2002 Houston Area

HIV/AIDS Needs Assessment

A COLLABORATIVE PROJ ECT OF THE: Houston Area Ryan White Planning Council

Houston Local Needs Assessment Task Force (LNATF) of the

State of T exas Assembly Group East (STAGE)

Houston Regional HIV/AIDS Resource Group

Harris County Hospital District

Harris County Public H ealth & Environmental Services - HIV Services

City of Houston Prevention Community Planning Group (CPG)

Housing Opportunities fo r Persons with AIDS (HOPWA)

ACKNOWLEDGEMENTS Collaboration is the key to effective planning, especially around an illness as complex as HIV/AIDS. This report could not have been written without the collaborative efforts of the following partners:

Houston Area Ryan White Planning Council Houston Local Needs Assessment Task Force (LNATF) of the State of Texas Assembly Group East (STAGE) City of Houston Prevention Community Planning Group (CPG) Houston Regional HIV/AIDS Resource Group Harris County Hospital District Harris County Public Health and Environmental Services - HIV Services Housing Opportunities for Persons with AIDS (HOPWA)

Special thanks to our… Fearless leaders: Steve DeCorte and Ken Malone, Co-Chairs, Joint Needs Assessment Group Inspired Group leaders:

Kaye Reynolds and Ann J. Robison, Co-Chairs, Joint Epidemiology Group Steve DeCorte and Ken Malone, Co-Chairs, Joint Data Collection Group Ann J. Robison and David Garner, Co-Chairs, Joint Gaps Analysis Group Katy Caldwell and Rodney Goodie, Co-Chairs, Joint Resource Inventory Group

Tireless Community Participants:

Ahmed Adu-Oppong Ron Hogan Lynn Pannill Mercy Atatah Gretchen Hollingsworth Maurice Peterson Neil Babineaux Kentwan Hubert Johnnie Petry Tom Breaux John Humphries Angel Polk Antoinette Boone Kevin Jackson Lucy Reyna Ardry “Skeet” Boyle Roy Jefferson, III Erin White Wanda Carrington Bill Kersten Ana Sanchez Neil Coburn Adriana Linares Christopher Schmitt Darrell Colone Jay Lockhart Rebecca Snearly Amber David Clifford Macklin Michael Springer Michael Dean Johnny Madison Willie Sylvester Paula Downes M. Naomi Madrid Bob Taylor Meg Ferris Rodney Mark Anthony Tolbert Sandra Foreman Lupe Martinez Bruce Turner Veronica Garza Vickie McBride Judy Valerius Sonya Gonzales-Adams Nancy Miertschin Louis E. Vanech Dena Gray Francis Mijares Anthony J. Waguespack Paz A. Guerra John Nechman Steven L. Walker Johnny Harris, Jr. Joseph Osei-Frimpong Lesley Williams Victor Hay Robin Owens

Remarkable Health Planners: Ritalinda D’Andrea Christopher Schmitt Dedicated Staff:

Diane Clark Elizabeth Love Ana Milan Julie Doyle Ann McFarland Tori Williams Georgette L. Monaghan

Expert Consultants from Stroudwater, NHG: Tracy Kulik, Karen Dodge, Barbara Feeney, Barbara Jacobowitz, Steve Blattner, Gregory Wolf But, most of all… heart felt thanks to the 750 people with HIV/AIDS and their caregivers for participating in this important process. The 2002 HIV/AIDS Needs Assessment is dedicated to you.

TABLE OF CONTENTS TTAABBLLEE OOFF CCOONNTTEENNTTSS Index of Tables and Figures…………………………………………………….… VI

Overview…………………………………………………………………………….... a Purpose……………………………………………………………………………………. b Region……………………………………………………………………………………... b

Houston Area 2002 Epidemiological Report……………….…………….……. 1 Introduction………………………………………………………………………………… 2

Sociodemographic Profile of the Houston Area……………………………………….. 2 Transportation………………………………………………………………………... 4 Population………………………………………………………………………….…. 4 Economics……………………………………………………………………….……. 6 Health and Health Resources………………………………………………….…… 8

Impact of HIV/AIDS in the Population………………………………………………..…. 9 Reported AIDS Cases………………………………………………………………….… 10 Cumulative Cases………………………………………………………………….… 10 Living AIDS Cases………………………………………………………………….... 12 Trends in AIDS Diagnoses…………………………………………………………... 14 Reported HIV Cases……………………………………………………………….… 17 Pediatric HIV/AIDS…………………………………………………………………... 21 Estimates of HIV Prevalence………………………………………………………... 22

Impact of HIV/AIDS by Geographic Area………………………………………………. 23

Co-Factors……………………………………………………………………………….… 23 Sexually Transmitted Infections…………………………………………………….. 23 Substance Use……………………………………………………………………….. 25 Tuberculosis………………………………………………………………………….. 26 Incarceration………………………………………………………………………….. 26

Glossary Of Terms……………………………………………………………………….. 28

Chapter 1: Procedures…………………………………………………………….. 31 Organizational Structure…………………………………………………………………. 32 Data Collection Methods…………………………………………………………………. 32 Methods of Analysis…………………………………………………………………….… 36

Chapter 2: Central Themes……………………………………………………….. 40 Section 1 – General Findings………………………………………………………….… 41 Section 2 – Service Summary………………………………………………………..….. 42 Section 3 – Provider Summary……………………………………………………….…. 48

IInnddeexx ooff TTaabblleess aanndd FFiigguurreess…………………………………………………………………………………………………………..……

OOvveerrvviieeww…………………………………………………………………………………………………………………………………………………………........

