FY2024 RWHAP PART A PC-PB REFLECTIVENESS AND ROSTER 4-30-24 (001).PDF

Planning Council/Planning Body Membership Roster and Reflectiveness Worksheet
The FY 2024 Part A Planning Council/Planning Body (PC/PB) Membership Roster and Reflectiveness Worksheet shows if the PC/PB membership complies with legislative reflectiveness 
and representation requirements at the time of completion. 
Per the Ryan White HIV/AIDS Treatment Extension Act of 2009 – Section 2602 (b)(1) 
Planning Council/Planning Bodies Must:
· Establish an HIV health services PC/PB
· Ensure the PC/PB composition reflects the demographics of the population of individuals with HIV/AIDS in the eligible area
· Particular consideration given to disproportionately affected and historically underserved groups and subpopulations
We have added new formulas for automatic data transfer between worksheets
Please fill out the tables in the following order:
1.     Membership Roster 
2.     Membership Category Tool
3.     Reflectiveness 
Note: Complete the comment boxes, as applicable, throughout the worksheet to describe plans to comply with legislative requirements. 
Step 1: Instructions for filling out the Membership Roster
Before submitting your Membership Roster, please ensure your responses are consistent with your PC/PB By-laws.
Membership Roster
Use the drop-down menus for the following information:
Position: Choose the PC/PB member’s role from the drop-down.
Agency Affiliation: Provide the member’s affiliated provider agency.
Gender: Choose self-reported gender.
Race/Ethnicity: Choose self-reported race/ethnicity.
  Membership Category: Please select the category that reflects the member's role from the drop-down menu. 
Manually fill in each of the categories below:
Name: Enter PC/PB member’s name, with their consent. Asterisk for self-identified members.
Member Since: Provide the member’s starting year as a PC/PB representative.
Unaffiliated client: Enter 1 for unaffiliated & 0 for affiliated.
Terms: Please indicate the number of terms the member has served.
Signature: Certification by the Chief Elected Official (CEO) or designee required if a membership category is vacant.
Membership Category Exceptions:
•        Combined Representation. If your agency provides both substance abuse and mental health services, one person may represent both categories if they are familiar with both 
programs.
•        State Representation. A member in a position of responsibility for both the Ryan White HIV/AIDS Program Part B and the State Medicaid agency may represent both entities.
•        Multiple Grant Representation. A member can represent any combination of Ryan White HIV/AIDS Program Part F grantees and Housing Opportunities for Persons with AIDS 
(HOPWA), if their agency receives grants from these funding streams and the member is familiar with all represented programs.
Note: A separation of PC/PB and recipient roles is necessary to avoid conflicts of interest. The legislation prohibits PC/PB public deliberations from being “chaired solely by an employee 
of the grantee.” [PHS Act 2602(b)(7)(A)]. A recipient representative, whose position is funded with RWHAP Part A funds, provides in-kind services, or has significant involvement in the 
RWHAP Part A grant, shall not occupy a voting seat in the PC/PB. A recipient representative may serve as a non-voting co-chair of the PC/PB.
Step 2: Instructions for filling out the Membership Category Tool 
The Membership Category Tool is used to ensure membership representation aligns with legislative requirements. It also provides vacancy statuses for all categories.
The worksheet auto-fills the vacancy status based on the roster information. If there are any vacancies, fill in the “vacancy duration”  AND "comments" sections.
Note: Each designated membership category must have at least one representative, given an entity from that category exists. A member can only represent one category at a time; 
however, they may shift between categories as per requirements.
Membership Category Exceptions:
1. One person can represent the substance abuse provider and mental health provider categories if their agency provides both services.
2. One member may represent the Ryan White HIV/AIDS Program Part B and the State Medicaid agency simultaneously.
3. A single member may represent any combination of grants from the Ryan White HIV/AIDS Program Part F and the Housing Opportunities for Persons with AIDS (HOPWA).
If a member qualifies for these exceptions in the roster, mark it as “Not Applicable” in the Membership Category Tool  “Comments” column.
Step 3: Instructions for filling out the Reflectiveness Table
The Ryan White HIV/AIDS Treatment Extension Act of 2009 – Section 2602(b)(1)
Specify HIV prevalence data source and year of data at the top of the spreadsheet. 
Include data (number and percentage) for HIV prevalence, PC/PB membership, and unaffiliated PC/PB client members for each category:
1. Race and ethnicity
2. Gender
3. Age
Additionally, ensure your PC/PB is reflective of any disproportionately affected or historically underserved populations in the jurisdiction.

