Public health clinics have such a shortage of Spanish-speaking case managers that janitors or other untrained workers sometimes are called on to translate sensitive information about HIV-AIDS to clients, according to a study released yesterday by CASA of Maryland, a Silver Spring-based immigrant advocacy group.

In focus groups of Latino residents and surveys of service providers in Prince George's and Montgomery counties, the study also found that most pamphlets and educational material on the disease are available only in English and that clients often fear the actions of immigration authorities and stigma in their community for seeking services.

Carmen A. Valenzuela-Dall, a doctor and researcher who authored the study, said governments need to do more to provide basic health services and need to hire culturally diverse and bilingual staffs.

Gaining access to health care is "such an adventure in this country for the undocumented immigrants and the people who don't speak English," Valenzuela-Dall said. Without bilingual health workers and materials, "how can we pretend to provide services?"

She compared the situation to putting up billboards telling illiterate people to write their governments for help.

The CASA report, funded by the Washington AIDS Partnership, a philanthropic group, was released in commemoration of World AIDS Day.

At yesterday's news conference, Maryland and Montgomery health officials said that they have worked to provide better outreach to foreign language speakers but acknowledged that much more needs to be done.

Naomi Tomoyasu, acting director of the state's AIDS Administration, said the agency is planning to buy one or two mobile health units to roam immigrant-heavy communities in Prince George's and Montgomery to reach more residents.

However, she said, lack of funding may curtail initiatives. The agency receives about $50 million a year, most of it from the federal government, to distribute to public health providers statewide, but budget cuts are expected next year as Congress slashes spending on social services.

Tomoyasu said the number of Latinos infected with HIV was probably "woefully underrepresented and undercounted."

Since HIV data collection began in 1994, about 2,200 new infections a year have been reported in Maryland. The state had 28,226 cases as of June 2004, about 23 percent of them in Prince George's and Montgomery counties. The numbers do not reflect the ethnicity of the cases.

Nationwide, Latinos account for 18.3 percent of the people living with HIV-AIDS, according to the federal Centers for Disease Control and Prevention.

Richard M. Helfrich, Montgomery's deputy health director, said that even as the county improves services for Latinos in Spanish, workers speaking other languages are needed. A quarter of the clients at the county's health clinic on Dennis Avenue in Silver Spring are French-speaking African immigrants, the same percentage as the Latino clients, he said.

Montgomery County Council President Tom Perez (D-Silver Spring) said county leaders have to do more to invest in culturally inclusive services. Otherwise, "that's not only bad public health policy, but that's against the law," he said. Federal law mandates that publicly funded agencies make services accessible to all eligible people, including those with limited English skills.

"Access to health care is not a privilege. It's a right," Perez said.