HHoouussttoonn AArreeaa 22000022 EEppiiddeemmiioollooggiiccaall RReeppoorrtt………………………………..…………………………..………….. 11

CChhaapptteerr 11:: PPrroocceedduurreess………………………………………………………………………………………………………………………….... 3311

CChhaapptteerr 22:: CCeennttrraall TThheemmeess……………………………………………………………………………………………………………….... 4400

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - I -

Chapter 3: Demographics…………………………………………………….…... 49 Houston EMA in National Context…………………………………………………….… 50 HIV AND AIDS in the EMA………………………………………………………………. 50 Geographic “Hot Spots”…………………………………………………….…………….. 51 Ryan White Client Characteristics………………………………………………………. 52 Economics…………………………………………………………………………………. 54 Population Characteristics……………………………………………………………….. 55

Chapter 4: Service Categories……………………………………………….….. 59 Ambulatory/Outpatient Medical Care………………………………..………………..… 61 Primary Medical Care…………………………………………………………..……. 63 Vision Care……………………………………………………………………….…… 68 Obstetrics & Gynecology……………………………………………………….….… 70 Pediatric Care…………………………………………………………….…….…….. 73 Specialty Care………………………………………………………………………… 75 Infectious Diseases…………………………………………………………………... 77

Case Management………………………………………………………………………... 79 Social Case Management………………………………………………………….... 80 Medical Case Management……………………………………………………….… 81

Nutritional Services……………………………………………………………………….. 83

Support Services……………………………………………………………….…………. 86 Adult Day Care……………………………………………………………………….. 88 Buddy/Companion Services……………………………………………………….… 90 Childcare…………………………………………………………………………….… 92 Client Advocacy/Legal Services…………………………………………….………. 93 Emergency Financial Assistance…………………………………………………… 95 Food Bank/Home-Delivered Meals……………………………………………….… 98 Health Education/Risk Reduction…………………………………………………… 101 Health Insurance Payments……………………………………………………….… 104 Housing Assistance………………………………………………………………….. 106 Housing………………………………………………………………………………... 108 Interpreter Services………………………………………………………………….. 110 Outreach Services…………………………………………………….……………… 113 Referral…………………………………………………………………………….….. 115 Transportation…………………………………………………………………..…….. 116

Dental Care…………………………………………………………………………….…... 119

Substance Abuse Treatment/Counseling…………………………………………….…. 122

CChhaapptteerr 33:: DDeemmooggrraapphhiiccss…………………………………………………………………………………………………………..……...... 4499

CChhaapptteerr 44:: SSeerrvviiccee CCaatteeggoorriieess………………………………………………………………………………………………..…….... 5599

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - II -

Drug Reimbursement Program…………………………………………………………... 127 Medications/Pharmacy…………………………………………………………... 129

Mental Health Services……………………………………………………………………. 133 Psychological & Psychiatric Treatment & Counseling……………………….. 134 Support Groups…………………………………………………………………... 135 Mental Health Services, Licensed Clinical…………………………………….. 136

Hospice……………………………………………………………………………………… 139 Home-Based Hospice………………………………………………………….… 141 Residential Hospice……………………………………………………………… 142

Home Health Care…………………………………………………………………………. 144 Paraprofessional Care…………………………………………….…………….. 146 Professional Care……………………………………………………….……….. 147 Specialized Care……………………………………………………….………… 148 Durable Medical Equipment………………………………………….…….….... 149

Rehabilitation……………………………………………………………………….…….… 151 Physical Therapy……………………………………………………….………… 152 Speech Pathology………………………………………………………………... 153 Low-Vision Training Services…………………………………………………… 154 Early Intervention……………………………………………………………...………….... 157

Chapter 5: Targeted Findings: Housing and Transportation………………. 158 Housing……………………………………………………………………………………… 161 Transportation…….………………………………………………………………………… 167 Recommendations.………………………………………………………………………… 173

Chapter 6: Focus Group Analysis…………………………………………….…. 174 African American Men Who Have Sex With Men………………………………….…… 177 Anglo Men Who Have Sex With Men………………………………….………………… 178 People with Disabilities……………………………………………………………………. 179 Incarcerated Women………………………………………………………………………. 180 Long-Term Survivors………………………………………………………………………. 181 Northern Rural Residents…………………………………………………………………. 182 Adults over 45………………………………………………………………………………. 183 Women – Currently Pregnant………………………………………………………….…. 184 Southern Rural Residents………………………………………………………………… 185 Substance Users………………………………………………………………………..…. 186 Women – Not Currently Pregnant……………………………………………………..…. 187 Youth, Ages 13 - 24………………………………………………………………………... 188

CChhaapptteerr 55:: TTaarrggeetteedd FFiinnddiinnggss:: HHoouussiinngg aanndd TTrraannssppoorrttaattiioonn……………………………….. 115588

CChhaapptteerr 66:: FFooccuuss GGrroouupp AAnnaallyyssiiss…………………………………………………………………………………………..…….. 117744

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - III -

Chapter 7: Provider Survey Findings…………………………………….……... 189 Purpose……………………………………………………………………………………… 190 Procedures………………………………………………………………………………….. 190 Profile of Responding Agencies………………………………………………………….. 192 Comparison of Client and Provider Responses: Service Barriers……………………. 196 Prevention Activities……………………………………………………………………….. 198 Suggested Service Improvements……………………………………………………….. 201 Focus Group Central Themes……………………………………………………………. 202 Recommendations…………………………………………………………………………. 203 Meeting the Unmet Need – A Possible Formula……………………………………….. 204

