The RWHAP grant recipients and subrecipients report client birth year. This information is then used to calculate the client's age during the designated year as a discrete variable. On the RWHAP Compass Dashboard, younger and older clients are sometimes highlighted as priority populations: Youth (aged 13–24) and Aged 50 years and older.
Part A of RWHAP provides emergency assistance to EMAs and TGAs that are most severely affected by the HIV epidemic. To qualify for EMA status, an area must have reported at least 2,000 AIDS cases in the most recent 5 years and have a population of at least 50,000. To be eligible for TGA status, an area must have reported 1,000–1,999 AIDS cases in the most recent 5 years and have a population of at least 50,000. EMAs and TGAs range in size from one city or county to more than 26 different geographic entities; 11 include parts of more than one state. The boundaries of EMAs and TGAs are based on the U.S. Census Bureau delineation of the Metropolitan Statistical Area at the time of first eligibility. Client-level data are reported based on provider location, rather than client location. It is important to note that data shown for EMAs and TGAs are not mutually exclusive; clients may have received services from providers in multiple EMAs and TGAs. In addition, data presented for EMAs and TGAs are not limited to entities receiving RWHAP Part A funding; all visualizations include data for all clients served by RWHAP providers in the EMA or TGA, regardless of the source of RWHAP funding (i.e., Parts A, B, C, and D data are included).
A measure of income issued every year by the Department of Health and Human Services (HHS). See Federal Poverty Level on HealthCare.gov.
The RWHAP grant recipients and subrecipients report all sources of health care coverage that each client had for any part of the reporting period. These data are further categorized for analysis. From 2010 through 2013, health care coverage was categorized as private only, Medicare only, Medicaid only, other public, other private, multiple coverages, and no coverage (uninsured).
The categorization schema was changed in the 2014 RSR to include a more granular classification of health care coverage. From 2014 through 2019, health care coverage was categorized as private employer, private individual, Medicare, Medicaid, Medicare and Medicaid (dual eligibility), Veterans Administration, Indian Health Service, other plan, multiple coverages, and no coverage. The Medicaid classification also includes the Children’s Health Insurance Program (CHIP) and other public state health care coverage programs.
The housing status variable captures the client’s housing status at the end of the reporting period and is categorized as stable permanent housing, temporary housing, or unstable housing. The definitions for each of these categories are based on the Housing Opportunities for Persons with AIDS Program Annual Progress Report Measuring Performance Outcomes.
The National HIV/AIDS Strategy (NHAS) is a roadmap for ending the HIV epidemic in the U.S. by 2030. NHAS is the nation’s third consecutive five-year national HIV strategy and covers 2022-2025, with a 10-year goal of reducing new HIV infections by 90% by 2030. The goals of the NHAS are to prevent new HIV infections, improve HIV-related health outcomes of people with HIV, reduce HIV-related disparities and health inequities, and achieve integrated, coordinated efforts that address the HIV epidemic among all partners and stakeholders.. The NHAS includes several goals and indicators, one of which is to increase viral suppression among people with diagnosed HIV to 95% by 2025. The RWHAP Compass Dashboard adopts this viral suppression goal from the NHAS, and identifies an aligned goal to increase retention in care among people with diagnosed HIV to 95% by 2025.
Screens that display the number of clients served (e.g., Characteristics of RWHAP Clients), include all RWHAP clients, regardless of HIV serostatus. This means the data include people with HIV as well as clients who are missing HIV serostatus information (e.g., clients who receive services that do not require serostatus to be reported, such as medical transportation services) and clients who do not have HIV (i.e., the families of people with HIV who are able to receive certain RWHAP services). In 2019, people with HIV represented an estimated 98% of all RWHAP clients.
Screens displaying outcome measure data (i.e., retention in care and viral suppression) include only people with HIV who also meet the criteria for that specific outcome measure. It is important to be aware that the denominator is not the same for all calculations visualized on
the site.
Retention in care and viral suppression data for the RWHAP should be interpreted carefully. Because these data are reported annually and de-identified, an individual client cannot be tracked across years. This affects how HIV-related outcomes are calculated (see below).
RWHAP clients who are not included in retention in care or viral suppression calculations did not meet inclusion criteria for those calculations but would have received at least one other RWHAP service (e.g., non-medical case management, housing, transportation, food bank/home-delivered meals). It is also important to note that these clients excluded from retention in care or viral suppression calculations may receive medical care at RWHAP clinics, where primary medical care services are paid using non-RWHAP-related funding sources (e.g., private, public, or other health care coverage types), or may receive care from providers outside the RWHAP system; these clients should not be presumed to be “out of care.”
