10 Funding and Policy Considerations

Publication Details

This chapter provides information on how to find appropriate sources of funding for services and programs related to HIV/AIDS and substance abuse. It will not address sources of funding for individual medical care (see Chapter 6 for a discussion of individual funding). There are several key steps that will increase the likelihood of successfully obtaining funds, regardless of the type of program or service for which support is being sought.

Keys to Successful Grantseeking

Before seeking funding, the substance abuse treatment professional should determine the basic information about the proposed project. The following questions will help focus this information:

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What are the organization's current capabilities, strengths, and areas for improvement?

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What is the organization's target population, and what are their unique or unmet needs?

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What is the proposed action to meet the identified unmet needs? How would the proposed project or service impact those needs? What will be accomplished and in what time period? Have similar projects been done locally or nationally; that is, are there model or demonstration projects? If so, can these projects be adapted to suit the organization's needs?

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Does the project support and supplement existing activities in the community or target area?

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Can this project actually be carried out? Is the plan realistic and achievable? How much funding is required and for how long? What staff, facility, and service changes or partnerships would be required to carry out the proposed plan?

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What is currently available in the community and who would support—or oppose—the proposed plan? Who is a potential partner and who is a potential competitor for funding?

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How will the success of the project be evaluated?

How To Identify Potential Funding Sources

It can seem a daunting task to identify potential funding sources. There are more than 40,000 private foundations in the United States, and about 37 percent of them have assets of at least $l million or award $100,000 or more in grants each year. There are many Federal, State, and local government funding sources as well.

On top of that, each funding source has its own funding priorities, eligible services and providers, funding and geographic restrictions, and application deadlines.

There are three types of funding streams: Federal, State and local, and private initiatives. Federal funding sources for substance abuse treatment and HIV/AIDS resources include Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs, Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), and U.S. Department of Housing and Urban Development (HUD). Individual State and local health and human services agencies allocate both Federal and State dollars for substance abuse treatment and HIV/AIDS. Private foundations and many corporations also provide grant awards. A discussion of each of three types of funding streams follows.

There are a number of resources to help identify potential funding sources. Many Federal, State and private grantmakers and clearinghouses provide information via the Internet. Other resources include computerized databases, directories, books, periodicals, and newsletters that may offer information on funding sources, proposal writing, program planning, and related topics.

Examples include:

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The Local/State Funding Report, a newsletter published weekly by Government Information Services of Thompson Publishing Group. Provides subscribers with updates on Federal and State funding opportunities, Washington Notes, and local/State grant and regulation alerts—a listing of funding notes and regulations issued by Federal agencies. For subscription information, call 202-872-4000.

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Federal Grants & Contracts Weekly, published by Aspen Publishers, Inc. Subscription information can be obtained by calling 800-638-8437

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The Federal Register, which announces funding initiatives and can be reached online at http://www​.federalregisterdigest.com.

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The Catalog of Federal Domestic Assistance provides information on all Federal government programs that award grants, including basic information on the granting agency, applications and award processes, eligibility criteria, addresses, and key contacts.

Check with your public library or local college or university libraries to see if their collections include these or similar grant resources.

A key private initiative resource is the Foundation Center, a nonprofit organization that maintains a comprehensive and up-to-date database on foundations and corporate giving programs. The Center offers free information to the public at five Foundation Center libraries and approximately 200 Cooperating Collections across the country. The two national library collections are located at

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79 Fifth Avenue/16th Street New York, NY 10003-3076 (212) 620-4230

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1001 Connecticut Avenue, NW Suite 938 Washington, DC 20036-5588 (202) 331-1400

Regional collections are available in Atlanta, Cleveland, and San Francisco at the following locations:

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50 Hurt Plaza Suite 150 Atlanta, GA 30303-2914

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1422 Euclid Avenue Suite 1356 Cleveland, OH 44115-2001

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312 Sutter Street Room 312 San Francisco, CA 94108-4314

The 200 Cooperating Collections contain a core collection of the Foundation Center's reference works and provide trained staff to direct grantseekers to appropriate funding information resources. Many of the collections maintain information on local funders. A complete list of Cooperating Collections can be obtained by calling (800) 424-9836.

Foundation Center resources include Internal Revenue Service Information Returns, which are filed annually by all private foundations and contain fiscal data, addresses, and lists of grantees and trustees; directories, books, and periodicals; computer resources including the Center's database on CD-ROM, its Web site, and other software computer programs; grantmaker files; current awareness files on materials of interest to grantseekers organized by subject heading; and a bibliographic database of approximately 13,000 listings.

The five Center libraries offer regular workshops, seminars, and funding panels of interest to both grantseekers and grantmakers.

Many foundations have their own Web sites. These are especially helpful to visit because they often contain the foundation's guidelines and its annual report. The annual report gives the fundseeker a better notion of what kinds of programs the foundation funds. For example, a funding category may be “education,” but until the grantseeker looks at the annual report it will not be clear whether or not the foundation is interested in postsecondary education.