Chapter 8: Special Study Populations: Themes & Recommendations…… 209 African American Men Who Have Sex With Men………………………………….…… 210 Youth, Ages 13 - 24………………………………………………………………………... 211 Women Living with HIV/AIDS…………………………………………………………….. 213 Incarcerated/Recently Released…………………………………………………………. 214

Chapter 9: Special Study: African-American Men Who Have Sex with Men (MSM) Living with HIV/AIDS……………………………….…. 216 Profile of Sociologic and Health Observations – African American MSM……………. 219 Service Use and Barrier Analysis………………………………………………………… 233 Service Need Analysis…………………………………………………………………….. 233 Service Gap Analysis……………………………………………………………………… 234 Qualitative Findings………………………………………………………………………... 235 Themes and Recommendations…………………………………………………………. 237

Chapter 10: Special Study: HIV-Infected Youth (Ages 13 - 24)………….…. 238 Profile of Sociologic and Health Observations – Youth.……………………………….. 243 Service Use and Barrier Analysis………………………………………………………… 255 Service Need Analysis…………………………………………………………………….. 255 Service Gap Analysis……………………………………………………………………… 256 Qualitative Findings………………………………………………………………………... 257 Themes and Recommendations…………………………………………………………. 260

Chapter 11: Special Study: HIV-Infected Women…………………………….. 262 Profile of Sociologic and Health Observations – Females…………………………….. 268 Service Use and Barrier Analysis………………………………………………………… 284 Service Need Analysis…………………………………………………………………….. 285 Service Gap Analysis……………………………………………………………………… 285 Qualitative Findings………………………………………………………………………... 286 Themes and Recommendations…………………………………………………………. 290

CChhaapptteerr 77:: PPrroovviiddeerr SSuurrvveeyy FFiinnddiinnggss…………………………………………………………………………..…………...... 118899

CChhaapptteerr 88:: SSppeecciiaall SSttuuddyy PPooppuullaattiioonnss:: TThheemmeess && RReeccoommmmeennddaattiioonnss………… 220099

CChhaapptteerr 99:: SSppeecciiaall SSttuuddyy:: AAffrriiccaann--AAmmeerriiccaann MMeenn WWhhoo HHaavvee SSeexx wwiitthh MMeenn ((MMSSMM)) LLiivviinngg wwiitthh HHIIVV//AAIIDDSS………………………………………………………………..…….. 221166

CChhaapptteerr 1100:: SSppeecciiaall SSttuuddyy:: HHIIVV--IInnffeecctteedd YYoouutthh ((AAggeess 1133 -- 2244))……………………..…….. 223388

CChhaapptteerr 1111:: SSppeecciiaall SSttuuddyy:: HHIIVV--IInnffeecctteedd WWoommeenn………………………………………………………….... 226622

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - IV -

Chapter 12: Special Study: Incarcerated Individuals Living with HIV…… 291 Profile of Sociologic and Health Observations – Incarcerated/Recently Released…. 299 Service Use and Barrier Analysis………………………………………………………… 301 Service Need Analysis…………………………………………………………………….. 301 Service Gap Analysis……………………………………………………………………… 301 Qualitative Findings………………………………………………………………………... 302 Health Care Programs for Incarcerated PLWH/A………………………………………. 306 Themes and Recommendations…………………………………………………………. 308

Chapter 13: Special Study: Out of Care Individuals Living with HIV……... 310 Importance……………………………………………………………………………….…. 311 Background…………………………………………………………………………………. 311 Harris County Experience……….………………………………………………………… 312 Geographic Variance…………..………………………………………………………….. 313 Conclusions………….……………………………………………………………………… 317 Recommendations…………………………………………………………………………. 318

Chapter 14: Recommendations………………………………………………….. 319 Recommendations…………………………………………………………………………. 318 General……………………………………………………….…………………… 320 Service Specific..……………………………………………………….………… 321 Other Service Needs………………………………………………….………… 322

Appendices…………………………………………………………………………… 324 A Sample Weighting………………………………………………….…………………… 325

B Data Tables………………………………………………….…………………………... 331 Use Ranking………………………………………………….…………………… 332 Need Ranking………………………………………………….…………..……… 333 Barrier Ranking………………………………………………….………...……… 334 Gap Ranking………………………………………………….…………………… 335

C Provider Survey Instrument………………………………………………….………… 340

D Client Survey Instrument……………………………………………………..………… 358

E List of Survey Sites………………………………………………….……………..……. 393

F Focus Group Recruitment Packet……………………………………………………... 395 Focus Group Participant Application……………………………….…...……… 396 Focus Group Recruitment Flyer………………………………………………… 397

G Sources of Funding………………………………………………….……………….…. 398

H Survey Question Topics………………………………………………………………... 401

J Providers Who Participated……………………………………………………………. 403

CChhaapptteerr 1122:: SSppeecciiaall SSttuuddyy:: IInnccaarrcceerraatteedd IInnddiivviidduuaallss LLiivviinngg wwiitthh HHIIVV………… 229911

CChhaapptteerr 1133:: SSppeecciiaall SSttuuddyy:: OOuutt ooff CCaarree IInnddiivviidduuaallss LLiivviinngg wwiitthh HHIIVV…………...... 331100

