The Health Resources and Services Administration (HRSA) allocated $940 million in 2002, through Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, to help states improve the quality and availability of health related services for people living with HIV/AIDS . These resources are allocated based upon recommendations made by community planning committees, which in turn base their recommendations on HIV/AIDS needs assessments. A methodologically sound, comprehensive needs assessment is a critical component of effective resource allocation decisions. Poor needs assessments might lead to poor resource allocation decisions, which might have life-threatening consequences for people living with HIV/AIDS. Little is known about the quality of Ryan White Title II (RWTII) needs assessments. This dissertation identifies seven elements of a high quality needs assessment, which might serve as an assessment tool for funding agencies and as a guidance tool for grantees. The author uses the seven elements in a review of RWTII needs assessments to provide evidence pertaining to the current level of quality of RWTII needs assessments. The seven elements are then applied in a case study of improved practice to demonstrate how to adequately apply the key elements of a high quality needs assessment.

Indiana University-Purdue University Indianapolis (IUPUI) / The letters Ryan White received over the course of his diagnosis, illness, and eventual death show a spatial distribution that reflected the United States’ response to Ryan’s condition. Ryan was diagnosed with AIDS in December of 1984 at the height of the epidemic, and the panic that surrounded it. In 2000, the Children’s Museum of Indianapolis accessioned a selection of letters sent to Ryan White and his mother, from 1980 to 1993. The expanded incorporation of these letters into the museum’s “Power of Children” gallery will introduce museum visitors to the public view on Ryan and the role he played in developing the public perception and awareness of AIDS in the 1980’s. Originally, it was anticipated that the distribution and number of letters Ryan received directly related to the concentration and spread of AIDS cases around the US. This research assumed that the AIDS community would have been more supportive and empathetic of Ryan’s diagnosis, resulting in those populations sending a higher number of letters. This assumption was also informed by the fact that the highest number of AIDS cases were in areas with large populations such as New York City, Los Angeles, and Miami. Yet findings showed relatively few letters were coming from the populated coasts where AIDS was more prevalent, and many more letters than expected came from areas with lower populations across the US. Ryan was one of the first children to go public with his AIDS diagnosis, which sparked strong reactions among people throughout the United States. Ryan’s correspondence and the outpouring of support he received allows insight into the multifaceted reaction to the AIDS crisis, especially from young people. Before Ryan became associated with the AIDS epidemic, this disease was seen primarily as an urban, gay, and drug-user related issue. The goal of this research is to gain further understanding of society’s shifting response to Ryan and AIDS during the 1980’s, by placing these letters in their social and geographic context.

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The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

No description available.

Vulnerable populations comprise a growing number of people living with HIV/AIDS and are at increased risk for poorer health outcomes. The purpose of this research was to approximate the effect of the Ryan White CARE Act on the health status of people living with HIV/AIDS who were receiving medical care in the United States. The vulnerable populations model was utilized to identify appropriate variables for analysis as well as to provide a sequencing for the testing of models. Data analyzed in this study came from the 1996 Baseline Survey of the HIV Cost and Services Utilization Study (HCSUS), a cooperative study between RAND and the Agency for Health Care Policy and Research (now known as the Agency for Health Care Quality and Research). Three analyses sequences, using different dependent variables, to estimate health status were conducted. In the first analysis, health status was measured by CD-4 count and stage of illness. In the second analysis, only CD-4 counts were used for health status. In the final analysis, health status was estimated based on AIDS diagnosis. Each of the three analyses included the same independent variables: race, gender, education, sexual orientation, income, insurance status, region of the country, receipt of case management, perceived health, and level of antiviral therapy. The three analyses suggested similar results. Specifically, that African Americans and women had better health status as compared to whites and men, respectively. Additionally, insurance, case management, and antiviral therapy were associated with poorer health status. Factors such as education, income, and region of the country yielded inconsistent results between models. To better understand the effect of the Ryan White CARE Act on health outcomes for people living with HIV/AIDS, future research should consider inclusion of a variable that more directly measures the CARE Act, such as payer source for medical care.