Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Amendments of 1996 (section 2625), for instance, authorized $10 million per year in grants to the states to carry out a series of outreach and other activities that would assist in making HIV counseling and testing available to pregnant women. The Congress, however, never appropriated funds for this purpose. Appropriating these funds now would go a long way towards building the infrastructure needed to lower perinatal transmission rates.

As discussed in Chapter 1, the Ryan White CARE Act Amendments of 1996 set up a decision process that could result in states' losing substantial amounts of AIDS funding unless they demonstrate substantial increases in prenatal HIV testing or a substantial decrease in HIV transmission rates, or institute mandatory newborn testing. In other words, under certain conditions, mandatory newborn testing would be required (to maintain federal funding) if current voluntary prenatal testing fails. The logic of this approach is unclear; newborn testing may confer benefits for HIV-infected newborns, but cannot prevent perinatal transmission. If the national goal is to prevent HIV transmission from mothers to children, the federal government should support, not undermine, prenatal testing and other state-based prevention efforts. The Ryan White CARE Act Amendments of 1996, paradoxically, could have the opposite effect.

Regional Approach

Health Resources and Services Administration (HRSA) currently funds a system of "HIV Programs for Children, Youth, Women, and Families" through Title IV of the Ryan White CARE Act. Many of these programs serve as de facto regional centers for specialized treatment of HIV-infected women and affected children and, to a lesser extent, coordination of prevention activities. Federal research funds in these and other centers also provide for both direct care and an infrastructure to support it. In FY 1998, HRSA funded 44 comprehensive direct service programs in 23 states, the District of Columbia, and Puerto Rico. Most are located in urban areas, but some serve rural areas (HRSA, 1998b). There is, however, no coordinated, regional approach. Thus,

The committee recommends that a regional system of perinatal HIV prevention and treatment centers be established.

This goal might be reached by expanding the mandate of existing centers, or by establishing new centers in areas not now covered.

The regional centers would assure optimal HIV care for all pregnant women and newborns, directly to those referred to the centers, and indirectly by working with primary care physicians who retain responsibility for the medical care of HIV-infected women. Moving beyond current practices, the regional centers

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