CChhaapptteerr 1144:: RReeccoommmmeennddaattiioonnss…………………………………………………………………………………………………….... 331199

332244 AAppppeennddiicceess…………………………………………………………………………………………………………………………………………………………

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - V -

INDEX OF TABLES & FIGURES IINNDDEEXX OOFF TTAABBLLEESS && FFIIGGUURREESS Epidemiological Report…………………………………………………………….. 1

Figure EPI-1: Map of the EMA/HSDA…………………………………………………………………………………... 3 Table EPI-1: Population, Square Miles, and Population Density, by Geographic Area…………………………… 5 Table EPI-2: Gender Distribution and Racial/Ethnic Composition, by County…………………………….………. 6 Table EPI-3: Poverty Estimates, by County……………………………...…………………………….……………… 7 Table EPI-4: Estimated People Without Insurance, by County, 1999…………………………….………………… 8 Table EPI-5: Unemployment Rate, by County……………………………...…………………………….…………… 8 Table EPI-6: Cumulative AIDS Cases, by Age Group, Texas – Through 9/30/01…………………………….….. 10 Table EPI-7: Cumulative AIDS Cases, by Gender/Race/Ethnicity, Texas – Through 9/30/01…………………... 10 Table EPI-8: Cumulative AIDS Cases, by Gender/Behavioral Risk, Texas – Through 9/30/01…………………. 11 Table EPI-9: Cumulative AIDS Cases, by Gender/Age Group, Houston Area – Through 12/31/01…………….. 11 Table EPI-10: Cumulative AIDS Cases, by Gender/Race/Ethnicity, Houston Area – Through 12/31/01………. 11 Table EPI-11: Cumulative AIDS Cases, by Gender/Behavioral Risk, Houston Area – Through 12/31/01……... 12 Table EPI-12: Living AIDS Cases, by Gender and Age Group, Texas – Through 12/31/01…………………….. 12 Table EPI-13: Living AIDS Cases, by Gender/Race/Ethnicity, Texas – Through 12/31/01……………………… 12 Table EPI-14: Living AIDS Cases, by Gender and Behavioral Risk, Texas – Through 12/31/01……………….. 13 Table EPI-15: Living AIDS Cases, by Gender and Age Group, Houston Area – Through 12/31/01……………. 13 Table EPI-16: Living AIDS Cases, by Gender and Race/Ethnicity, Houston Area – Through 12/31/01……….. 13 Table EPI-17: Living AIDS Cases, by Gender/Behavioral Risk, Houston Area – Through 12/31/01……………. 14 Figure EPI-2: AIDS Cases by Year of Diagnosis, Houston Area - Through 12/31/01……………………………. 15 Figure EPI-3: Percent of AIDS Diagnosis by Age Group, Houston Area - Through 12/31/01…………………... 15

Figure EPI-4: Percent of AIDS Diagnosis by Race/Ethnicity and Year of Diagnosis, Houston Area - Through 12/31/01………………………………………………………………………………………………….. 16

Figure EPI-5: Percent of AIDS Diagnoses by Behavioral Risk Houston Area - Through 12/31/01……………... 16 Table EPI-18: Living HIV Infections, by Gender and Age Group, Texas – Through 12/31/01…………………... 17 Table EPI-19: Living HIV Infections, by Gender and Race/Ethnicity, Texas – Through 12/31/01…………….… 17 Table EPI-20: Living HIV Infections, by Gender/Behavioral Risk, Texas – Through 12/31/01…………….…….. 18 Table EPI-21: Living HIV Infections, by Gender and Age Group, Houston Area – Through 12/31/01…………. 18 Table EPI-22: Living HIV Infections, by Gender/Race/Ethnicity, Houston Area – Through 12/31/01…………… 18 Table EPI-23. Living HIV Infections, by Gender/Behavioral Risk, Houston Area – Through 12/31/01…………. 19 Figure EPI-6: HIV not AIDS Cases by Gender, Houston Area – Through 12/31/01…………….……………….. 19 Figure EPI-7: HIV not AIDS Cases by Race/Ethnicity, Houston Area – Through 12/31/01…………….……….. 20 Figure EPI-8: HIV not AIDS Cases by Behavioral Risk, Houston Area – Through 12/31/01…………….……... 20

Figure EPI-9: Living with HIV/AIDS at the End of Each Year by Race/Ethnicity, Houston Area – Through 12/31/01………………………………………………………………………………………………….. 21

Table EPI-24: Living Pediatric AIDS Cases and HIV Infections, Houston Area – Through 12/31/01…………… 21 Table EPI-25: Living HIV Infections and AIDS Cases, by County – Through 12/31/01……………...…………... 23 Table EPI 26: Reported Cases of Chlamydia and Gonorrhea, by County – Through 12/31/00…………….….. 24 Table EPI-27: TCADA 2001 Admissions, by County……………...……………...……………...…………….…….. 25

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - VI -

Chapter 1 Procedures…………………………………………………………. 31 Table 1-1: Focus Groups……………...……………...……………...……………...……………...…………….……. 35 Table 1-2: Service Categories and Individual Services……………...……………...……………...……………….. 37 Table 1-3: Calculating Use, Needs, Barriers and Gaps……………...……………...……………...…………….…. 38

