severe-need criteria in allocating resources, the Committee’s findings and recommendations may also be relevant to those programs. In the remainder of this chapter, the Committee uses the term “resource needs” instead of “severity of need” to reflect Congress’ interest in the relationship between need and resource allocation. The Committee uses the term “severity of need,” however, when referencing the specific severity-of-need component of the Title I application.

Congress specified that “[Title I] supplemental awards are to be directed principally to those eligible areas with ‘severe need,’ or the greatest or expanding public health challenges in confronting the epidemic” (U.S. Congress, 2000). Reflecting this notion, Congress increased the weight assigned to severity of need in determining the supplemental award from 25 percent to 33 percent in the 2000 reauthorization (Ryan White CARE Act. 42. U.S.C. § 300ff-13 [2003]). In determining severity of need, Congress directed HRSA/HAB to consider factors such as: “(I) STDs, substance abuse, tuberculosis, severe mental illness, or other co-morbid factors; (II) new or growing populations of individuals with HIV; (III) homelessness; (IV) current prevalence of HIV; (V) increasing need for HIV services including the relative rates of increase in the number of cases of HIV disease; [and] (VI) unmet need for services” (Ryan White CARE Act. 42 U.S.C. §. 300ff-13 [2003]). Congress further directed HRSA/HAB to “employ standard, quantitative measures to the maximum extent possible in lieu of narrative self-reporting when awarding supplemental awards” (U.S. Congress, 2000).

In addressing its charge, the Committee organized its work into the following tasks:

  1. Developing a conceptual framework for factors affecting resource needs;

  2. Defining criteria for assessing measures of resource needs;

  3. Evaluating the process and data currently used to award Title I supplemental funds;

  4. Proposing a new way of identifying predictors of resource needs; and

  5. Making recommendations to evaluate and implement this approach.

Although HRSA/HAB uses explicit criteria to evaluate resource needs and allocate Title I supplemental grants, no consistent indicators are used to evaluate relative need, and much of the evaluation process is subjective. The Committee also found that the process for awarding Title I supplemental grants focuses on the characteristics of individuals, such as the prevalence of comorbid conditions that often accompany HIV disease,



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