74
32%
73
31%
47
20%
33
14%
179
77%
166
72%
133
57%
111
48%
88
38%
62
27%
115
50%
102
44%
81
35%
52
22%
50
22%
30
13%
85
37%
73
31%
55
24%
142
61%
135
58%
126
54%
141
Service
Mental health services through group
counseling led by a psychologist or
social worker (NOT FOR
SUBSTANCE ABUSE).
Support groups led by peer or nonlicensed group leader (NOT FOR
SUBSTANCE ABUSE).
Counseling for your family (children,
spouse, and/or partner).
Bereavement counseling by phone or
in-person.
Buddy/Companion services to provide
you with social support and
assistance with routine, day-to-day
living tasks.
Supportive services that provide you
with access to recreational activities
and outings.
Non-medical home care to help you
complete household or other routine
tasks in order to allow you to remain
in your home (as opposed to a
nursing home or other comparable
setting).
Day or respite care designed to
temporarily relieve your primary
caregiver from providing day-to-day
care.
Legal services to assist you with
powers of attorney, wills, bankruptcy,
interventions to ensure access to
services, discrimination, etc.
Physical and occupational
rehabilitation therapy.
Information on how to prevent
becoming re-infected with HIV.
Access to free condoms and other risk
reduction items (ex. Lube, dental
dams, etc.) to assist you with
practicing safer sex.
Support (ex. safer sex support group
or workshop) from other HIV+ peers in
practicing safer sex strategies (ex.
Using condoms, adhering to
medication regime, etc.)
Counseling for you and an HIV
negative partner(s) to assist you in
communicating and developing
strategies to keep your partner(s) HIV
negative.
Assistance with disclosing your HIV
status with your sexual or drug
partners.
Outpatient substance abuse treatment
or counseling.
Need
#
Need
%
Ask
#
Ask
%
Receive
#
Receive
%
105
45%
99
43%
84
36%
100
43%
91
39%
83
36%
44
19%
35
15%
25
11%
39
17%
34
15%
30
13%
49
21%
36
16%
29
13%
68
29%
40
17%
33
14%
51
22%
41
18%
33
14%
17
7%
13
6%
10
4%
64
28%
47
20%
26
11%
45
19%
37
16%
29
13%
78
34%
66
28%
70
30%
146
63%
124
53%
138
59%
84
36%
70
30%
75
32%
48
21%
37
16%
42
18%
42
18%
31
13%
32
14%
55
24%
48
21%
46
20%
142
Service
24 hour-a-day residential substance
abuse counseling (can include detox).
Substance abuse one-on-one
psychological or psychiatric
counseling.
Substance abuse group counseling.
Substance abuse support groups led
by peer or non-licensed group leader.
Bus/light rail passes to get to health or
social service appointments or to
access supportive services.
Taxi services to get to health or social
service appointments or to access
supportive services.
Transportation from volunteer drivers
who pick you up at your home to take
you to health, social, or supportive
services and appointments.
Need
#
Need
%
Ask
#
Ask
%
Receive
#
Receive
%
21
9%
16
7%
13
6%
62
61
27%
26%
57
51
25%
22%
54
52
23%
22%
51
22%
40
17%
39
17%
117
50%
103
44%
91
39%
54
23%
33
14%
22
9%
79
34%
68
29%
52
22%
46. Below is a list of problems that you may or may not have had when trying to obtain or use
HIV/AIDS services. Please circle the response on the line beside each item to say whether or not it was
a problem for you in the last year.
Barrier
Not knowing that a service or treatment was available
to me.
Not knowing a location of the service(s).
My physical health has not allowed me to get to the
place where the service is provided.
I do not believe HIV or AIDS is a problem for me that
requires assistance.
Not knowing what medical services I need to treat my
HIV infection or AIDS.
My state of mind or mental ability to deal with the
treatment.
Not understanding the instructions for obtaining the
service or treatment.
Not knowing who to ask for help.
Sensitivity of the organization and person providing
services to me regarding my issues and concerns.
Discrimination I experienced by the persons or
organization providing the services.
Experience or expertise of the person providing
services to me.
The amount of time I had to wait between scheduling
an appointment and the actual day of the appointment.
The amount of time I had to wait in the waiting room
prior to being called in on the day of the appointment.
The organization providing the service made me feel
like a number.
I do not get along with people providing services.
I have been denied a service in the past.
Agree
Disagree
Agree %
114
91
117
139
49%
40%
45
184
20%
54
178
23%
44
187
19%
103
127
45%
60
82
170
150
26%
35%
90
139
39%
49
182
21%
99
133
43%
90
141
39%
83
148
36%
52
35
59
180
195
172
22%
15%
26%
143
Barrier
I have been denied or have been afraid to seek
services due to a criminal justice matter.
My ability to communicate or interact with the service
provider.
The people providing services to me are not helpful.
The organization did not provide the right referrals to
the services I need.
My ability to find my way through the system.
There was no specialist who could provide the care I
needed.
Fear of my HIV or AIDS status being found out by
others – lack of confidentiality.
Fear that I would be reported to immigration or other
authorities.
No transportation.
No childcare.
I was not eligible for the service.
There was too much paperwork or red tape.
I can’t afford one or more of the service.
There are too many rules and regulations.
My lack of or inadequate insurance coverage.
I have been terminated or suspended from seeking
services.