Chapter 3 Demographics 49 Table 3-1: Reported HIV Cases and Rate by County, 1999……………...……………...……………...…………... 50 Table 3-2: Reported AIDS Cases and Rate by County, 1999……………...……………...…………….………….. 50 Figure 3-1: Houston Service Area and HIV Rate per 100,000 Population……………...…………….…………… 51 Figure 3-2: Map of EMA and HSDA……………...……………...……………...……………...…………….……….. 52 Table 3-3: Population, Square Miles, and Population Density, by Geographic Area……………...…………….... 53 Table 3-4: Poverty Estimates, by County……………...……………...……………...……………...…………….….. 54 Table 3-5: Estimated People Without Insurance, by County, 1999……………...……………...…………….……. 55 Table 3-6: Unemployment Rate, by County……………...……………...……………...……………...……………... 55 Figure 3-3: Age Distribution of Client Survey Respondents……………...……………...……………...…………… 56 Table 3-7: Client Survey Respondent Demographics and Epidemiology……………...……………...…………… 57

Chapter 4 Service Categories……………………………………………….. 59 Table 4-1: Calculating Use, Needs, Barriers & Gaps……………...……………...………………………………….. 60 Figure 4-1: Primary Care – Reported Barrier (B), Need (N), Use (U) ……………...……………...………………. 63 Figure 4-2: Viral Load Knowledge……………...……………...…………………………...……………...…………… 65 Figure 4-3: Comorbidity Rates……………...……………...…………………………...……………...……………….. 66 Table 4-2: Prevalence of Health Conditions in the General Populations……………...……………...……………. 67 Figure 4-4: Vision Care – Reported Barrier (B), Need (N), Use (U) ……………...……………...…………………. 68 Figure 4-5: Ob/Gyn Services – Reported Barrier (B), Need (N), Use (U) ……………...……………...…………... 70 Figure 4-6: Sexually Transmitted Infections……………...……………...…………………………………………….. 72 Table 4-3: Rate of Sexually Transmitted Infections……………...……………...…………………………………… 72 Figure 4-7: Pediatric Care – Reported Barrier (B), Need (N), Use (U) ……………...……………...……………… 73 Figure 4-8: Specialty Services – Reported Barrier (B), Need (N), Use (U) ……………...……………...………… 75 Figure 4-9: Infectious Diseases – Reported Barrier (B), Need (N), Use (U) ……………...……………...……….. 77 Figure 4-10: Social Case Management – Reported Barrier (B), Need (N), Use (U)……………...…………….…. 80 Figure 4-11: Medical Case Management – Reported Barrier (B), Need (N), Use (U)…………………………….. 81 Figure 4-12: Nutritional Supplements – Reported Barrier (B), Need (N), Use (U)……………...…………….…… 84 Figure 4-13: Buddy/Companion Services – Reported Barrier (B), Need (N), Use (U)……………………………. 90 Figure 4-14: Legal Services/Client Advocacy – Reported Barrier (B), Need (N), Use (U)…………………………… 93 Figure 4-15: Emergency Financial Assistance – Reported Barrier (B), Need (N), Use (U)………………………….. 95 Figure 4-16: Food Bank/Home Delivered Meals – Reported Barrier (B), Need (N), Use (U)……………………….. 98 Figure 4-17: Health Education – Reported Barrier (B), Need (N), Use (U)……………...…………….……………... 101 Figure 4-18: Housing Assistance – Reported Barrier (B), Need (N), Use (U) )……………...…………….………… 106 Figure 4-19: Housing Related Services – Reported Barrier (B), Need (N), Use (U)…………………………………. 108 Figure 4-20: Interpreter Services – Reported Barrier (B), Need (N), Use (U)……………...…………….………….. 110 Figure 4-21: Outreach Services – Reported Barrier (B), Need (N), Use (U)……………...…………….……………. 113 Figure 4-22: Transportation – Reported Barrier (B), Need (N), Use (U)……………...…………….………………… 116

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - VII -

Figure 4-23: Dental Care – Reported Barrier (B), Need (N), Use (U)……………...…………….….……….……….. 119 Figure 4-24: Substance Abuse Treatment & Counseling – Reported Barrier (B), Need (N), Use (U)……………… 122 Figure 4-25: Percent of Survey Respondents Using Substances)……………...…………….…..………………….. 124 Figure 4-26: Percent of Survey Respondents Using Substances and Alcohol)……………...…………….………… 125 Figure 4-27: Medications/Pharmacy – Reported Barrier (B), Need (N), Use (U)……………...…………….………. 129 Figure 4-28: Drug Reimbursement Use)……………...…………….….……………...…………….………………….. 130 Figure 4-29: Psychological & Psychiatric Treatment & Counseling – Reported Barrier (B), Need (N), Use (U)…... 134 Figure 4-30: Support Groups – Reported Barrier (B), Need (N), Use (U)……………...…………….………………. 135 Figure 4-31: Mental Health Services – Reported Barrier (B), Need (N), Use (U)……………...…………….………. 136 Table 4-4: Rates of Mental Illness in U.S. Population)……………...…………….….……………...…………….…... 138 Figure 4-32: Home-Based Hospice – Reported Barrier (B), Need (N), Use (U)…….….……………...…………….. 141 Figure 4-33: Residential Hospice – Reported Barrier (B), Need (N), Use (U)…….….……………...………………. 142 Figure 4-34: Paraprofessional Care – Reported Barrier (B), Need (N), Use (U)…….….……………...……………. 146 Figure 4-35: Professional Care – Reported Barrier (B), Need (N), Use (U)…………………………………………... 147 Figure 4-36: Specialized Care – Reported Barrier (B), Need (N), Use (U) )………………………………………….. 148 Figure 4-37: Durable Medical Equipment – Reported Barrier (B), Need (N), Use (U)……………………………….. 149 Figure 4-38: Physical therapy – Reported Barrier (B), Need (N), Use (U) )………………………………………….. 152 Figure 4-39: Speech Pathology – Reported Barrier (B), Need (N), Use (U) )………………………………………… 153 Figure 4-40: Low-Vision Training Services – Reported Barrier (B), Need (N), Use (U)……………………………… 154 Figure 4-41: Reported Severe Disabilities)………………………………………………………………………………. 155