Another excellent source of funding ideas is the annual reports of organizations similar to the fundseeker's. For example, if the fundseeker works at a program for people with HIV disease and ex-offenders, he should receive the annual report of any agencies with similar missions. These agencies could be halfway houses for ex-offenders or housing programs for HIV-positive individuals. The annual reports will have a list of funders. This in turn will lead the fundseeker back to the names of foundations he can research at the Foundation Center or on the Internet.

State and Federal Policy Shifts

Dramatic changes in clinical management of HIV/AIDS have resulted in a shift from regarding AIDS as a fatal disease to a chronic one, and as a result funding urgency and need has diminished in the eyes of both policymakers and some segments of the public. Questions have been raised about why AIDS support has been so great given that other disease conditions such as cancer and heart disease kill many more people. Organizations advocating for these conditions have begun to lobby intensively for increased funding, thereby increasing competition for dollars that were allocated to HIV/AIDS.

Welfare reform eliminated Social Security benefits for individuals with a diagnosis of substance abuse or dependence, which has decreased the availability of public benefits and increased the stigma associated with these diagnoses. In 1997, CSAT received 2 years of supplemental funding to help such individuals make the transition to the elimination of benefits. At the end of the 2-year period, individuals with a diagnosis of substance abuse or dependence will no longer be eligible for SSI benefits.

Arrest and incarceration of individuals with substance abuse disorders is increasing at local, State, and Federal levels. People with substance abuse disorders end up in jails and prisons where they may or may not receive appropriate treatment for their substance abuse problems. In addition, prisoners are at increased risk for HIV infection.

The Ryan White CARE Act (P.L. 101–381) was originally passed in 1990 and amended in 1996 (P.L. 104–146). The act, which is reauthorized in 5-year increments, is up for reauthorization in 2000. Public Law 102–321 in 1992 restructured the Alcohol, Drug, and Mental Health Administration (ADAMHA) into SAMSHSA within the U.S. Department of Health and Human Services (HHS). This law established separate block grants to enhance the delivery of services regarding substance abuse and mental health. The law is periodically reauthorized. For current information regarding HIV/AIDS set-asides, contact the Single State Authority (SSA).

AIDS-related comprehensive treatment planning groups are increasingly recommending the mainstreaming of some services to help address fragmentation of services and funding. In some instances, this takes the form of awarding services under competitive bid processes to private or public organizations that historically have not been identified as HIV/AIDS service organizations. Examples of mainstreaming include

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Awarding Housing Opportunities for Persons With AIDS (HOPWA) contracts to private housing brokers who maintain lists and links of available housing units, manage vendor payments, and provide home management skills training to residents

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Awarding home-based meal services to meal delivery organizations such as Meals on Wheels

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Providing transportation by private bus companies and taxi-jitney services

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Providing contracts to private providers for mental health services and spiritual counseling

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Awarding dollars for return-to-work initiatives to work placement companies such as Goodwill Industries and Manpower Development Services

There are several advantages to mainstreaming:

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Increased familiarity with scopes of work for specific services

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Less time and effort spent in program startup

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Industry-wide standards of care, service, and quality are often already in place

Those considering mainstreaming services may have to address the following challenges:

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Refragmentation of services

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Increase in the size and complexity of multidisciplinary teams

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Reluctance of private sector providers to attend multidisciplinary team meetings without identifying meeting attendance as billable services

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Difficulties in establishing linked entries in Uniform Reporting System from private providers

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Possible exposure of people with HIV/AIDS to providers not trained in cultural competency, HIV/AIDS, or substance abuse treatment

Funders Concerned About AIDS (FCAA) was organized in 1987 to advance the private philanthropic response to HIV/AIDS. This organization seeks not only to sustain but also to increase the philanthropic resources available to fight HIV/AIDS and assists funders in enhancing the strategic nature of their HIV/AIDS-related grantmaking. FCAA works to help funders in the following ways:

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Viewing HIV/AIDS within the larger social context and integrating HIV/AIDS funding into the broader grantmaking agendas of funders

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Broadening the support and understanding of HIV/AIDS at the international, national, and local levels

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Supporting high-quality, effective, collaborative, and nonduplicative programs and services

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Targeting populations that are currently underserved by HIV/AIDS services and related health, welfare, and education services

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Demonstrating explicit support for effective new approaches in the fight against HIV/AIDS

FCAA carries out primary and secondary research into HIV/AIDS funding trends and issues and provides the philanthropic sector with technical assistance. They can be contacted by phone at: (212) 573-5533; or by writing to 50 East 42nd Street, 19th floor, New York, NY 10017.

Obtaining Funds

It is important to be aware that there are three kinds of support: capital (buildings, equipment), general (general program support), and project support. Most funders prefer project support, since they can easily see the results of their funding. Yet even general support can sometimes be cast as “project” support. For example, the fundseeker could add a component to the program or add 10 slots to the program. These can be marketed to the foundation as projects.