Other
Agree
Disagree
Agree %
29
202
13%
72
40
159
190
31%
17%
44
83
185
137
19%
38%
34
195
15%
60
171
26%
23
79
22
59
70
58
64
59
208
152
209
171
161
171
165
170
10%
34%
10%
26%
30%
25%
28%
26%
28
9
199
88
12%
9%
144
47. Have you ever used any of the following substances?
Substance
Alcohol
Marijuana (pot, grass, weed, hash)
Cocaine
Crack (rock)
Heroin (smack, H, junk, skag)
Methamphetamine (Meth, crystal, crank, Tina)
Speedball
GHB (Gamma Hydroxybutyrate, liquid ecstasy, gina, G)
Poppers (rush)
Ecstasy (X, E, MDMA, Adam)
Tranquilizers/Barbiturate
Ketamine (Special K, K)
Hallucinogen (LSD, acid, peyote, mescaline, PCP)
Pills not prescribed by my doctor
Other substances
Any Non-Alcohol/Marijuana
#
207
191
140
82
53
122
48
53
93
79
66
30
77
64
19
188
%
89%
82%
60%
35%
23%
53%
21%
23%
40%
34%
28%
13%
33%
28%
8%
81%
47a. Have you used, during the past 6 months, any of the following substances?
Substance
Alcohol
Marijuana (pot, grass, weed, hash)
Cocaine
Crack (rock)
Heroin (smack, H, junk, skag)
Methamphetamine (Meth, crystal, crank, Tina)
Speedball
GHB (Gamma Hydroxybutyrate, liquid ecstasy, gina, G)
Poppers (rush)
Ecstasy ((X, E, MDMA, Adam)
Tranquilizers/Barbiturate
Ketamine (Special K, K)
Hallucinogen (LSD, acid, peyote, mescaline, PCP)
Pills not prescribed by my doctor
Any Non-AlcoholMarijuana
#
94
96
16
9
8
35
6
13
16
9
12
2
4
15
63
%
41%
41%
7%
4%
3%
15%
3%
6%
7%
4%
5%
1%
2%
6%
27%
48. If you have used any substances, have you ever injected any substances not prescribed by a medical
person?
Response
Yes
No
TOTAL
#
74
158
232
%
32%
68%
100%
145
49. In the past year, if you have injected substances: How many people have you shared needles with in
the past year?
Number of People
0
1
2
10
20
TOTAL
#
52
1
3
1
1
58
%
90%
2%
5%
2%
2%
100%
50. How would you describe your residency status in the United States?
Status
Citizen/Legal Resident
Have a Visa (student, temp or permanent)
Have legal refugee or asylum status
Undocumented
TOTAL
#
223
1
1
7
232
%
96%
0.4%
0.4%
3%
100%
146
CONSENT FORM
2013 SACRAMENTO TGA HIV/AIDS CARE NEEDS ASSESSMENT
The HIV Health Services Planning Council of the Sacramento Transitional Grant Area (TGA) is
conducting an assessment of the service needs of people living with HIV and AIDS in Sacramento,
Placer, Yolo and El Dorado Counties.
You have been invited to participate and contribute your experiences, knowledge, and opinions
about the service needs of people like yourself living with HIV/AIDS. Completing this survey
gives you a voice in the planning for HIV and AIDS treatment services throughout the Sacramento
TGA.
This survey is entirely confidential. This assurance of confidentiality means that no information
about your participation can be obtained by anyone outside of the needs assessment group. While
we ask some questions about your background for the purposes of analysis, your name will never be
linked to your answers. The results of this needs assessment may be published, but your name will
never be used in any report or publication.
Your consent is entirely voluntary and your decision to participate or not will have no effect on the
care you are receiving or the relationships you have with providers and caregivers at any agency.
By signing below, you consent to complete the survey for which you will receive a $20 Safeway
Gift Card for your time.
PARTICIPANT’S SIGNATURE: ________________________________________________________
PARTICPANT’S NAME: _____________________________________________________________
Address: ___________________________________________________________________________
City __________________________
CALIFORNIA
Telephone: __ __ __ - __ __ __ - __ __ __ __
Zip Code ________________
Date: __ __/ __ __/ 20__
If you have any questions, please call the HIV Health Services Planning Council at (916) 876-5548
It is possible that the Needs Assessment Committee will conduct follow-up focus groups of 10-12 people
after the surveys are conducted to discuss HIV/AIDS services.
Would you be interested in participating if focus groups are held?
YES
NO
147
Confidential ID: ____ ____ ____ ____ ____ ____ ____
SACRAMENTO TGA NEEDS ASSESSMENT SURVEY
OF PEOPLE LIVING WITH HIV AND AIDS
A Project of the Sacramento HIV Health Services Planning Council
INTRODUCTION
Thank you for agreeing to participate in this important survey. Completing this survey gives you a voice
in the planning of HIV and AIDS treatment services throughout the Sacramento TGA.
For each question below, circle or write in an answer. There are no right or wrong answers. Please take
as much time as you need to answer each question based on your experiences. If you have any questions
or need help reading the survey or interpreting the questions, please ask for assistance.
Your responses are completely confidential. Your name will never be linked to your answers.
Thank you in advance for completing this survey. Please go to the next page.
Confidential ID Needed
We will be obtaining responses from many people living with HIV and AIDS over the next few weeks.
Please create a confidential identifier which you will place on the top of every page of your survey.
This ID is unique to you, and will protect your confidentiality.