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Retention in Care
Retention in HIV medical care was defined as people with HIV who had at least two medical visit dates that were at least 90 days apart in the measurement year. Because the data sets are restricted to one calendar year of data each, the first of these HIV medical care visits in the year must have occurred before September 1 of the measurement year, thus giving the client an opportunity to meet the retention criteria by December 31. -
Viral Suppression
Viral suppression was calculated among people with HIV who had at least one outpatient ambulatory health services visit and at least one viral load test during the measurement year. Viral suppression was defined as a most recent viral load test result of <200 copies/mL.
Recipients and subrecipients report race/ethnicity information for RWHAP clients according to Office of Management and Budget standards. Race and ethnicity are submitted as separate variables and combined for analysis. The race/ethnicity variable is categorized as American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, White, and multiple races (i.e., two or more categories of race reported).
In this dashboard, clients categorized by race were not Hispanic or Latino; the number of clients reported in each race category may, however, include clients whose ethnicity was not reported.
The RWHAP grant recipients and subrecipients are expected to make every effort to obtain and report race and ethnicity, based on each client's self-report. Self-identification is the preferred means of obtaining this information.
Data are reported by RWHAP grant recipients and subrecipients in 50 states, the District of Columbia, and three territories—Guam, Puerto Rico, and the U.S. Virgin Islands. Five of the six U.S. Pacific territories (excludes Guam) do not submit client-level data and, therefore, are not included in this report.
State-level analyses include data submitted for all parts of the RWHAP. In addition, state delineation of data is based on provider location, rather than client location.
Transmission category is the term for the classification that summarizes a client’s possible HIV risk factor at the time of HIV acquisition. The summary classification results from selecting – from a presumed hierarchical order of probability – the single risk factor most likely to have been responsible for transmission.
Transmission categories are presented separately by gender (i.e., male, female, transgender).
For male clients, transmission categories include male-to-male sexual contact, injection drug use, male-to-male sexual contact and injection drug use, heterosexual contact, perinatally acquired HIV, and other.
For female clients, transmission categories include heterosexual contact, injection drug use, perinatally acquired HIV, and other.
For transgender clients, transmission categories have been modified to be more reflective of the transgender experience of transmission while continuing to follow a relative hierarchy of likelihood for transmission. That is, transmission category data for transgender clients are presented as sexual contact, injection drug use, sexual contact and injection drug use, perinatally acquired HIV, and other.
The definitions of transmission categories are adapted from CDC’s NHSS definitions for transmission categories. Clients with more than one reported risk factor are classified in the transmission category listed first in the hierarchy. The only exceptions are (1) men who had sexual contact with other men and who injected drugs and (2) perinatally acquired HIV. It is important to note that data by transmission category are based on the reported risk factor most likely to have been responsible for the original transmission of HIV; data may not be reflective of current behavior (e.g., injection drug use).
These groups make up separate transmission categories, which are defined in order of the hierarchy as follows:
- Male-to-male sexual contact: Male clients who report sexual contact with other men (i.e., homosexual contact) and males who report sexual contact with both men and women (i.e., bisexual contact).
- Injection drug use: Clients who report use of drugs intravenously or through skin-popping.
- Male-to-male sexual contact and injection drug use: Male clients who report sexual contact with other men or with both men and women and report the use of drugs intravenously or through skin-popping.
- Heterosexual contact: Clients who report specific heterosexual contact with an individual with, or at increased risk for, HIV infection (e.g., a person who injects drugs).
- Perinatally acquired HIV: This category is exclusively for infants and children with HIV attributed to perinatal transmission. This category includes clients born after 1980 who are known to be people with HIV and whose HIV is attributed to perinatal transmission, as well as infants with indeterminate serostatus.
- Other: Clients who report transmission from the receipt of transfusion of blood, blood components, or tissue; clients who report hemophilia/coagulation disorder. Beginning with 2014 data collection, unknown risk factor was no longer included in the classification of other transmission, nor was it collected as a separate category for the RSR. All analyses in this report have been adjusted for consistency during 2012 through 2016 to only include blood transfusion or hemophilia/coagulation disorder.
For transgender clients, the following transmission category hierarchy is used:
- Sexual contact: Transgender clients who report any sexual transmission.
- Injection drug use: Transgender clients who report use of drugs intravenously or through skin-popping.
- Sexual contact and injection drug use: Transgender clients who report sexual contact and report the use of drugs intravenously or through skin-popping.
- Perinatally acquired HIV: As above.
- Other: Clients who report transmission from the receipt of transfusion of blood, blood components, or tissue; clients who report hemophilia/coagulation disorder. Beginning with 2014 data collection, unknown risk factor was no longer included in the classification of other transmission, nor was it collected as a separate category for the RSR. All analyses in this report have been adjusted for consistency during 2012 through 2016 to only include blood transfusion or hemophilia/coagulation disorder.