To obtain some of the funds discussed in this section, following is a list of suggestions for administrators.

1.

Keep up with trend data to give to policymakers.

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Know the local, State, and Federal politics regarding the pertinent issue and/or the proposal.

3.

Be aware of political and philosophical realities for the community.

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Become active in community task forces and on advisory or planning councils (e.g., Ryan White Planning Council, HIV/AIDS State Task Force). Join subcommittees, bring up substance abuse treatment issues whenever possible, and bring clean and sober clients to meetings to put a face on the disease of addiction.

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Form coalitions, especially in rural areas.

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Work with other agencies in the area to eliminate or decrease duplication of services and maximize resources.

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Form partnerships with local research entities (e.g., universities, private agencies) and community-based organizations.

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Invite political representatives to tour the agency or discuss ideas before applying for funding. Build support for your application at the grassroots level.

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Find new partners to apply collaboratively for funding.

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Add business representatives and other community leaders to the agency's board so that more effective partnerships can be built.

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Build the board infrastructure so that the organization has a strong foundation before it receives funding. Involve board members in developing funding proposals and in marketing proposals to foundations and other funding sources.

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On a regular basis, do an exhaustive review of potential funding resources, including nontraditional funding sources.

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Invite researchers to the program and build relationships before submitting a proposal. Make them true partners in the development of the proposed project's design and evaluation. Researchers can also be helpful in conducting needs assessment. Include funding for evaluation in the proposal.

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Contact the major pharmaceutical companies that produce HIV/AIDS drugs to determine if they have funding available for local or State initiatives. Check with the local pharmaceutical representative to discover the appropriate way to contact a specific pharmaceutical company.

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If a name is available, call the project officer for the grant and clarify any questions. Attend any pre-application workshops offered by the granting organization.

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Present the proposed project as a model program with potential for replication. Emphasize the innovative and effective aspects of the project. Clearly address the diversity of the program's target population and staff.

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Along with the application, include a feasible, realistic timeline and budget that provides the granting agency with target dates for achieving key project milestones. Involve the substance abuse treatment agency's financial experts or outside experts in developing a budget to implement the proposed project. Avoid projects that are too costly, but make sure that the budget is sufficient to carry out the project. Include any supply, copying, telephone, and postage charges, meeting costs, and other types of “hidden” costs. Budgets also should include any in-kind contributions.

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Clearly present the substance abuse treatment organization's experience and expertise. If the funding agency permits supporting documentation, include letters of endorsement and memorandums of agreement from clients, community leaders, and collaborating organizations.

19.

Seek funding from more than one resource so that you do not become dependent on one particular funding source.

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Ask outside reviewers in the community to review the grant application prior to submission. If they do not understand the proposal or have questions, chances are the funding agency will, too. Clarify any issues raised by outside reviewers. Request letters of support from organizations that refer clients to the program or that will work with the project.

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Make sure that the proposed project meets the needs of the target population and that provided services are culturally competent.

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Attend grantmaking and proposal-writing workshops.

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Meet grant application submission deadlines and follow the granting agency's guidelines exactly (e.g., page margins, line spacing, inclusion or exclusion of supporting documentation, page limits).

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Stay in touch with the funder, even when a report is not due, and notify the funder when a milestone is reached or when the program gets publicity. Call the funder and ask whether the funder wants to visit the program. There may be a special event, like a graduation, that the funder should see.

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Think “outside the box” when researching potential funders. For example, a program may be for HIV-positive women with children. There may be a funding source that would support a therapy group worker for the children. However, this funder may be primarily interested in mental health, not HIV/AIDS or substance abuse treatment.

Federal Initiatives

Substance Abuse Prevention and Treatment Block Grant Funding

Within HHS, SAMHSA administers the Substance Abuse Prevention and Treatment (SAPT) Block Grant. SAPT Block Grant funding is allocated by formula to the 50 States, the District of Columbia, and 10 Territories. States and Territories administer the SAPT Block Grant funds through a principal agency, defined as the SSA. The SSA is responsible for planning, carrying out, and evaluating activities to prevent and treat substance abuse and related activities.

Each Principal Agency designates an SSA director as the point of contact for that State or Territory's SAPT Block Grant. SAPT Block Grant funds are subject to certain set-asides and requirements for States, Territories, administrators, and providers of services. States and Territories must expend the Block Grant in accordance with the percentage to be allocated to treatment, prevention, and other activities as prescribed by law.

Funding requirements

States and Territories must spend at least 35 percent of the Block Grant funds for prevention and treatment activities regarding alcohol, 35 percent for prevention and treatment activities regarding other substances, and 20 percent on primary prevention programs. In addition, a certain amount of the Block Grant must be spent on gender-specific women's substance abuse treatment services, including HIV/AIDS services.

Women's services

The amount set aside for women's services is to be spent on individuals who have no financial means of obtaining such services. All programs providing such services will treat the family as a unit and therefore will admit both women and their children into treatment services, if appropriate.

