Meeting the service needs of HIV-infected persons: is the Ryan White CARE Act succeeding?

To evaluate the success of the Ryan White CARE Act in meeting HIV-related service needs, we surveyed HIV-infected clients (n = 1,056) at San Francisco CARE-funded agencies. Most CARE clients were male (85.1%), 51.7% were nonwhite, 84.9% were uninsured or underinsured, and 43.9% had a most recent CD4+ count < 200 cells. The most common HIV risk groups were gay/ bisexual male noninjection drug user (IDU) (53.3%) and gay/bisexual male IDU (22.1%). Health care needs were high for medical (85.5%), dental (70.2%), and mental health care (69.7%); need for basic necessities was great for food (57.2%) and living expenses (55.5%). Unmet health care needs were common for dental care (41.0%), home health care (39.9%), and alternative therapies (38.6%); unmet needs for basic necessities were frequent for childcare (59.5%), household help (52.3%), and transportation (47.9%). Unmet needs for medical care (5.8%) and food (14.7%) were low. Poor persons, those with dependents, and gay/bisexual male IDUs had greater unmet needs. Women and racial/ethnic minorities did not consistently have greater unmet needs. The CARE Act is serving those it intended to reach, is successfully meeting two important service needs, and has equalized access to services for women and racial/ethnic minorities. Remaining unmet needs require continued funding and strategies to increase access to care.