Research & Evaluation Core

1999 Client Survey - Executive Summary

by Matt Mutchler, Ph.D. APLA Research & Evaluation Specialist 323.993.1522 or mmutchler@apla.org

Introduction

The 1999 AIDS Project Los Angeles client survey was mailed to 4,666 APLA clients in Fall 1999. These clients represent the study population defined as clients who agreed to receive mail from the agency as of October, 1999. 1,610 clients responded to APLA's 1999 Client Survey, representing a 34.5% response rate (the highest yet) and 21% of the total population of APLA clients.

Highlights:

• There is a greater prevalence of poverty in the 1999 client survey results compared to the 1997 survey results as seen by significant increases in reliance on public benefits (P<.05).
• One-third of clients have returned to work after leaving work because of HIV.
• There is a high prevalence of drug, alcohol, and tobacco use.
• There is a high prevalence of sexual risk behaviors.
• Clients who responded to the 1999 client survey are less likely to be taking their HIV medications exactly as their physician prescribes compared to clients who responded in 1997 (P<.05).
• The majority of clients reported good to excellent general health and reported feeling the same as or better than they did 1 year ago.
• APLA services continue to be rated as above average.

New Areas of Investigation

• Medical Status (T-cell and viral load counts)
• New Quality of Life Measure
• Recreational Drug Use
• Alcohol Use
• Cigarette Use
• Sexual and Injection Risk Behaviors

Demographic Profile of Survey Respondents (gender, race/ethnicity, sexual orientation, and age):

• 89.9% of the clients who responded were male and 8.4% of the clients who responded were female; transgender clients composed 1.7% of the total respondents.
• The breakdown of racial/ethnic categories is: 50.4% White/Caucasian, 26.5% Latino/Hispanic, 15% African American/Black, 4.3% 'Other', 2.2% Asian/Pacific Islander, and 1% Native American.
• The majority of clients in each major racial/ethnic category self-identify as gay (83.8% of Whites, 72% of Latinos, and 58.6% of Blacks). Caucasian clients were more likely to report being gay (P<.05).
• The average age of the clients who responded to the survey was 42. The majority of clients (75.4%) were between 30 and 49 years of age.

Language:

• Most clients reported speaking English only (78%).
• 11.3% of clients reported being bilingual (Spanish and English) and 7.8% of clients reported being monolingual Spanish speakers.

Education and Income:

• The majority of clients of all racial/ethnic groups (male and female) reported at least some college education.
• Caucasians were more likely to report more higher educational attainment (P<.05).
• Men were more likely to report more higher educational attainment (P<.05).
• The largest proportion of clients reported living on poverty level income ( less than $8,400 annually).
• Women were significantly more likely to report incomes at or below the poverty level (P<.05).
• Caucasians were more likely to report higher incomes (P<.05).
• Men were more likely to report higher incomes (P<.05).

Employment and Return to Work:

• The largest proportion of clients reported being disabled and unable to work (35%).
• 31% of the clients reported employment as their source of income.
• African Americans were more likely to be unemployed (P<.05).
• 64% of clients relied on public assistance programs as their source of income.
• 63% of all clients stopped working because of HIV at some point.
• 33% of those returned to work after stopping because of HIV.
• 42% of unemployed clients were looking for work.
• 80% of those looking for work reported needing assistance.

Homeless Status:

• 3.3% of clients said that they were homeless within the last 6 months and another 10.3% indicated that they are at risk of becoming homeless within the next 3 months.
• African American clients were more likely to report being homeless (P<.05).

Households with Children:

• 10.2% of clients reported having children under age 18 living with them.
• Among those with children, 27% said that they need APLA to provide child care.

Health Coverage:

• The proportion of clients who reported being on public health insurance in 1999 was significantly higher compared to 1997 (58% vs. 53%; P<.05).

Access to Health Care and HIV Medications:

• Access, for the clients who responded to the APLA client survey, is not a significant problem. Clients agreed with statements such as 'I am able to see a doctor when I need to.' on average.