At a minimum, treatment programs receiving funding for women's services must also provide or arrange for the following services for pregnant women and women with dependent children, including women who are trying to regain custody of their children:

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Primary medical care, including referral for prenatal care and child care while the women are receiving such services

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Primary pediatric care for children, including immunizations

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Gender-specific substance abuse treatment and other therapeutic interventions for women that may address issues of relationships, sexual and physical abuse, and parenting, and child care while the women are receiving these services

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Therapeutic interventions for children in custody of women in treatment that may, among other things, address their developmental needs, their issues of sexual and physical abuse, and neglect

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Sufficient case management and transportation to ensure that women and their children have access to services provided

Procedures for the implementation of women's services will be developed in consultation with the State medical director for substance abuse services.

Services for individuals with HIV/AIDS and/or injection drug users

States with a certain rate of AIDS cases must spend at least 5 percent of the total Block Grant funds on HIV/AIDS Early Intervention Services for persons in substance abuse treatment. States so designated have an AIDS rate of 10 or more cases per 100,000 individuals, as indicated by the number of cases reported to and confirmed by the Director of the CDC for the most recent calendar year for which the data are available.

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HIV/AIDS Early Intervention Services are defined as

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Appropriate pretest counseling for HIV and AIDS

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Testing services, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures to prevent and treat the deterioration of the immune system and conditions arising from the disease

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Appropriate posttest counseling Designated States must

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Carry out one or more projects to make early intervention services for HIV/AIDS available at the substance abuse treatment site to individuals undergoing substance abuse treatment

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Make available from the grant the prescribed money for these activities

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Carry out such projects only in geographic areas of the State that have the greatest need for the projects

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Require programs participating in the project to establish linkages with a comprehensive community resource network of related health and social services organizations to ensure a wide-based knowledge of the availability of these services

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Require any entity receiving money from the Block Grant for operating a substance abuse treatment program to follow procedures developed by the SSA, in consultation with the State medical director for substance abuse services, and in cooperation with the public health agency

If the State plans to carry out two or more HIV/AIDS early intervention projects, the State must carry out one such project in a rural area of the State, unless the requirement is waived.

All entities providing early intervention services for HIV disease to an individual must comply with payment provisions and restrictions on expenditure of grant. The individual will enter services voluntarily (i.e., with informed consent) and will not be required to undergo such services as a condition for receiving substance abuse treatment or any other services.

Capacity of treatment for injecting substance abusers

All programs that receive funding under the grant and that treat individuals for injection drug use (IDU) must notify the State within 7 days upon reaching 90 percent of admission capacity. Each individual who requests and is in need of treatment for IDU must be admitted to a program no later than

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Fourteen days after requesting admission to such a program, or

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One hundred and twenty days after the date of the request if no such program has the capacity to admit the individual on the date of the request, or if interim services are made available to the individual no later than 48 hours after the request (including referral for prenatal care)

Outreach requirements

Any organization that receives funding for treatment services for injection drug users must actively encourage individuals in need of such treatment to undergo treatment. The States require organizations to use outreach models that are scientifically sound, or if no such models are available that apply to the local situation, to use an approach that reasonably can be expected to be an effective outreach method. By this definition, all outreach efforts must include the following tasks:

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Selecting, training, and supervising outreach workers

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Contacting, communicating, and following up with high-risk substance abusers, their associates, and neighborhood residents, while observing Federal and State confidentiality laws, including 42 CFR (see Chapter 9)

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Promoting awareness among injection drug users about the relationship between IDU and diseases such as HIV

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Recommending steps to ensure that HIV transmission does not occur

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Encouraging entry into treatment In turn, the State must

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Establish a capacity management program to enable a program to report quickly to the State when it reaches 90 percent of its capacity—to ensure maintenance of a continually updated record of all reports and make excess capacity information available to such programs

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Establish a waiting list management program that provides systematic reporting of treatment demand

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Require that any program receiving funding from the grant for treatment for injection drug users establish a waiting list that includes a unique client identifier for each injection drug user seeking treatment, including those receiving interim services while waiting for admission to the treatment program

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Ensure that individuals who cannot be placed in treatment within 14 days are enrolled in defined interim services, that mechanisms are developed for maintaining contact with individuals awaiting admission, and that those who remain active on a waiting list are admitted to a treatment program within 120 days

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Ensure that programs consult the capacity management system so that patients on a waiting list are admitted as soon as possible to a program providing such treatment within a reasonable geographic area

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Develop effective strategies for monitoring programs' compliance with SAPT Block Grant requirements

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Report the specific strategies to be used to identify compliance problems and corrective actions to be taken to address those problems

Eligibility and restrictions for funding with SAPT Block Grants

Only public or private nonprofit entities are eligible to receive SAPT Block Grant funding. States cannot spend Block Grant funds to provide inpatient hospital services; make cash payments to intended recipients of services; purchase or improve land; purchase, construct, or improve facilities; purchase major medical equipment; or provide individuals with hypodermic needles or syringes for use of illegal drugs.