______
What is the first
letter of your
first name
______
What is the last
letter of your
last name
______ ______
What is the
month of your
birthday
(For January through
September use a
leading "0" e.g. 01 for
January)
______ ______
______
What is the day What is the first
of your birthday letter of your
mother's first
(For days 1 - 9 use a
name? (If you
leading "0" e.g. 01)
don't know, list
the first letter of
your father's first
name)
(01=Jan, 02=Feb, 03=Mar, 04=Apr, 05=May, 06=June, 07=July, 08=Aug, 09=Sept, 10=Oct, 11=Nov, 12=Dec)
Please copy the confidential ID you have created to the top right of each page of the survey.
Name of Interviewer: _______________________
Today’s Date: _____ / ___ / ___
Location of Interview: ______________________
Interview Start Time: _______________________
148
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
1. Are you currently (Circle number next to the answer)
HIV+ with symptoms .............. 1
HIV+ with no symptoms........... 2
Please see
HIV negative ........................ 3
the
interviewer.
2. When were you born? ............
__ __
Mo.
3. Are you…
Male ...................................................
Female ...............................................
Transgender - Male to female (MTF) ............
Transgender - Female to male (FTM) ...........
Intersex...............................................
__ __
Yr.
1
2
3
4
5
4. What do you consider your ethnic background? (circle
one)
African-American / Black ........................
1
Asian Pacific Islander ............................
2
Hispanic / Latino ..................................
3
Native American ...................................
4
White/Caucasian (non Hispanic) ................
5
More than one......................................
6
Other (Specify) _________________________
7
4a. What language(s) do you speak most frequently
home?
English ...............................................
Spanish ..............................................
Other (Specify) ________________________
5. Do you consider yourself (circle one)
Heterosexual/Straight ............................
Homosexual – Gay male ..........................
Homosexual – Lesbian ............................
Bisexual .............................................
Other: (Specify)_________________________
at
1
2
3
1
2
3
4
5
6. What is the highest level of education you completed?
Grade school or less ...............................
1
Some high school ...................................
2
Graduated high school/GED/trade school .....
Some college/2 year college degree ............
Completed 4 year college .........................
Graduate level or professional study ...........
3
4
5
6
7. What is the zip code and city and/or neighborhood
where you live?
____________
___________________
Zip
City and/or Neighborhood
8. Where do you currently live? (Circle one)
In an apartment/house I own ....................
In an apartment/house I rent ....................
At my parent’s/relative’s apt./house ..........
Living/crashing with someone & not paying
rent .................................................
Single Room Occupancy (SRO) with tenancy...
Single Room Occupancy (SRO) without tenancy
In a “supportive living” /assisted living facility
In a group home or residence including
residential drug therapy ........................
In a half-way house or transitional housing ....
Skilled Nursing Home ..............................
Homeless (on the street/in car) .................
Homeless shelter ...................................
Jail or correctional facility .......................
Hospital / Institution ..............................
Residential Hospice Facility ......................
Other (Specify) ___________________________
9. How much do you pay monthly for housing?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
_______
10. Is your living situation …?
(Circle 1 for “Yes” or 2 for “No” for each item)
Yes
1
No
2
1
1
2
2
11. Are you on a waiting list to get into housing?
Yes ...................................................
No ...................................................
1
2
a. Safe ........................................
b. Habitable (clean and livable)
c. Stable ......................................
11a. Have you ever been on a waiting list for housing?
(Circle “Yes” or “No”)
Yes No
I. If yes, did it result in placement
Yes
No
II. If no, why not? (Mark all that apply)
____ Substance Abuse
____ Pets
____ Incarceration
____ Criminal Record
____ Significant Other’s Criminal Record
____ Rental History
____ Significant Other’s Rental History
____ Not enough Money
____ Housing location
____ Mental Health
____ Physical Health
____ Lack of transportation where
housing available
____ Other: ________________________
149
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
12. Have you ever received a referral for
housing?
Yes ................................ 1
(GO TO Q.12a)
No ................................ 2
(GO TO Q.13)
12a. IF RECEIVED A REFERRAL for housing, did it
result in a housing placement?
Yes ......................................................
No ........................................................
1
2
13. In your household, how many….
(fill in #)
Other adults are living with you? ...........
Children and teens are living with you?
IF YOU DO NOT LIVE WITH ANYONE, SKIP TO Q. 14.
13a. Is anyone else in your household HIV positive?
(Circle 1 for “yes”, 2 for “no” or 8 for “Don’t Know”
for each item)
a. Partner/wife/husband ........
b. Adult family member/
relative
c. Other adults .....................
d. Children..........................
Yes
No
1
2
Don’t
Know
8
1
1
1
2
2
2
8
8
8
14. Over the last two (2) years, have you lived in each
of the places listed below?
(Circle one answer for each of
the items below)
Yes
No
a. In a half-way house or
transitional housing ............... 1
2
b. In a treatment facility (drug or
psychiatric) .......................... 1
2
c. Homeless (on the street/in
1
2
car)….
d. Homeless shelter ................... 1
2
e. Jail or correctional facility ....... 1
2
f. Other (Specify)
___________________________
1
2
150
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
15. What best describes your current job (work)
situation? (Circle one)
Employed full-time (33-40 hours a week) .........
Employed part-time (less than 33 hours a week)
Not working – looking for work .....................
Not working – student /homemaker /other.......
Not working – not looking for work.................
Retired ..................................................
Other (Specify)
___________________________
1
2
3
4
5
6
7
16. What is your reported estimated yearly income
from all sources and before taxes?
$0
$ 8,600 (up to $716 a month) ..........