Recipient Name: 
Maricopa County
Grant Number: 
H89HA11478
6/26/2024
21
21
48%
Yes
Name                   
(use an * to self-identify)
PC/PB Position
Agency Affiliation
Gender
Race/Ethnicity
Membership Category      
Member 
since?
Unaffiliated 
1 for Yes   
0 for No
Term(s)
Steve Gallardo
Member
Maricopa County Board of 
Supervisors
Male
Hispanic
Local Public Health Agency
3/1/2023
0 1st term
Randall Furrow
Chair
N/A
Male
White, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
4/10/2024
1 1st term
Cedric McIntosh
Member
Terros Health
Male
Black, Not Hispanic
Social Service Provider - housing 
and homeless services 
7/27/2022
0 1st term
Duvia Lozano
Member
Chicanos Por La Causa
Female
Hispanic
Mental Health & Substance 
Abuse Provider
1/30/2019
0 2nd term
Emily Halling
Member
Southwest Center for HIV/AIDS
Additional 
identity
White, Not Hispanic
Community Based Organization 
(CBO) serving affected 
populations/AIDS Service 
Organization (ASO)
1/11/2023
0 1st term
Erica TeKampe
Member
HIV Care Directions
Female
White, Not Hispanic
Hospital Planning Agency or 
healthcare planning agency
5/1/2024
0 1st term
Patricia Sandoval
Member
AZ Dept. of Health Services
Female
Hispanic
State Part B Agency
4/12/2023
0 1st term
Jason Vail Cruz
Member
Valleywise Health
Additional 
identity
White, Not Hispanic Part C Recipient
6/8/2022
0 1st term
Taylor Kirkman
Member
Valleywise Health
Female
White, Not Hispanic
Part D Recipient, or if none 
present, representative of 
organization addressing the 
needs of children, youth, and 
families with HIV
11/29/2023
0 1st term
Alain Barnes
Member
N/A
male
Multi-Race
Affected Communities, including 
PWH and historically 
underserved subpopulations
10/19/2022
1 1st term
Anthony Holscher
Member
N/A
Male
White, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
4/24/2022
1 1st term
Bradley Reece
Member
N/A
Male
White, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
9/27/2023
1 1st term
Brian Hegenbart
Member
N/A
Male
White, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
3/27/2024
1 1st term
Celeste Amaya
Member
N/A
Female
Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
12/6/2024
1 1st term
Eric Eason
Member
N/A
Male
Black, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
4/22/2020
1 2nd term
Tashawn Blount
Member
N/A
Male
Black, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
8/31/2022
1 1st term
Shane Sangster
Member
Native Health
Male
American Indian / 
Alaska Native
Healthcare provider, including 
Federally Qualified Health Center
7/27/2022
0 1st term
Eva Galindo 
Member
N/A
Transgender: 
male-to-female
Black, Not Hispanic Non-Elected Community Leader
8/31/2021
0 1st term
Cynthia Quinn
Member
Maricopa County Jails
Female
White, Not Hispanic
Representatives of/or formerly-
incarcerated PWH
7/14/2021
0 1st term
James Michael Brown
Member
N/A
Male
White, Not Hispanic
Affected Communities, including 
PWH and historically 
underserved subpopulations
6/26/2024
1 1st term
Celeste Ibarra
Member
N/A
Transgender: 
male-to-female
American Indian / 
Alaska Native
Affected Communities, including 
PWH and historically 
underserved subpopulations
6/26/2024
1 1st term
PC Member Total
21
10
Date:
Date:
Date:
Attest: (Clerk of the Board):
Approved as to Form: (Maricopa County Attorney)
Comments: If you are not in compliance with the membership requirements of RWHAP Legislation, provide a detailed and succinct narrative documenting efforts, plans, and a 
proposed timeline to fill the membership category vacancy.
Annual certification by the Chief Elected Official (CEO) or designee (required only if a membership category is vacant) attesting there are plans to fill vacancies:
CEO or designee signature:
Comments: If you are not in compliance with the 33% unaffiliated client mandate, please provide a detailed and succinct narrative on how you plan to comply:
N/A
FY 2024 Part A Planning Council/Planning Body Membership Roster 
Date of form completion:
What is the minimum authorized/prescribed number of PC/PB members according to PC/PB Bylaws?:
Number of appointed PC/PB members: 
Percentage of unaffiliated PC/PB client members
Do at least two members of the PC/PB publicly disclose their HIV status?
Describe current PC/PB Bylaw term limits and/or membership rotations:
No. Years/Term: 3/2______No. 