References

CFR, Title 45, Volume 1, parts 120 to 137, pages 490–09, revised as of October 1, 1997 contains the regulations regarding the SAPT Block Grant. Subpart L—Substance Abuse Prevention and Treatment Block Grant Authority: 42 U.S.C. 300x-21 to 300x-35 and 300x-51 to 300x-64. Source: 58 Federal Register 17070, March 31, 1993, unless otherwise noted.

Information contact

CSAT, Division of State and Community Assistance. Phone: (301) 443-3820; Fax: (301) 443-8345.

The Ryan White CARE Act

The Ryan White CARE Act of 1990 was created to improve the quality and availability of care for individuals and families affected by HIV/AIDS. The act was amended and reauthorized in 1996.

In 1997, the Health Resources and Services Administration (HRSA) in HHS consolidated into its new HIV/AIDS Bureau all of the lead programs in the United States that deliver HIV/AIDS health care and support services for low income and uninsured individuals. The Bureau houses all of the programs authorized under the Ryan White CARE Act. Grant applications for all Ryan White CARE Act programs can be obtained from the HRSA Grants Application Center. The center may be contacted by phone at (888) 300-4772 or by e-mail at: moc.mocten.xi@CAG.ASRH. The street address is 40 West Gude Drive, Suite 100, Rockville, MD 20850.

Ryan White CARE Act Programs include

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Title I, II, III, and IV grants

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Special Projects of National Significance (SPNS)

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AIDS Education and Training Centers (AETCs)

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Dental Reimbursement Program

Within the HIV/AIDS Bureau, the Division of Service Systems administers Title I, II, and AIDS Drug Assistance Programs; the Division of Community Based Programs administers Title III, IV and the HIV/AIDS Dental Reimbursement Program; and the Division of Training and Technical Assistance administers the AIDS Education and Training Center Program. The SPNS Program is administered by the HIV/AIDS Bureau's Office of Science and Epidemiology.

A description of each Ryan White program follows.

Ryan White Title I

Title I funding provides formula and supplemental grants to eligible metropolitan areas (EMAs) that are disproportionately affected by HIV/AIDS (there were 49 of them in 1997).

Title I eligibility

Metropolitan areas are eligible for funding if they have reported more than 2,000 AIDS cases in the past 5 years and if they have a population of at least 500,000. (This provision does not apply to EMAs funded prior to fiscal year 1997.)

Grantees

Grants are awarded to the chief elected official (CEO) of the city or county administering the health agency that provides services to the greatest number of people with HIV in the EMA. The CEO usually designates an administrative agent, often the local health department, to select service providers and administer contracts. The CEO must establish an HIV/AIDS Health Services Planning Council that is representative of the local epidemic, including health care agencies and community-based providers. At least 25 percent of the council's voting membership must be composed of people with HIV disease.

Funding

The Planning Council sets priorities for the allocation of funds within the EMA, develops a comprehensive plan, and assesses the grantee's administrative mechanism in allocating funds. The councils are not allowed to become involved in the selection of providers to receive Title I funding or in the administration of contracts with selected providers. These are grantee responsibilities.

Eligible services

Title I funding may be used to provide a wide range of community-based services, including

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Outpatient health care, including medical and dental care, developmental and rehabilitation services, and mental health and substance abuse treatment services

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Support services, such as case management, home health and hospice care, housing and transportation assistance, nutrition services, and day and respite care

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Inpatient case management services that expedite discharge and prevent unnecessary hospitalization

Eligible providers

Eligible providers include public or nonprofit entities. Private for-profit entities are eligible only if they are the only available provider of quality HIV/AIDS care in the EMA.

Title I funding has two components: formula and supplemental grants. Formula grants are awarded based on the estimated number of people living with HIV disease in the EMA. Supplemental grants are competitive and based on demonstration of severe need and other criteria, including the ability to use the funds responsibly and cost-effectively; plans to allocate funds in accordance with the local demographics of AIDS; and inclusive planning council membership. Effective fiscal year 1999, Title I will have a single grant application for formula and supplemental funds. Applications will be reviewed internally only and will be considered as noncompeting continuations.

Information contact

Division of Service Systems, HIV/AIDS Bureau, HRSA, 5600 Fishers Lane, Room 7A-55, Rockville, MD 20857. Phone: (301) 443-6745; Fax: (301) 443-8143.

Ryan White Title II

The Title II AIDS Drug Assistance Program (ADAP) provides funds to States to make protease inhibitors and other therapies available to uninsured and underinsured individuals.

Funding

Title II base and supplemental grants are awarded to States, the District of Columbia, Puerto Rico, and eligible U.S. Territories on a formula basis according to the rate of infection. Grants are awarded to the State agency designated by the Governor to administer Title II funding, usually the State health agency.

States receiving Title II funding are required to have a process that periodically convenes individuals with HIV disease, providers, public health agencies, and representatives of other Ryan White CARE Act grantees to develop a Statewide Coordinated Statement of Need (SCSN).