Chapter 5 Targeted Findings: Housing and Transportation…………… 158 Figure 5-1: Self-Defined (Write-In) Needs)……………………………………………………………………………….. 159 Figure 5-2: Self-Defined (Write-In) Services Not Available…………………………………………………………….. 160 Table 5-1: Individual Service Gaps……………………………………………………………………………………….. 161 Figure 5-3: Percent of SSI Benefits Needed to Rent a One-Bedroom Apartment…………………………………… 164 Table 5-2: Individual Service Needs……………………………………………………………………………………… 167 Table 5-3: Methods of Transportation…………………………………………………………………………………….. 168 Figure 5-4: HIV Medical Appointments Missed Due to Transportation………………………………………………... 169 Figure 5-5: HIV Services Appointments (Non-Medical) Missed Due to Transportation……………………………… 169 Figure 5-6: 10-County Transportation Need Map……………………………………………………………………….. 170 Figure 5-7: Outer Loop Transportation Barrier Areas…………………………………………………………………… 171 Figure 5-8: Advance Time Required for Transportation Service Booking…………………………………………….. 172

Chapter 6 Focus Group Analysis…………………………………………… 174 Table 6-1: Gap Analysis – African American MSM……………………………………………………………………… 177 Table 6-2: Gap Analysis – Anglo MSM…………………………………………………………………………………… 178 Table 6-3: Gap Analysis - Disabled……………………………………………………………………………………….. 179 Table 6-4: Gap Analysis - Incarcerated Women………………………………………………………………………… 180 Table 6-5: Gap Analysis - Long-Term Survivors………………………………………………………………………… 181 Table 6-6: Gap Analysis (Not Differentiated South vs. North)………………………………………………………….. 182 Table 6-7: Gap Analysis – Older Adults………………………………………………………………………………….. 183 Table 6-8: Gap Analysis – Women (Not Differentiated by Pregnancy Status)……………………………………….. 184

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - VIII -

Table 6-9: Gap Analysis – Rural (Not Differentiated Southern vs. Northern………………………………………….. 185 Table 6-10: Gap Analysis – Substance Users…………………………………………………………………………… 186 Table 6-11: Gap Analysis - Women (Not Differentiated by Pregnancy Status)………………………………………. 187 Table 6-12: Gap Analysis – Youth (Age 13 – 24)………………………………………………………………………... 188

Chapter 7 Provider Survey Findings……………………………………….. 189 Table 7-1: Question 8. Does Your Agency Provide the Following?……………………………………………………. 191 Table 7-2: Organizational Structure………………………………………………………………………………………. 192 Figure 7-1: Provider Service Tenure……………………………………………………………………………………... 193 Table 7-3: Services Provided – ASO vs. Non-ASO……………………………………………………………………... 194 Table 7-4: Client Populations Served…………………………………………………………………………………….. 195 Figure 7-2: Most Frequently Reported Collaborations………………………………………………………………….. 196 Table 7-5: Client-Reported Barriers………………………………………………………………………………………. 196 Table 7-6: Provider Reported Barriers……………………………………………………………………………………. 197 Figure 7-3: Prevention Services: Populations Served…………………………………………………………………... 198 Table 7-7: Populations Targeted for Prevention Services……………………………………………………………… 199 Figure 7-4: Prevention Service Sites: ASO vs. Non-ASO………………………………………………………………. 200 Figure 7-5: Funding Sources for Prevention……………………………………………………………………………... 201 Table 7-8: Agency Suggestions to Better Serve Clients………………………………………………………………... 202

Chapter 8 Special Study: AA MSM………………………………………….. 209 Table 8-1: Comorbidities - Incarcerated/Recently Released vs. All Respondents…………………………………… 215

Chapter 9 Special Study: AA MSM………………………………………….. 216 Table 9-1: Ethnicity – African-American MSM…………………………………..……………………………………….. 217 Table 9-2: HIV Status - AA MSM…………………………………..…………………………………………………….... 217 Figure 9-1: Sexual Orientation by Special Study Group……………………………………………………………….... 218 Figure 9-2: Highest Education Level Achieved…………………………………..………………………………………. 219 Table 9-3: Care Status…………………………………..…………………………………………………………………. 219 Figure 9-3: Reasons Out of Care - AA MSM vs. All Respondents…………………………………………………….. 220 Figure 9-4: Viral Load Knowledge - AA MSM vs. All Respondents……………………………………………………. 220 Figure 9-5: Viral Load Profiles - AA MSM…………………………………..……………………………………………. 221 Figure 9-6: Reason For HIV Testing by Special Study Group………………………………………………………….. 221 Figure 9-7: income Level – All Respondents…………………………………..……………………………………….... 222 Figure 9-8: Percent Uninsured by Special Study Group………………………………………………………………… 223 Figure 9-9: Health insurance Source by Special Study Group (insured Only)………………………………………... 224 Figure 9-10: Frequency of Disability Problems by Special Study Group…………………………………………….... 225 Figure 9-11: Comorbidities – AA MSM vs. All Respondents………………………………………………………….... 226 Figure 9-12: Admission of ‘Ever’ injecting Substances by Special Study Group……………………………………... 227 Figure 9-13: Substance Abuse by Special Study Group………………………………………………………………... 228 Figure 9-14: Drug Reimbursement Use by Special Study Group…………………………………………………….... 229 Figure 9-15: Use of Prescribed Medication by Special Study Group………………………………………………….. 230 Figure 9-16: Living Alone by Special Study Group…………………………………..………………………………….. 231

