Use of Ryan White CARE Act and Other Assistance Grant Funds

HEHS-00-54: Published: Mar 1, 2000. Publicly Released: Mar 23, 2000.

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William J. Scanlon
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Pursuant to a congressional request, GAO provided information on three federal human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) programs--the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act), the Centers for Disease Control and Prevention's (CDC) HIV/AIDS prevention grants, and the Department of Housing and Urban Development's Housing Opportunities for Persons Living With AIDS (HOPWA)--that fund prevention activities, health care, and other assistance, focusing on: (1) the characteristics of the persons who are served under the CARE Act; (2) how CARE Act, CDC prevention, and HOPWA funds are distributed to treatment, support services, housing, prevention, and program administration; (3) whether the current approach to funding under the CARE Act leads to advantages or disadvantages in particular areas; (4) whether CARE Act services are reaching rural areas; and (5) how the salaries of administrators of organizations providing HIV/AIDS services compare with the salaries of administrators of other similar nonprofit organizations.

GAO noted that: (1) the CARE Act funds appear to be reaching groups of infected individuals that have generally been found to be underserved, including the uninsured and the poor; (2) African Americans, Hispanics, and women are served by the CARE Act in higher proportions than their representation in the AIDS population; (3) these groups make up the majority of CARE Act clients; (4) the CARE Act funds both health care and support services, such as case management, housing, transportation, and nutrition; (5) most of the funds are used for medical treatment and medications; (6) CDC supports a wide range of state and local HIV prevention activities; (7) about two-thirds of CDC's fiscal year 1998 HIV prevention funds to states, localities, schools, and organizations were used for health education and risk reduction, public information, evaluation and research, capacity building and infrastructure development, and community planning; (8) about one-third was used for counseling about the risks of contracting HIV and the need to notify partners about potential HIV infection, testing for the virus, and referring persons who test positive to appropriate care; (9) HOPWA helps low-income people with HIV/AIDS and their families secure housing and provides other services; (10) HOPWA funds may be used for a variety of housing-related expenses, social services, and program development; (11) between 1994 and 1998, about two-thirds of HOPWA funds were used for housing assistance; (12) all the programs have limitations on how program funds can be used for administrative purposes; (13) the levels of funding differ in different areas, with urban areas generally receiving higher funding per AIDS case when an area is designated as an eligible metropolitan area (EMA); (14) EMAs receive funds directly from the federal government under title I of the CARE Act, in addition to the funds provided through the states under title II; (15) while HOPWA funds also vary between states and their eligible metropolitan statistical areas, HOPWA state awards are allocated to provide assistance in areas of the state that are outside any EMA that receives HOPWA allocation; (16) while the vast majority of people with AIDS reside in urban areas, the number of AIDS cases is growing in rural areas, which may offer more limited medical and social services; (17) CARE Act drug assistance services are reaching the rural AIDS population in proportion to the AIDS cases in rural areas; and (18) the compensation for administrators of organizations that received federal HIV/AIDS funds was generally comparable to that of administrators of similar nonprofit organizations.

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