Every two years the Office of AIDS Coordination, working with the HIV Planning Council and HIV Consumer Council, takes on the task of preparing a countywide HIV needs assessment to evaluate services and spending in HIV/AIDS healthcare. Specifically, the assessment is used to determine how the county will use Title I and Title II Ryan White Care Act funds.

“It’s designed to find out what Ryan White services people are accessing, but even more importantly to find out what their unmet needs are,” said Clark Barnett, a consultant working with the Office of AIDS Coordination on the assessment. “It’s got two components, figuring out people who are not in the field of care right now, which means people who have not accessed any medical services in the last 12 months, and finding out why they’re not getting care, and the other one is for people who are in there and what needs they have, like housing transportation and case management and, of course, the primary one is medical care.”

Title I grants are awarded to eligible metropolitan areas based on case rates. Major services funded under Title I include outpatient health care and support services, including case management, home health, hospice care, housing, transportation and nutrition. Title II grants are given to states for healthcare and support services for persons with HIV/AIDS. Allocation decisions are made by states and are used for home and community-based healthcare and support services, pharmacy support through ADAP (AIDS Drug Assistance Program), and to support a local OAC to assess needs and organize a regional plan for delivery of HIV/AIDS services, medical care and support services.

“It’s probably one of the most important documents that the planning council creates,” said St. Clair Adams, the current co-chair of the HIV Consumer Council and a member of the HIV Planning Council. The last needs assessment became an integral part of the budget planning process this past year when the HIV Planning Council, faced with tremendous cuts in state and federal funding, had to reduce their budget by over $500,000.

“The unfortunate thing is we were using two-year-old data at the time we were faced with that cut,” Adams said. “It was hard to kind of predict what priorities people had after the budget cut because there would be different priorities if they knew things had to be cut.”

Last year, the HIV Planning Council completely defunded the county’s benefits counseling program and made severe cuts to food delivery services and the complementary therapies program, which provides massage and acupuncture to clients to help them cope with the side effects of HIV and AIDS medications.

As the state and federal governments continue to make cuts in general healthcare programs, Ryan White funds will be used by more and more people who fall out of the other programs.

“Anything cut on the outside that may send services the Ryan White Care Act way could affect our budget,” Adams added. “For example, if DentiCal were to be totally cut, all of those individuals who would qualify for Ryan White Dental would all have to go to Ryan White. Those individuals who would be cut from Medical, they would have to come over for direct care and services. A lot of unknowns could affect the HIV Planning Council Title I and Title II dollars.”

There is an additional focus this year on targeting the needs of individuals who are currently not receiving treatment for HIV and AIDS. The Ryan White Care Act mandates that its grantee, in this case the County Health and Human Services agency, reach out to those individuals who are not in the system.

“Part of our focus in the needs assessment this year is to really get more information about barriers to access and care for people who are HIV-positive,” Deborah Roseman of the HIV Planning Council’s support staff told the Gay and Lesbian Times. “The treatments are so effective now, there is every reason for somebody who is HIV-positive to have access to get care and treatment, so we want to assess why folks who are not accessing care are not doing so.”

The needs assessment committee is already talking to other cities to see how they have set up a process to reach individuals not currently in care. Additionally they will be placing needs assessment surveys with organizations that may already be providing services to HIV-positive individuals who are not currently in care. Most importantly though, they are hoping to communicate through “gate keepers” in the community who know of people who are HIV-positive, particularly people who are HIV-positive who may have friends or acquaintances who may be positive but not in care.

“We are not in anyway trying to force somebody into care if they don’t wish to,” Roseman said. “What we’re trying to do is figure out what the barriers are so that we can reduce them and allow people easier access to effective care and treatment.”

Adam added, “It’s very important that individuals actually participate in this with budget cuts coming down. We need all the input from individuals we can get so we can serve them with the limited dollars that will be provided. It’s extremely important that we find individuals who are not in care and find out what is needed to get them into care.”

Individuals who are not currently receiving HIV or AIDS health care can contact the HIV Consumer Council at (619) 702-6051 to receive a guide to HIV services as well as information on getting in touch with a peer advocate and case manager. The HIV Consumer Council will also provide individuals who are entering into the system with a manual that contains names of all the doctors they can be referred to for care. To obtain a copy of the needs assessment survey, call (619) 296-3400 ext. 104.