$8,601 - $11,600 ($717 - $967 a month).........
$11,601 - $16,500 ($968 - $1375 a month) .......
$16,501 - $23,200 ($1376 - $1933 a month) ......
$23,201 - $26,000 ($1934 - $2167 a month) ......
$26,001 - $35,000 ($2168 - $2917 a month) ......
Greater than $35,001 ($2918 or more a month)
1
2
3
4
5
6
7
17. Do you have any health insurance?
Yes ...................................................
No ...................................................
1
2
17a. What kind of health insurance do you have?
(Circle 1 for “Yes” or 2 for “No” for each item)
a. Insurance through work ..................
b. COBRA or OBRA (insurance through
my last employer) .........................
c. Private insurance, not through work ..
d. Medicare ....................................
e. Medi-Cal ....................................
f. Other Insurance
(Specify)_____________
Yes
No
1
2
1
1
1
1
2
2
2
2
1
2
18. Which of the following benefits do
(Circle 1 for “Yes”, 2 for “No” or 8
for “Don’t Know”)
a. Food stamps ......................
b. Long term disability .............
c. Short term disability .............
d. Supplemental Security Income
(SSI)
e. Public Health Service, Bureau
of Indian Affairs (BIA) ............
f. State Disability Insurance (SDI)
g. Social Security Disability
Insurance (SSDI) ...................
h. Veteran’s benefits (VA) .........
i. CHAMPUS (VA Assistance for
non-military personnel) ..........
j. Worker’s compensation .........
k. Annuity/Life insurance
payments
l. Retirement .........................
m. Rent supplement ................
n. Subsidized housing (HOPWA
Subsidy, Section 8 certificate or
Shelter Plus Care) .................
o. General Assistance (GA) ........
p. Emergency Financial
Assistance From whom
(Specify)
_______________________
q. WIC .................................
r. TANF/CalWORKS – formerly
AFDC
s. Other (Specify)
__________________
t. Not eligible for benefits .........
you receive?
Don’t
Know
8
8
8
Yes
1
1
1
No
2
2
2
1
2
8
1
1
2
2
8
8
1
1
2
2
8
8
1
1
2
2
8
8
1
1
1
2
2
2
8
8
8
1
1
2
2
8
8
1
1
2
2
8
8
1
2
8
1
1
2
2
8
8
19. In the past year, how many agencies
have provided medical/case
management to you at the same time?
Write #
151
Ongoing Needs Assessment Survey Tool
20. What was the month and year that
you first tested positive for HIV?
Confidential ID: ____ ____ ____ ____ ____ ____ ____
__ __
Mo.
__ __
Yr.
21. After receiving your HIV diagnosis, when did you have
your first visit with a doctor for your HIV/AIDS?
(Circle one)
Within a month after diagnosis ..................... 1
One to three months after diagnosis............... 2
Four to six months after diagnosis ................. 3
Seven months to a year after diagnosis ........... 4
More than a year after diagnosis ................... 5
I haven’t seen a doctor for my HIV ................. 6
22. What is the most likely way you were infected by
(Circle one)
Having sex with a man ...............................
Having sex with a woman ............................
Having sex with a transgender ......................
Sharing needles ........................................
Blood products/Transfusion (blood or tissue
recipient) .............................................
Hemophilia .............................................
Acquired at birth ......................................
Other
(specify)____________________________
Don’t Know .............................................
HIV?
1
2
3
4
5
6
7
8
9
23. Have you ever been told by your doctor, nurse, or
other health care team member that you have AIDS?
Yes .................................. 1
(GO TO
Q.23a)
No .................................. 2
(GO TO Q.24)
23a. IF YES TO Q. 23, when were you
told that you had AIDS?
__ __
Mo.
23b. Where were you diagnosed with AIDS?
______________
City
_______________
State
__ __
Yr.
24. At this time, do you think that your HIV status is
presenting you with a problem that requires assistance
(health, financial, social, etc.)?
Yes ...................................................
1
No ...................................................
2
25. How would you rate your physical health now as
compared to when you first sought treatment for
your HIV infection?
Much better ............................................
A little better ..........................................
About the same ........................................
A little worse ...........................................
Much worse .............................................
5
4
3
2
1
26. How would you rate your emotional health now as
compared to when you first sought treatment for
your HIV infection?
Much better ............................................ 5
A little better .......................................... 4
About the same ....................................... 3
A little worse ........................................... 2
Much worse ............................................. 1
27. Has your T-Cell count …?
(Circle 1 for “Yes”, 2 for “No” or 8 for
“Don’t Know”)
Yes
No
Don’t
Know
1
1
1
1
1
2
2
2
2
2
8
8
8
8
8
(Circle 1 for “Yes”, 2 for “No” or 8 for
“Don’t Know”)
Yes
No
Don’t
Know
a. Ever rose above 30,000 copies
b. Ever rose above 10,000 copies
c. Currently above 10,000 copies
1
1
1
2
2
2
8
8
8
a. Ever dropped below 500 cells/UL
b. Ever dropped below 350 cells/UL
c. Ever dropped below 200 cells/UL
d. Now dropped below 350 cells/UL
e. Now dropped below 200 cells/UL
28. Has your viral load …?
2013 Version
152
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
29. What was the date of the last visit you
_ __
had with a doctor for your HIV infection __ __
Mo.
Yr.
(ESTIMATE IF NECESSARY)?
