Houston Local Needs Assessment Task Force (LNATF) of The

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.

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
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
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
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
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

INDEX OF TABLES & FIGURES

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

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