Quality of Life:

• Most clients reported good to excellent general health (60.7%).
• Most clients said that they felt better than or the same as they did 1 year ago (72.3%).

Medical Status:

• Most clients reported having a confirmed AIDS diagnosis (57.1%).
• 20.2% of clients reported being HIV positive without symptoms and 22.6% reported being HIV positive with symptoms.
• The largest proportion of clients found out they were HIV positive 3 to 10 years ago (44.6%).
• The average T-cell count among clients was 372.
• Among clients who responded to the survey, 49% reported undetectable viral load status (<400 copies/ml).
• 27.5% of the respondents reported having been hospitalized over night for an AIDS-related illness in the past year at least once.
• Of those on HIV medications, 97% are currently on either double or triple therapy.

Adherence to HIV Medications:

• 55.4% of clients reported being non-adherent to their HIV combination therapy in the past 7 days.
• 47.7% did not take their HIV medications exactly as their physician prescribed and 42.9% of clients missed or forgot to take their HIV medications in the past 7 days.
• Poorer general health and reporting sexual risk behaviors, reporting crack use, and reporting heavy drinking (5 or more drinks on at least 5 occasions) in the past 6 months predicted non- adherence to HIV medications among all client respondents.
• 'I forgot', 'I slept through the dose time', and 'I felt depressed' were the top 3 reasons cited for missing HIV medications.
• The majority of clients (77.8%) reported that their HIV medications have caused side effects that bother them 'A Little Bit', 'A Lot', or 'Terribly'.
• The degree of severity of side effects (worse side effects) is positively associated with non-adherence to HIV medications (P<.05).

Sexual and Injection Risk Behaviors:

• 31% of all clients who responded reported some sexual risk behavior (unprotected anal or vaginal sex) in the past 6 months.
• Gay and bisexual men reported significantly higher (P<.05) proportions (34% and 30%, respectively) of sexual risk behaviors compared to heterosexual women and men (15% and 12%, respectively).
• Age (19-39), inhalant use, reporting multiple sexual partners, and feeling the effects of drinking alcohol or using drugs before having sex predicted sexual risk behaviors among sexually active gay men (P<.05).
• Non-adherence to HIV medications, recreational drug use, tobacco use, and alcohol use were associated with sexual risk behaviors among both gay men and bisexual men (P<.05).
• 56% of clients reporting high sexual risk behaviors did not always disclose their HIV status.
• 3.3% of clients reported injecting drugs in the past 6 months.

Recreational Drug Use, Alcohol Use, and Tobacco Use:

• 52% of respondents reported some recreational drug use in the past 6 months.
• Gay male, less educated, Caucasian, younger (20-29), non-adherent, and sexual risk taking clients reported higher prevalences of drug use (P<.05).
• 69% of clients reported some alcohol use in the past 6 months.
• 40% of clients reporting smoking cigarettes in the past 6 months.

Utilization of and Satisfaction with APLA Client Services:

• The top 5 most used services by respondents were: Publications (66.8%), Dental (55.5%), Clientline (49.5%), Residential (37.0%), and Case Management (36.9%).
• On average, clients used 4.6 APLA services in the past year.
• The majority of clients (60.1%) rated AIDS Project Los Angeles's services and programs as "Above Average to Excellent."

Survey Limitations:

There are a few limitations to keep in mind when interpreting this report. The survey findings are based on self-reported data that may be biased toward socially desirable responses. Only clients who agreed to receive mail from the agency are included in the study population. As a result, those who do not receive mail from the agency could not be surveyed. Caucasians were significantly over-represented among clients who responded to the survey (P<.05). Therefore, the findings may not be generalizable to the population of APLA clients. However, female and homeless clients were not under-represented for the first time.

For Additional Information:

Please go back to the Research & Evaluation page for other reports on substantive research domains included in APLA's 1999 Client Survey. Please consult the Glossary of Statistical Terms for help deciphering statistical concepts.