I have never seen a doctor or gone to a clinic
since I found out I was HIV+. (GO TO Q.35)
30. Since you found out you were HIV positive,
(Circle 1 or "Yes" or 2 for "No" for each
item)
Yes
No
Has there ever been a period of time
1
of more than a year (12 months)
2
(GO TO
when you didn’t see a doctor or go Q.30a)
to a clinic? .........................
Has there ever been a period of time
1
2
of more than six months when
(GO TO (GO TO
you didn’t see a doctor or go to a Q.30a)
Q.31)
clinic? ..............................
30a. Since that time have you gone back to see a doctor?
Yes ..................................... 1 (GO TO Q.30b)
No ...................................... 2 (GO TO Q.31)
30b. IF YES TO Q.30a, What happened to make you seek
medical care after not seeing a doctor or clinic
professional for more than six months?
(Circle 1 or "Yes" or 2 for "No" for each
item)
Yes
No
a. I got sicker ..................................
1
2
b. Change in my income .....................
1
2
c. Change in my insurance status ..........
1
2
d. Heard about new doctor / clinic ........
1
2
e. There was a change in my doctor’s or
clinic’s attitudes ...........................
1
2
f. There were different drugs or
treatments available ......................
1
2
g. I had stable housing .......................
1
2
Other (specify) ______________________
1
2
30c. If you have not seen a physician for your HIV care in
the past six months, why?
31. Where do you receive your medical care most often?
(Circle 1 or "Yes" or 2 for "No" for each
item)
Yes
No
a. Alternative treatment/medical facility
(such as holistic health centers)
1
2
b. Community / Neighborhood Clinic
(CARES, Well Space Health, County
Clinics, etc.) ..................................
1
2
c. Veteran’s Administration Medical
Center
1
2
d. Emergency Room ...........................
1
2
e. Hospital (Kaiser Permanente, Mercy,
Sutter, UC Davis Medical Center, etc.) .
1
2
f. Private Doctor’s Office/Clinic ...........
1
2
g. Other (specify)
___________________________
1
2
2013 Version
32. Thinking about the past year, how often did you get
medical care from any physician or clinician that can
prescribe medications from a pharmacy?
Never .................................... 1 (GO TO Q.35)
Only when you were sick ............. 2 (GO TO Q.33)
On a regular on-going basis .......... 3 (GO TO Q.33)
33. Have you had the same doctor or gone to the same
clinic for your HIV infection … (Circle one)
Since you found out you were HIV+ ............... 1
For two or more years ............................... 2
Since last year......................................... 3
34. Did you miss any medical appointments in the last
year?
Yes ..................................... 1 (GO TO Q.34a)
No ...................................... 2 (GO TO Q.35)
34a. IF MISSED, did you reschedule for the next
available appointment?
Yes ..................................... 1 (GO TO Q.34b)
No ...................................... 2 (GO TO Q.35)
34b. IF RESCHEDULED, did you make it to
the rescheduled appointment?
Yes
1
No
2
35. At any time in the last year, have you been diagnosed
with any of the following diseases listed below?
(Circle 1 for “yes”, 2 for “no" or 8
Don't
for “Don’t Know)
Yes
No
Know
a. Hepatitis A or B ...................
1
2
8
b. Hepatitis C.........................
1
2
8
c. Syphilis .............................
1
2
8
d. Herpes (genital) ..................
1
2
8
e. Gonorrhea .........................
1
2
8
f. Chlamydia ..........................
1
2
8
g. Genital warts ......................
1
2
8
h. Yeast infections ..................
1
2
8
i. Other (specify)
_________________
1
2
8
36. Since you found out you were HIV positive, have you
ever had any opportunistic infections?
Yes ..................................... 1 (GO TO Q.36a)
No ...................................... 2 (GO TO Q.37)
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Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
36a. What types of infections or symptoms? (Put a
check mark next to the item in the list below.)
Names of different infections:
___1Candidiasis
___2Cryptococcosis
___3Cryptosporidiosis
(chronic intestinal)
___4Cytomegalovirus
disease (usually of the
retina)
___5HIV encephalopathy
___6Herpes
___7Histoplasmosis
___8Isoporiasis
___9Kaposi’s Sarcoma (KS)
___10Lymphoma (including
Burkitts,
immunoblastic, or the
brain)
___11Mycobacterium
avium complex (MAC)
___12Pneumonia or
pneumoncystis carinii
pneumonia (PCP)
___13Salmonella
___14Shingles
___15Toxoplasmosis
___16Tuberculosis
___17Wasting syndrome
37. Have you ever taken any medicines for your HIV
infection?
(GO TO Q.38)
Yes....................................... 1
No ....................................... 2
(GO TO Q.42)
38. How many prescription drugs are you
currently taking? (IF NONE GO TO Q.40)
_____
#
38a. How many of your prescription drugs are paid for
or reimbursed by each of the following sources?
(IF YOU DON”T KNOW, CIRCLE “99”)
Don't
Know
Write #
ADAP .....................................
Medi-Cal/Medicare ....................
Private insurance ......................
Veterans benefits .....................
Out-of-pocket ..........................
Other (specify)________________
99
99
99
99
99
99
39. Are you taking any of the following?
(Circle 1 for “Yes”, 2 for “No" or 8 for
“Don’t Know”)
a. Anti-retrovirals and/or protease
inhibitors ..............................
b. Antibiotics (such as Bactrim) that
fight off infections...................
c. Antifungal (such as Diflucan) that
are for body rashes or thrush .......
d. Steroids which help you with your
appetite or build weight ............
e. Antidepressants for depression or
anxiety .................................
f. Herbal and/or other supplements .