Funding restrictions

States have limited discretion in using formula funds, but must direct some portion of the grant to the provision of therapeutics or to support ADAPs. In addition, States are awarded earmarked Title II ADAP funds, which must all be used for ADAP.

States with more than 1 percent of the total AIDS cases reported nationally during the past 2 years must contribute matching funds, based on a yearly formula. Title II awards include earmarked funds to support the ADAP, which provides medications to low-income individuals with HIV disease who are uninsured or have limited coverage from private insurance or Medicaid. States must document their progress in making HIV/AIDS medications (including drugs for the prevention and treatment of opportunistic diseases) available to eligible people.

Eligible services

States may use Title II funding to support a wide range of support services, including

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Home and community-based health care and support services

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Continuation of health insurance coverage, through a health insurance continuation program (HICP)

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Pharmaceutical therapies, through the ADAP program

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Local consortia that assess needs, organize and deliver HIV/AIDS services in consultation with service providers, and contract for services

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Direct health and support services

Eligibility

Public or nonprofit providers are eligible. Private for-profit providers are eligible only if they are the only available provider of quality HIV/AIDS care in the service area.

The majority of States provide some Title II services directly and others through subcontracts with local Title II HIV/AIDS consortia. Title II defines a consortium as an association of public and nonprofit health care and support service providers and community-based organizations that plans, develops, and delivers services to people living with HIV disease.

Information contact

Division of Service Systems, HIV/AIDS Bureau, HRSA, 5600 Fishers Lane, Room 7A-55, Rockville, MD 20857. Phone: (301) 443-6745; Fax: (301) 443-8143.

Ryan White Title III

Title III grants provide competitive funding to public and private nonprofit entities for outpatient early intervention/primary care services. In 1997, 166 Title III programs were funded to provide early intervention services, and 4 communities were funded as early intervention planning grants. Forty percent are Community Health Centers and Migrant Health Centers, 20 percent are hospital or university-based medical centers, 19 percent are city and county health services, and 18 percent are community-based health centers that are not federally funded. Three percent provide health care for the homeless, family planning clinics, and comprehensive hemophilia diagnostic and treatment centers.

Eligible services

A wide array of services are eligible for funding, including

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Risk-reduction counseling and partner involvement in risk education

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Education to prevent early transmission

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Antibody testing, medical evaluation, and clinical care

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Antiretroviral therapies

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Ongoing medical, oral health, nutritional, psychosocial, and other care for individuals with HIV

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Case management to ensure access to services and continuity of care

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Addressing coepidemics that occur frequently in association with HIV infection, including substance abuse and tuberculosis

Information contact

Division of Community-Based Programs, HIV/AIDS Bureau, HRSA, 4350 East-West Highway, Bethesda, MD 20814. Phone: (301) 594-4444; Fax: (301) 594-2470.

Ryan White Title IV

Title IV grants offer competitive funding to public and private nonprofit entities to coordinate services and enhance access to research for children, youth, women, and families who are infected or affected by HIV and AIDS. Grantees are expected to interface with established service delivery systems to plan and provide a range of services including HIV prevention efforts, counseling and testing, primary medical care, and opportunities for clinical research. In accomplishing this, grantees must identify and address barriers to care for the targeted populations. Applicants who do not propose to serve one or more of the target populations must provide sufficient justification.

Projects funded under Ryan White Title IV are expected to serve not only individual persons, but also family members affected by HIV disease. The family structures range from the traditional, biological family unit to nontraditional family units with partners, significant others, and unrelated caregivers.

Title IV has three priority areas: access to clinical research, activities to reduce perinatal HIV transmission, and consumer involvement.

Funding eligibility

Public and nonprofit entities that provide primary health care directly or through contracts are eligible to apply for funding. Eligible entities include, but are not limited to, State or local health departments, university medical centers, public or nonprofit private hospitals, community health centers receiving support under section 330 of the Public Health Service Act, hemophilia treatment centers, drug abuse treatment agencies, tribal health programs, school-based clinics, and institutions of higher education.

To be eligible, the applicant must either be located in a geographic area not currently funded for comprehensive services by Title IV, or in an area where the existing grantee's project period is ending. Applicants in areas with an existing Title IV project are not eligible for funding. The Comprehensive Family Services Branch should be contacted at (301) 443-9051 regarding questions about geographic areas eligible for Title IV funding.

Availability of funding

Each approved project will have a maximum project period of 3 years and a 12-month budget period, starting August 1. Preference for funding in new areas is given to applicants that help achieve an equitable geographical distribution of programs, especially programs that provide services in rural or underserved communities where the number of HIV-infected and affected women, children, and families is increasing and in areas that receive limited or no Ryan White CARE Act monies.

Information contact

Title IV Program, HRSA, 5600 Fishers Lane, Room 18A-19, Rockville, MD 20857. Phone: (301) 443-9051; Fax: (301) 443-1728.

