February 2001

The purpose of this study was to understand how clients are accessing both HIV and non-HIV medications, to assess the effectiveness of these systems and to make recommendations. In February 2001, data was collected through four means: a mailed survey to clients registered with an AIDS Service Organization; a client focus group; key informant interviews; and a review of monthly reports. People With AIDS Coalition was recruited to collaborate because of their extensive client database. A survey and cover letter, in both English and Spanish, were mailed to 2,568 clients.

Discounting returned mail, 1,620 individuals received the survey; 261 completed and returned it for a 16% response rate. Seven people of mixed gender and race attended a focus group held at The Center for AIDS: Hope and Remembrance Project; six people acted as key informants and numerous others were available to answer questions when called; and finally, the HIV Services Department of Harris County provided information on contracts and monthly reports.

Client Concerns
Of the 261 responding to the survey, 55.2% (144) were males, 45.3% (114) females and 1.3% (3) transgendered. Slightly over half were African American (55.6% or 145), followed by 27.6% (72) White/Caucasian, 10% (26) Hispanic/Latino, and 2.7% (7) Native American. The ages ranged from 21 to 65, the average being 43 years. Most were disabled (67.3% or 171), the greatest percent (41.7% or 106) had monthly incomes of $532 or less and 16% (42) had on average two children less than 12 years of age living in the household. Although the greatest number of respondents were in the lowest income category that does not necessarily mean they had a more difficult time in getting medications than those with higher incomes. Those with higher incomes may have more difficulty qualifying for assistance programs and meeting eligibility criteria. Those with incomes between $533 and $1500 accounted for 54.4% of the respondents. Slightly over 40% were diagnosed with HIV between 1995 and 1999 and 93.7% have been prescribed HIV medications; 84.8% claimed adherence to medication regimen "usually" or "always." 65.5% were taking non-HIV medications and the two top-ranked non-HIV medication were for treatment of depression (52.1%) and elevated blood pressure (36.1%). Roughly 80% of respondents got their medications from the clinic (59.2%) or pharmacy (40.4%) or both and these locations are convenient for them. 44.2% received medications through the state AIDS Drug Assistance Program (ADAP); 32.7% relied on a local organization for their medications; 20.4% paid for their medications; and 19% had Medicaid coverage. The required co-payments ranged from $0 to $150+ and the majority paid between $0 to $10 monthly. A greater percentage (30.6%) of respondents paid for their own non-HIV medications with an average monthly expenditure of $10. The self-paying respondents indicated problems with qualifying for eligibility as their primary barrier to obtaining HIV medication. Another barrier to care was lost paperwork. There were also numerous verbal and written comments about the lengthy wait times in pharmacy lines and problems with missing or incorrect paperwork.

Funded by the Ryan White Planning Council.