2013 Version
Yes
No
Don’t
Know
1
2
8
1
2
8
1
2
8
1
2
8
1
1
2
2
8
8
40. How often have you skipped taking your HIV/ AIDS
medication as prescribed by your doctor in the last
two (2) years?
Never / Have not skipped .............. 1 (GO TO Q.42)
Once or twice a month.................. 2
Once or twice a week ................... 3
More than twice a week ................ 4
I have stopped taking my medicine ... 5
41. If skipped or stopped taking your HIV/AIDS
medication, why?
(Circle 1 for "Yes" or 2 for "No" for each item)
a. Side effects ...............................
b. Difficult schedule and requirements ..
C, Didn’t want others to see the
medications
d. Didn’t understand the directions ......
e. Felt that medication didn’t work......
f. Could not afford medication ............
g. Forgot to take the medication .........
h. Hard to coordinate with food .........
i. Just did not want to take them ........
j. Homeless ...................................
k. Medication made me feel good so I
felt I didn’t need them anymore ......
l. My doctor advised me to stop taking
my medications ..........................
Other (specify) _____________________
Yes
1
1
No
2
2
1
2
1
1
1
1
1
1
1
2
2
2
2
2
2
2
1
2
1
2
1
2
42. Since you were infected with HIV have you
received mental health counseling or treatments?
(GO TO Q.43)
Yes ................................ 1
(GO TO Q.44)
No ................................. 2
43. Which of the following mental health counseling or
treatments did you receive?
(Circle 1 for "Yes" or 2 for "No" for each item)
Yes No
a. Inpatient (in a hospital at least overnight) 1
2
b. Individual counseling/therapy .............
1
2
c. Group counseling/therapy ..................
1
2
d. Medication for psychological or
behavioral problems ....................
1
2
44. At any time in the last two years have you been
diagnosed with any of the following mental health
problems?
(Circle 1 or "Yes" or 2 for "No" for each item)
Yes No
a. Anxiety .....................................
1
2
b. Bipolar Disorder ..........................
1
2
c. Dementia ...................................
1
2
d. Depression .................................
1
2
Other (specify) _____________________
1
2
155
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
45. For each of the services below:
1. Under column A, circle 1 for “yes” if you needed the service in the past year or circle 2 for “no” if you didn’t need the service.
2. Under column B, circle 1 for “yes” if you asked for the service in the past year or circle 2 for “no” if you didn’t ask for the service.
3. Under column C circle 1 for “yes” if you received the service in the past year or circle 2 for “no” if you didn’t receive the service.
MEDICAL CASE MANAGEMENT/CLIENT ADVOCACY/INFORMATION AND
REFERRAL SERVICES
For each service below…
A
Did you need
this service
this past year?
Yes
No
B
Did you ask for
this service
this past year?
Yes
No
C
Did you receive
this service
this past year?
Yes
No
Medical case management session(s) with a medical case manager to
help you coordinate your HIV/AIDS care and help access benefits.
1
2
1
2
1
2
Benefits counseling session(s) with a medical case manager or benefits
counselor to help you access benefits.
1
2
1
2
1
2
Education and referral to clinical research opportunities available to
clients.
1
2
1
2
1
2
Intake session when you first come to an agency and a staff member
assesses your care needs.
1
2
1
2
1
2
Client advocacy where a counselor assists you to work through a
particular problem in obtaining a service, or in a complaint against a
service provider.
1
2
1
2
1
2
Comments about your need or use of these services:
155
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
CHILD CARE/CHILDREN-RELATED SERVICES
For each children-related service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Child care for your child while you attended a medical or social service
appointment.
1
2
1
2
1
2
Child welfare services to aid in family preservation/unification, foster
care, parenting education, or other child welfare services.
1
2
1
2
1
2
Childhood developmental assessment and early intervention services to
aid in your child’s psychosocial and intellectual development.
1
2
1
2
1
2
Permanency planning to help you or your family determine what will be
done with your children if you become unable to care for them.
1
2
1
2
1
2
Comments about your need or use of these services:
FOOD AND NUTRITION SERVICES
For each food and nutrition service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Food Voucher assistance to help you pay for food.
1
2
1
2
1
2
Food Bank services that provide you with access to food banks/closets to
obtain food, meals and nutritional supplements.
1
2
1
2
1
2
Home Delivery of food, meals, and nutritional supplements to your home
because you were unable to leave your home due to illness.
1
2
1
2
1
2
Nutritional counseling and education.
1
2
1
2
1
2
Comments about your need or use of these services:
156
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
HEALTH SERVICES
Medical/Dental/Medication/Complementary Therapies
For each health care service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Visits with a doctor, nurse, or assistant to take care of your HIV
Outpatient medical care.
1
2
1
2
1
2
Visit to a medical specialist based on a referral from your doctor.
1
2
1
2
1
2
Visit with a doctor, nurse, or assistant to examine or treat non-HIV
health conditions.
1
2
1
2
1
2
Education or counseling about HIV, HIV transmission, and how to reduce
the risk of HIV transmission
1
2
1
2
1
2
In home visits from health care workers because your illness prevented
you from leaving the house.
1
2
1
2
1
2
In home specialized health care requiring intravenous (IV) treatment or
other high tech treatments.
1
2
1
2
1
2
Health Insurance assistance to help you pay for health insurance
premiums or co-pays.
1
2
1
2
1
2
Doctor prescribed medications.