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - IX -

Figure 9-17: Living With Children by Special Study Group……………………………………………………………... 231 Figure 9-18: Reported Sexually Transmitted infections– AA MSM vs. All Respondents…………………………….. 232 Table 9-4: AA MSM - Use and Barriers Analysis…………………………………..……………………………………. 233 Table 9-5: AA MSM - Need Analysis…………………………………..…………………………………………………. 233 Table 9-6: AA MSM - Gap Analysis…………………………………..…………………………………………………… 234

Chapter 10 Special Study: Youth…………………………………………….. 238 Figure 10-1: HIV Infections: Age 13 – 19 and 20 – 24, Reported from 34 Areas (2000)……………………………. 239 Table 10-1: Total Living Adult/Adolescent PLWH/A, TDH 2002……………………………………………………….. 240 Table 10-2: Gender – Youth, Age 13 – 24……………………………..………………………………………………… 241 Table 10-3: Ethnicity – Surveyed Youth……………………………..…………………………………………………… 241 Table 10-4: HIV Status – Youth……………………………..……………………………..……………………………… 242 Figure 10-2: Highest Education Level by Special Study Group……………………………..…………………………. 242 Figure 10-3: Sexual Orientation by Special Study Group……………………………..………………………………... 243 Table 10-5: Care Status – All Youth……………………………..………………………….…………………………….. 243 Table 10-6: Reason Out of Care by Special Study Group……………………………..……………………………….. 244 Figure 10-4: Viral Load Profile by Special Study Group……………………………..………………………………….. 244 Figure 10-5: Viral Load Profiles - Youth……………………………..………………………….………………………… 245 Figure 10-6: Reason For HIV Testing by Special Study Group……………………………..…………………………. 245 Figure 10-7: Transportation “Not Easy” by Service Type All Youth vs. All Respondents……………………………. 246 Figure 10-8: Percent Uninsured by Special Study Group……………………………..………………………………... 247 Figure 10-9: Health Insurance Source by Special Study Group (Insured Only)…………………………………….... 248 Figure 10-10: Comorbidities: Youth vs. All Respondents……………………………..………………………………… 249 Figure 10-11: Substance Abuse by Special Study Group……………………………..……………………………….. 250 Figure 10-12: Drug Reimbursement Use by Special Study Group……………………………..……………………… 251 Figure 10-13: Use of Prescribed Medication by Special Study Group……………………………..………………….. 252 Figure 10-14: Living Alone by Special Study Group……………………………..……………………………………… 253 Figure 10-15: Living With Children by Special Study Group……………………………..…………………………….. 253 Figure 10-16: Hepatitis (A, B, or C) by Special Study Group……………………………..……………………………. 254 Figure 10-17: Chlamydia vs. Syphilis by Special Study Group……………………………..………………………….. 254 Table 10-7: Youth - Use and Barriers Analysis……………………………..…………………………………………… 255 Table 10-8: Youth – Need Analysis……………………………..………………………….…………………………….. 255 Table 10-9: Youth – Gap Analysis……………………………..………………………….………………………………. 256

Chapter 11 Special Study: Females………………………………………….. 262 Figure 11-1: AIDS Cases In Adult/Adolescent Women by Race/Ethnicity, 2000…………………………………….. 263 Figure 11-2: AIDS Cases Among Women by Risk Exposure, 2000…………………………….……………………... 264 Table 11-1: Ethnicity – Females…………………………….…………………………….………………………………. 265 Table 11-2: HIV Status – Females…………………………….…………………………….……………………………. 265 Figure 11-3: Sexual Orientation by Special Study Group…………………………….………………………………… 266 Figure 11-4: Education Level by Special Study Group…………………………….……………………………………. 267 Table 11-3: Care Status – Females vs. All Respondents…………………………….………………………………… 268 Figure 11-5: Reasons Out of Care – Females vs. All Respondents…………………………………………………… 268