Special Projects of National Significance (SPNS) Program

SPNS programs explore new care models for national replication. The purpose of SPNS programs is to support demonstrations and evaluations of innovative and replicable models for delivering health care and support services to people living with HIV/AIDS.

Eligibility

Awards are made to nonprofit organizations wishing to evaluate a model of care. A competitive grant award process is used to assure fair and equitable distribution of funds.

Information contact

SPNS Program, Office of Science and Epidemiology, HIV/AIDS Bureau, HRSA, 5600 Fishers Lane, Room 7A-08, Rockville, MD 20857. Phone: (301) 443-9976; Fax: (301) 443-4965.

AIDS Education and Training Centers (AETCs)

The AETC Program is a network of 15 regional centers and 75 associated sites that conduct targeted, multidisciplinary education and training programs for health care providers. The AETCs serve all 50 States, the District of Columbia, the Virgin Islands, and Puerto Rico.

Priority

The AETCs are aimed at training primary health care providers, including physicians, nurses, and dentists. Training is also provided for mental health and allied health professionals.

Funding

The majority of AETC resources have been focused in areas of high HIV prevalence and incidence, with remaining resources allocated to suburban and rural needs. Each AETC involves at least one CARE Act Title I EMA (areas that have high incidence of HIV disease).

AETCs collaborate with other CARE Act-funded organizations, area health education centers community-based HIV/AIDS organizations, medical and health professional organizations, medical and health professional schools, local hospitals, health departments, community and migrant health centers, medical societies, and other professional organizations.

Information contact

AETC Program, HIV/AIDS Bureau, HRSA, 5600 Fishers Lane, Room 9A-39, Rockville, MD 20857. Phone: (301) 443-6364; Fax: (301) 443-9887.

HIV/AIDS Dental Reimbursement Program

The HIV/AIDS Dental Reimbursement Program reimburses accredited schools of dentistry and graduate dental programs for providing dental care to people with HIV. Eligible applicants must have documented uncompensated costs of oral health care for HIV-positive persons, and must be accredited by the Commission on Dental Accreditation.

Funding

This program takes into account the number of patients served by each individual applicant and unreimbursed oral health costs, as compared to the total number of patients served and total costs incurred by all eligible applicants.

Information contact

Division of Community-Based Programs, HIV/AIDS Bureau, HRSA, 4350 East-West Highway, Bethesda, MD 20814. Phone: (301) 594-4444; Fax: (301) 594-2470.

HUD

As part of its Super Notice of Funding Availability (SuperNOFA), HUD makes funding available for housing assistance and supportive services under the HOPWA program. The HOPWA program is intended to provide low-income housing for persons with HIV/AIDS and their families. There are two types of funding assistance: grants for SPNSs and grants for projects that are part of Long-Term Comprehensive Strategies. SPNS grants are intended for projects that may serve as national models in addressing the housing and related special needs of eligible individuals. Long-Term Comprehensive Strategies grants are for eligible persons who need specially tailored support rather than formula allocations.

Eligibility

States, local governments, and nonprofit organizations are eligible for SPNS grants. Certain States and units of local government may be eligible for Long-Term Comprehensive Strategies grants. HOPWA provides both formula and competitive grants. Qualified States and urban areas with the highest number of AIDS cases receive annual formula grants, which comprise 90 percent of total HOPWA funds. The competitive grant program awards the remaining 10 percent of HOPWA funds to projects with a national impact and to projects in areas that do not receive formula funds.

Eligible grantees

Cities with a population of more than 500,000 and at least 1,500 cumulative AIDS cases may apply for the formula grants. States with more than 1,500 cumulative AIDS cases (in areas outside cities eligible to receive HOPWA) may also apply. For competitive grants, States and local governments that do not qualify for formula grants and nonprofit organizations may apply.

Funding

Grants of up to $1 million are available. An additional 10 percent may be allocated for administrative costs, and another $50,000 may be allocated to an applicant to collect project outcome data.

Services

Grants may be used to fund the following:

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Housing information services, including fair housing counseling and project-based or tenant-based assistance

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New construction of a community residence or similar dwelling

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Acquisition, rehabilitation, conversion, lease, or repair of facilities to provide housing and services

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Operating costs for housing

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Short-term rent, mortgage, and utility payments to prevent homelessness

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Supportive services

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Administrative expenses

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Resource identification and technical assistance

Funding may also be used to help communities improve their needs assessment capacity, initiate long-range HIV/AIDS housing planning, and enhance facility operations.

Information contact

For an application kit, supplemental information, or technical assistance, call HUD's SuperNOFA Information Center at (800) 483-8929 or (800) 483-8209 (TDD) for the hearing impaired. Applicants requesting a HOPWA grant application must refer to it specifically. For general information on HUD policies, programs, and initiatives for the homeless, call HUD's toll-free National Homeless Assistance Hotline (800-HUD-1010), which provides callers from across the country with the names and phone numbers of local homeless assistance providers, as well as tips on what individuals can do to help the homeless.