1
2
1
2
1
2
Drug reimbursement assistance to help you pay for medications and
prescriptions.
1
2
1
2
1
2
Treatment adherence services to provide you with education and
counseling on ways to help you routinely take HIV/AIDS medications and
follow through on HIV/AIDS treatments.
1
2
1
2
1
2
Complementary therapies, such as acupuncture, chiropractic, and
massage services.
1
2
1
2
1
2
Dental visits with a dentist, hygienist, or assistant to take care of oral
health problems.
1
2
1
2
1
2
Comments about your need or use of these services:
157
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
HOUSING AND UTILITIES SERVICES
For each housing and utilities service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Utilities assistance to help you pay for essential utilities (such as gas,
electricity, phone, etc.)
1
2
1
2
1
2
Housing/Rental assistance to help you pay for permanent housing.
1
2
1
2
1
2
Housing/Rental assistance to help you pay for short-term/emergency
housing.
1
2
1
2
1
2
Housing information services from a housing specialist to assist you in
finding or getting housing, or qualifying for housing programs.
1
2
1
2
1
2
Comments about your need or use of these services:
MENTAL HEALTH SERVICES
For each mental health service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Mental health services through one-on-one psychological or psychiatric
counseling (NOT FOR SUBSTANCE ABUSE).
1
2
1
2
1
2
Mental health services through group counseling led by a psychologist or
social worker (NOT FOR SUBSTANCE ABUSE).
1
2
1
2
1
2
Support groups led by peer or non-licensed group leader (NOT FOR
SUBSTANCE ABUSE).
1
2
1
2
1
2
Counseling for your family (children, spouse, and/or partner).
1
2
1
2
1
2
Bereavement counseling by phone or in-person.
1
2
1
2
1
2
Comments about your need or use of these services:
158
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
OTHER SOCIAL/SUPPORTIVE SERVICES
For each social/supportive service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Buddy/Companion services to provide you with social support and
assistance with routine, day-to-day living tasks.
1
2
1
2
1
2
Supportive services that provide you with access to recreational
activities and outings.
1
2
1
2
1
2
Non-medical home care to help you complete household or other routine
tasks in order to allow you to remain in your home (as opposed to a
nursing home or other comparable setting).
1
2
1
2
1
2
Day or respite care designed to temporarily relieve your primary
caregiver from providing day-to-day care.
1
2
1
2
1
2
Legal services to assist you with powers of attorney, wills, bankruptcy,
interventions to ensure access to services, discrimination, etc.
1
2
1
2
1
2
Physical and occupational rehabilitation therapy.
1
2
1
2
1
2
Comments about your need or use of these services:
159
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
Prevention for Positives
For each Prevention for Positives question below:
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Information on how to prevent becoming re-infected with HIV.
1
2
1
2
1
2
Access to free condoms and other risk reduction items (ex. lube, dental
dams, etc.) to assist you with practicing safer sex.
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Support (ex. safer sex support group or workshop) from other HIV+ peers
in practicing safer sex strategies (ex. using condoms, adhering to
medication regime, etc.)
Counseling for you and an HIV negative partner(s) to assist you in
communicating and developing strategies to keep your partner(s) HIV
negative.
Assistance with disclosing your HIV status with your sexual or drug
partners.
Comments about your need or use of these services:
160
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
SUBSTANCE ABUSE TREATMENT SERVICES
For each substance abuse treatment service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Outpatient substance abuse treatment or counseling.
1
2
1
2
1
2
24 hour-a-day residential substance abuse counseling (can include
detox).
1
2
1
2
1
2
Substance abuse one-on-one psychological or psychiatric counseling.
1
2
1
2
1
2
Substance abuse group counseling.
1
2
1
2
1
2
Substance abuse support groups led by peer or non-licensed group leader.
1
2
1
2
1
2
Comments about your need or use of these services:
TRANSPORTATION SERVICES
For each transportation service below…
A
B
Did you need
this service
this past year?
Yes
No
Did you ask for
this service this
past year?
Yes
No
C
Did you
receive this
service this
past year?
Yes
No
Bus/light rail passes to get to health or social service appointments or to
access supportive services.
1
2
1
2
1
2
Taxi services to get to health or social service appointments or to access
supportive services.
1
2
1
2
1
2
Transportation from volunteer drivers who pick you up at your home to
take you to health, social, or supportive services and appointments.
1
2
1
2
1
2
Comments about your need or use of these services:
161
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
46. Below is a list of problems that you may or may not have had when trying to obtain or use HIV/AIDS services. Please circle the response on the line
beside each item to say whether or not it was a problem for you in the last year.
Agree/Yes or Disagree/No
Agree/Yes
Disagree/No
a. Not knowing that a service or treatment was available to me.
Agree/Yes
Disagree/No
b. Not knowing a location of the service(s).
Agree/Yes
Disagree/No
c. My physical health has not allowed me to get to the place where the service is provided.
Agree/Yes
Disagree/No
d. I do not believe HIV or AIDS is a problem for me that requires assistance.
Agree/Yes
Disagree/No
e. Not knowing what medical services I need to treat my HIV infection or AIDS.
Agree/Yes
Disagree/No
f. My state of mind or mental ability to deal with the treatment.
Agree/Yes
Disagree/No
g. Not understanding the instructions for obtaining the service or treatment.
Agree/Yes
Disagree/No
h. Not knowing who to ask for help.
Agree/Yes
Disagree/No
i. Sensitivity of the organization and person providing services to me regarding my issues and concerns.