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - X -

Figure 11-6: Viral Load Knowledge by Special Study Group…………………………….…………………………….. 269 Figure 11-7: Viral Load Profiles - Females…………………………….…………………………….…………………… 269 Figure 11-8: Reason For HIV Testing by Special Study Group…………………………….………………………….. 270 Figure 11-9: Income Level - All Respondents…………………………….……………………………………………… 271 Figure 11-10: Transportation "Not Easy" by Service Type, All Respondents…………………………………………. 272 Figure 11-11: Percent Uninsured by Special Study Group…………………………….……………………………….. 273 Figure 11-12: Health Insurance Source by Special Study Group (Insured Only)…………………………………….. 274 Figure 11-13: Frequency Disability Is A Problem by Special Study Group……………………………………………. 275 Figure 11-14: Comorbidities: Females vs. All Respondents…………………………….……………………………… 276 Figure 11-15: Admission of ‘Ever’ Injecting Substances by Special Study Group……………………………………. 277 Figure 11-16: Substance Use by Special Study Group…………………………….…………………………………… 278 Figure 11-17: Drug Reimbursement Use by Special Study Group…………………………………………………….. 279 Figure 11-18: Use of Prescribed Medication by Special Study Group………………………………………………… 280 Figure 11-19: Living Alone by Special Study Group…………………………….………………………………………. 281 Figure 11-20: Living With Children by Special Study Group…………………………….……………………………… 282 Figure 11-21: Reported Sexually Transmitted Infections– Females vs. All Respondents…………………………… 283 Table 11-4: Females - Use and Barriers Analysis…………………………….…………………………………………. 284 Table 11-5: Females - Need Analysis…………………………….…………………………….………………………… 285 Table 11-6: Females - Gap Analysis…………………………….…………………………….………………………….. 285

Chapter 12 Special Study: Incarcerated/Recently Released……………. 291 Table 12-1: Gender – Incarcerated/Recently Released………………………………………………………………… 293 Table 12-2: Race – Incarcerated/Recently Released…………………………………………………………………… 293 Table 12-3: Ethnicity – Incarcerated/Recently Released……………………………………………………………….. 294 Table 12-4: HIV Status – Incarcerated/Recently Released…………………………………………………………….. 294 Table 12-5: HIV Services – Incarcerated/Recently Released………………………………………………………….. 294 Figure 12-1: Sexual Orientation by Special Study Group………………………………………………………………. 295 Figure 12-2: Highest Education Level by Special Study Group………………………………………………………… 295 Figure 12-3: Income Level – All Respondents…………………………………………………………………………… 296 Table 12-6: Care Status – Incarcerated/Recently Released…………………………………………………………… 296 Figure 12-4: Percent Uninsured by Special Study Group………………………………………………………………. 297 Figure 12-5: Frequency Of Disability Problems by Special Study Group……………………………………………… 297 Figure 12-6: Substance Use by Special Study Group…………………………………………………………………... 298 Figure 12-7: Percent Injecting Substances by Special Study Group…………………………………………………... 298 Figure 12-8: Insurance Among Incarcerated…………………………………………………………………………….. 300 Figure 12-9: Insurance Among Recently Released……………………………………………………………………... 300 Table 12-7: Incarcerated/Recently Released - Use and Barrier Analysis……………………………………………... 301 Table 12-8: Incarcerated/Recently Released - Need and Gap Analysis………………………………………………. 301 Table 12-9: Comorbidities – Incarcerated vs. All Respondents………………………………………………………… 309

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - XI -

Chapter 13 Special Study: Out of Care……………………………………… 310 Figure 13-1: Self-Reported HIV Status for All Respondents and Special Study Groups…………………………….. 312 Figure 13-2: Map of Ten County EMA/HSDA……………………………………………………………………………. 313 Figure 13-3: Out-of-Care – Outer Loop…………………………………………………………………………………… 314 Figure 13-4: Reason Out-of-Care – All Respondents…………………………………………………………………… 315 Table 13-1: Care Status – All Respondents……………………………………………………………………………… 315 Table 13-2: Out-of-Care Reasons by Special Study Group…………………………………………………………….. 316 Figure 13-5: Viral Load Knowledge by Special Study Group…………………………………………………………… 317

Appendix A Sample Weighting………………………………………………… 324 Table A-1: Table of Weight Assignments……………………………………………………………………….………... 326 Table A-2: Suggested Cell Sizes…………………………………………………………………………………...……... 327 Table A-3: Suggested Cell Percentages…………………………………………………………………………………. 328 Table A-4: Weighted Response Levels (Q34: Exposure Methodology)……………………………...……….………. 329 Table A-5: Weighted Cell Percentages…………………………………………………………………………………… 330

Appendix B Data Tables………………………………………………………… 331 Table B-1: Use Ranking - All Respondents……………………………..……………………………..……….………... 332 Table B-2: Need Ranking - All Respondents……………………………..……………………………..……….………. 333 Table B-3: Barrier Ranking - All Respondents……………………………..……………………………..……….…….. 334 Table B-4: Gap Ranking - All Respondents……………………………..……………………………..……….………... 335 Table B-5: Services Analysis for African-American MSM……………………………..………………………………... 336 Table B-6: Services Analysis for Incarcerated/Recently Released Individuals……….……….……….……….…….. 337 Table B-7: Services Analysis for Women of Childbearing Age……………………………..……….……….………… 338 Table B-8: Services Analysis for Youth 13 - 24……………………………..……………………………..……….….… 339

Appendix E List of Survey Sites………………………………………………. 393 Table E-1: List of Survey Sites and Number of Participants at Each……….……….……….……….……….………. 394

Appendix G Sources of Funding………………………………………………. 398 Table G-1: Sources of Funding – All Respondents……….……….……….……….…………………………………… 399 Figure G-1: Sources of Funding – Percent of Agencies by Funding Source……….……….……….……….………. 399 Figure G-2: Sources of Funding – Number of Agencies by Funding Source……….……….……….……….………. 400

Appendix H Question Topics…………………………………………………... 401 Table H-1: Client Survey Question Topics……………………………………………………………………………….. 402

INDEX OF TABLES & FIGURES Houston EMA/HSDA 2002 Comprehensive HIV/AIDS Needs Assessment - XII -