Rotations___N/A_____
Comments: Updated in 2023, new Bylaws now include term limits. Planning Council members may only serve two consecutive three-year terms. For current member, their previous terms were grandfathered in 
and term limits only apply moving forward from the date of the approved bylaws.

Recipient Name:
Grant Number:
Membership Categories
Vacancy Status 
Vacancy 
Duration (if 
applicable)
Comment Section: 
Comments are required for all legislatively mandated categories. Include barriers for 
recruitment and plans to address vacancy.
Healthcare Provider, including Federally 
Qualified Health Center
NOT VACANT
Community Based Organization (CBO) 
Serving Affected Populations/AIDS Service 
Organization (ASO)
NOT VACANT
Social Service Provider - Housing and 
Homeless Services 
NOT VACANT
Social Service Provider - Other
VACANT
N/A
Social Service Provider - Other is represented by the same Member as the 
Social Service Provider - Housing and Homeless Services Membership category.
Mental Health Provider
VACANT
N/A
Mental Health Provider is represented by the same Member as the Mental Health and 
Substance Abuse Provider Membership category.
Substance Abuse Provider
VACANT
N/A
Substance Abuse Provider is represented by the same Member as the Mental Health 
and Substance Abuse Provider Membership category.
Mental Health & Substance Abuse Provider
NOT VACANT
Local Public Health Agency
NOT VACANT
Hospital Planning Agency or Healthcare 
Planning Agency
NOT VACANT
Affected Communities, including People 
with HIV and Historically Underserved 
Subpopulations
NOT VACANT
Non-Elected Community Leader
NOT VACANT
State Medicaid Agency
VACANT
6 years
Medicaid has identified that they do not have capacity for ongoing participation 
and membership. A Medicaid representative has agreed to attend one to two meetings 
per year to present data and reports to the Planning Council.
State Part B Agency
NOT VACANT
State Part B Agency & State Medicaid 
Agency
VACANT
N/A
See comment under "State Medicaid Agency" above.
Part C Recipient
NOT VACANT
Part D Recipient, or if none present, 
Representative of Organization Addressing 
the Needs of Children, Youth, and Families 
with HIV
NOT VACANT
Other Federal HIV Programs, including HIV 
Prevention programs
VACANT
4 months
The position for HIV Prevention is currently open due to recent staffing changes.
 We’ve identified a potential candidate who is currently undergoing the approval 
process by the Planning Council. 
Representatives of/or Formerly-
Incarcerated People with HIV
NOT VACANT
Maricopa County
H89HA11478

Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
White, not Hispanic
6529
43.97%
10
47.62%
5
50.00%
Black, not Hispanic
2481
16.71%
4
19.05%
2
20.00%
Hispanic
4766
32.09%
4
19.05%
1
10.00%
Asian/Pacific Islander
268
1.80%
0
0.00%
0
0.00%
American Indian/Alaska Native
412
2.77%
2
9.52%
1
10.00%
Multi-Race
394
2.65%
1
4.76%
1
10.00%
Other/Not Specified
0
0.00%
0
0.00%
0
0.00%
Total 
14850
100%
21
100%
10
100%
Gender 
Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
Male
12632
85.06%
11
52.38%
8
80.00%
Female
2113
14.23%
6
28.57%
1
10.00%
Transgender: male-to-female
101
0.68%
2
9.52%
1
10.00%
Transgender: female-to-male
2
0.01%
0
0.00%
0
0.00%
Other gender identity
2
0.01%
2
9.52%
0
0.00%
Total 
14850
100%
21
100%
10
100%
Age
Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
Number 
Percentage 
(include % 
with # )
 13-19 years
59
0.40%
0
0.00%
0
0.00%
20-29 years
1256
8.46%
3
14.29%
3
30.00%
 30-39 years
3069
20.67%
5
23.81%
1
10.00%
40-49 years
3124
21.04%
4
19.05%
1
10.00%
50-59 years
3975
26.77%
6
28.57%
3
30.00%
60+ years
3340
22.49%
3
14.29%
2
20.00%
Other/Unknown
27
0.18%
0
0.00%
0
0.00%
Total
14850
100%
21
100%
10
100%
Planning Council/Planning Body Reflectiveness Table
(Use most recent HIV Prevalence data)
HIV Prevalence in 
EMA/TGA
Total Members of 
the PC/PB
Unaffiliated RWHAP 
Part A Clients on 
PC/PB
Race/Ethnicity
HIV Prevalence data source and year of data:
PC Reflectiveness and Roster