For general information on housing and AIDS, contact the AIDS Housing of Washington National Technical Assistance Project at: (206) 448-5242; or by e-mail at: gro.gnisuohsdia@ofni.

The Centers for Disease Control and Prevention

The CDC, the nation's prevention agency, monitors health, detects and investigates health problems, conducts research to enhance prevention, develops and advocates public health policies, implements prevention strategies, promotes healthy behaviors, and fosters safe and healthful environments.

The CDC's National Center for HIV, STD (sexually transmitted diseases), and TB Prevention (NCHSTP) is responsible for public health surveillance, prevention research, and programs to prevent and control HIV infection and AIDS, other STDs, and TB. Center staff work in collaboration with government and nongovernment partners at community, State, national, and international levels, applying well-integrated multidisciplinary programs of research, surveillance, technical assistance, and evaluation.

Two key CDC services are the CDC National AIDS Clearinghouse (NAC) and the CDC National Prevention Information Network (NPIN). NAC provides information about HIV/AIDS, STDs, and TB to people and organizations working in prevention, health care, research, and support services. All of the clearinghouse's services are designed to facilitate the sharing of information about education, prevention, published materials, and research findings, and news about HIV/AIDS, STD, and TB-related trends. Health information specialists at the clearinghouse answer questions, provide referrals, and offer technical assistance. By using the CDC NAC databases and other CDC resources, staff members help callers find up-to-date information about organizations that provide HIV/AIDS-, STD-, and TB-related services, educational materials, and funding resources. To contact a health information specialist, call (800) 458-5231 (English and Spanish), or (800) 243-7012 (TDD) for the hearing impaired, Monday through Friday, 9 a.m. to 6 p.m. EST.

State and Local Initiatives

Each State has an SSA, such as a department of human resources, which is responsible for allocating State and Federal funds for substance abuse treatment and prevention and for HIV/AIDS services (often located with STD services). Grantseekers should contact their SSA for information regarding the availability of State and local funding initiatives.

At the community level, Join Together, a project of the Boston University School of Public Health, is a national resource for communities working to reduce substance abuse and gun violence. The project assists in locating resource materials, colleagues, or training opportunities. Information is provided about Federal Register announcements, foundation profiles, materials, and online documents available from other organizations, as well as tips for finding grants. A technical assistance team can assist in locating information and provide a directory of more than 75,000 people working in substance abuse treatment throughout the nation. A categorized database provides more than 3,000 Web links to relevant substance abuse treatment information.

Contact Information

Join Together, 441 Stuart Street, Boston, MA 02116. Phone: (617) 437-1500; Fax: (617) 437-9394; e-mail: gro.rehtegotnioj@ofni or gro.rehtegotnioj@retsambew.

Special Populations

Over the past 5 years minorities, women, adolescents, homeless and low-income individuals, and incarcerated persons have become increasingly affected by the HIV/AIDS pandemic. Many funding sources target specific special populations. Directories, such as those published by the Foundation Center and Aspen Publishers, allow grantseekers to search for private foundations and corporate giving by specific subject area, such as substance abuse, women, children and adolescents, and HIV/AIDS. Federal, State, and local funding sources should be contacted directly to determine target population eligibility.

Grantwriting Information

Grantwriters can be helpful in developing an effective grant application. In deciding whether or not to use the services of a grantwriter, it is important to consider cost as well as existing agency staff writing capacity and available funding. If the agency has never used a grantwriter before, it may be helpful to contact other organizations in the area to assist in determining the range of costs associated with grantwriters as well as the names of local grantwriters. Often, grantwriters specialize in a particular field, such as health or education. A grantwriter's prior experience in writing HIV/AIDS or substance abuse treatment grant applications can be very helpful, not only in the writing of an application, but also in the development of the proposed service or project for which funding is sought.

Building agency grantwriting capacity can be an effective alternative to the use of a grantwriter. Check with a local college or university's evening education program to see if classes are offered on grantwriting. A number of grantwriting resources (i.e., workshops, “how-to” books, directories of consultants) are available through the Internet using the key word “grantwriting.”

Strategies To Ensure Ongoing Funding

Some funding sources offer one-time funding only; others provide the opportunity for continuation of funding after the initial grant award period. With the latter, especially, it is important that grant recipients have a mutually productive relationship with the funding source during the grant award period, including

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Timely reporting

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Good working relationship with project officer(s)

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Meeting established timelines

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Meeting goals and objectives

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Financial accountability

When applying for continuation funds, the grantee must be able to demonstrate that the program has “made a difference” with prior funding (i.e., project outcomes) and that need still exists for funding and services. The program also needs to adapt to changes in the environment since the initial funding application and to changes within the funding agency itself.

With one-time funding, the grantee should look for new funding sources well before the end of the initial grant award (i.e., at least a year in advance). Grantseekers should keep in mind that potential funding sources may not have the same interests or requirements as the current funder.