The survey was developed by the Hawai'i Health & Harm Reduction Center (HHHRC) and the Hawai`i Department of Health. It was promoted by service providers at HHHRC, Hawai`i Island HIV/AIDS Foundation (HIHAF), Malama Pono, and Maui AIDS Foundation. Data were analyzed and visualized by Jack Barile, PhD, Joy Agner, MS, OTR, and Angela Zheng.
398 PLWHA across O`ahu, Kaua`i, Hawai`i Island, and Maui participated in the survey.
Where possible, demographic comparisons are made with the latest Hawai`i State Epidemiological Profile to illustrate how representative the needs assessment participants are of the state population of PLWHA.
Individuals who completed the needs assessment tend to be older than the PLWHA included in the epidemiological profile, with a high percentage of the respondents over 55 (58%). This may be reflective of the fact that younger PLWHA are less likely to be engaged in care.
Although the epidemiological profile does not have information on where people receive case management services, it does have information on where people live. Assuming that most people receive case management in the county where they live, the samples are similar in terms of location, with slight overrepresentation of individuals from Hawai`i Island and Kauai, and underrepresentation of individuals in Honolulu County.
A high proportion of the sample reported concurrent chronic conditions. The most prevalent were heart disease, depression, anxiety and chronic pain.
The majority of the sample did not report using illicit drugs in the past 12 months. Of those who did, marijuana was most common, followed by methamphetamines.
The majority of the sample continued their education after high school, and 31% either completed Bachelor’s or graduate degrees.
Social security was the most common type of income, indicating that a high percentage of the sample (58%) is living in poverty. Among those that specified “other” income, assistance from family and friends was the most common income source, followed by general assistance.
There were not notable differences between the needs assessment and the epidemiological profile in method of transmission. For both, by far the most common method of transmission is male to male sexual contact.
When participants are placed into one race category only, and groups are aggregated to match categories in the epidemiological profile, we see that both show an overrepresentation of White and underrepresentation of Asian PLWHA compared to the state population (23% and 36% respectively). Differences between the epidemiological profile and the needs assessment are illustrated below.
A high proportion of people living in Hawaii are multiracial, and aggregating race categories can mask important differences between groups. The needs assessment provided 17 race options, and 22% of participants selected more than one race. A breakdown of all of the categories selected is illustrated in the graph below.
The majority of individuals in the sample were homosexual men.
Nearly everyone in the sample was able to access HIV case management. For those who couldn't, transportation and lack of stable living conditions were primary barriers.
A high percentage of participants needed dental care, and 16% of the total sample described it as difficult to access. Primary barriers were cost, waiting time, and that the service wasn't available.
22% of the total sample sought out counseling services. Most the participants did not have difficulty finding services. Of those that did have difficulty, not knowing where to get services was the primary barrier.
39% of participants wanted information about HIV and AIDS. Fortunately, most found it easy or possible with some work to find the information they needed.
Alternative therapy (including acupuncture, chiropractic care, massage therapy, etc.) was the 6th most sought out service in the needs assessment, and the most difficult to access. 20% of the total sample described it as very difficult or too difficult to access. The most common barrier was not being able to afford it.
16% of the participants required assistance with daily self care. 81% of them found it easy or possible with some work to find the assistance they needed. Among those who had difficulty, not knowing where to get it was the primary barrier.
30% of the sample needed help enrolling in insurance coverage. 91% of those who needed help enrolling in insurance found it easy or possible with some work. Primary barriers for those who found it difficult are below.
50% of participants needed help paying for medical bills. Primary barriers for those who found it difficult included knowing where to get assistance and qualifying for assistance.
Despite the fact that 33% of the sample reported using marijuana and 10% reported using methamphetamine, only 6% of the participants attempted to access alcohol and drug abuse services. The majority found it easy to access the services they needed.
Only 8% of the sample sought out assistance with employment, and the majority found it easy or possible with some work to find employment assistance.
Only 8% of the total sample sought out education assistance. However, among those who attempted to access education services, 54% described it as very difficult or too difficult to access. The most significant barriers were not knowing where to get it and not qualifying for assistance.
Only 11% of the participants who needed help paying for food found it easy to access food assistance. 19% described it as possible with some work, and 10% found it very difficult or too difficult to access. Primary barriers were not qualifying for food assistance, the service wasn't available, or too long of a wait.
35% of the participants needed housing services in the past year. Of the total sample, the majority of those (75%) found it easy or possible with some work to access housing services. Among those who found it difficult, wait time and lack of housing services were primary barriers.
8% of the total sample needed help paying their bills, and found it very difficult or too difficult to access. Primary barriers were that the service was not available, the participants didn't know where to get it, or long wait times.
It is possible to live a long and healthy life despite a diagnosis of HIV, but it takes a community effort to reduce stigma and improve essential services. If you would like to get involved in supporting services for people with HIV/AIDS in Hawai`i by volunteering or providing donations, or if you interested in prevention services, such as PrEP, please contact the following organizations.