Agree/Yes
Disagree/No
j. Discrimination I experienced by the persons or organization providing the services.
Agree/Yes
Disagree/No
k. Experience or expertise of the person providing services to me.
Agree/Yes
Disagree/No
l. The amount of time I had to wait between scheduling an appointment and the actual day of the appointment.
Agree/Yes
Disagree/No
m. The amount of time I had to wait in the waiting room prior to being called in on the day of the appointment.
Agree/Yes
Disagree/No
n. The organization providing the service made me feel like a number.
Agree/Yes
Disagree/No
o. I do not get along with people providing services
Agree/Yes
Disagree/No
p. I have been denied a service in the past.
Agree/Yes
Disagree/No
q. I have been denied or have been afraid to seek services due to a criminal justice matter.
Agree/Yes
Disagree/No
r. My ability to communicate or interact with the service provider.
Agree/Yes
Disagree/No
s. The people providing services to me are not helpful.
Agree/Yes
Disagree/No
t. The organization did not provide the right referrals to the services I need.
Agree/Yes
Disagree/No
Continued on next page.
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Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
46. Continued: Below is a list of problems that you may have had when trying to obtain or use HIV/AIDS services.
Please circle the response on the line beside each item to say whether or not it was a problem for you in the last
year.
u. My ability to find my way through the system.
Agree/Yes
Disagree/No
v. There was no specialist who could provide the care I needed.
Agree/Yes
Disagree/No
w. Fear of my HIV or AIDS status being found out by others – lack of confidentiality.
Agree/Yes
Disagree/No
x. Fear that I would be reported to immigration or other authorities.
Agree/Yes
Disagree/No
y. No transportation.
Agree/Yes
Disagree/No
z. No childcare.
Agree/Yes
Disagree/No
aa. I was not eligible for the service.
Agree/Yes
Disagree/No
bb. There was too much paperwork or red tape.
Agree/Yes
Disagree/No
cc.I can’t afford one or more of the service.
Agree/Yes
Disagree/No
dd. There are too many rules and regulations.
Agree/Yes
Disagree/No
ee. My lack of or inadequate insurance coverage.
Agree/Yes
Disagree/No
ff. I have been terminated or suspended from seeking services
Agree/Yes
Disagree/No
gg. Other ___________________________________________
Agree/Yes
Disagree/No
163
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
47. Have you ever used any of the following substances?
Alcohol .....................................
Marijuana (pot, grass, weed, hash) ...
Cocaine ....................................
Crack (rock) ...............................
Heroin (smack, H, junk, skag) .........
Methamphetamine (Meth, crystal,
crank, Tina) .....................
Speedball ..................................
GHB (Gamma Hydroxybutyrate, liquid
ecstasy, gina, G))......................
Poppers (rush) ............................
Ecstasy (X, E, MDMA, Adam) ...........
Tranquillizers/Barbiturate .............
Ketamine (Special K, K).................
Hallucinogens (LSD, acid, peyote,
mescaline, PCP) .......................
Pills not prescribed by my doctor
(specify)________________________
Other substances (specify)
____________________________
Ever used
No
Yes
2
1
2
1
2
1
2
1
2
1
47a. HAVE YOU USED, during the past 6 months, any
of the following substances?
Used in last 6 months
No
Yes
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
2
2
2
1
1
1
1
2
2
2
2
1
1
1
1
2
1
2
1
2
1
2
1
2
1
2
1
48. IF YOU HAVE USED ANY SUBSTANCES, Have you
ever injected any substances not prescribed by a
medical person?
Yes .................................................. 1
No ................................................... 2
49. IN THE PAST YEAR, IF YOU HAVE INJECTED
SUBSTANCES: How many people have you shared
needles with in the past year?
Write Number of People
50. How would you describe your residency status in
the United States?
Citizen/Legal Resident ...........................
1
Have a Visa (student, temp or permanent)...
2
Have legal refugee or asylum status ...........
3
Undocumented ....................................
4
Other (specify) _______________________
5
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Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
51. (Optional) Before we finish this survey, do you have any other comments about your satisfaction with the way
you get HIV or AIDS related services? If not enough space, please continue your comments on the other side.
165
Ongoing Needs Assessment Survey Tool
Confidential ID: ____ ____ ____ ____ ____ ____ ____
FOR OFFICE USE ONLY:
Mode of transmission (Q22)
MSM .................................
IDU ..................................
Heterosexual Transmission .....
MSM/IDU ...........................
Adult Hemophiliac/blood
products ...........................
Don’t Know (DK)..................
Race/Ethnicity (Q4)
African American .................
Asian/Pacific Islander ...........
Hispanic/Latino ..................
Native American/Alaskan
Native ..............................
White ...............................
More than one ....................
Gender (Q3)
Man .................................
Woman .............................
Transgender .......................
County of Residence
Sacramento .........................
El Dorado............................
Placer ................................
Other ____________ ..............
1
2
3
4
5
8
1
2
3
4
5
6
1
2
3
Special Population
None ................................
Adolescents (16-24) – Q2 ........
Recently released from
Incarceration – Q14
In-Migrant (moved to
Sacramento region in last year)
......................................
Homeless - Q14 ..................
Out of care (medical) – Q29 ....
Over 55 – Q2 ......................
Rural – Q7..........................
Undocumented – Q50 ............
Women w/ children – Q13 ......
0
1
2
3
9
4
5
6
7
8
Interviewer Initials .............
01
02
03
04
Interviewer Notes
166