A rapid test also may have broader application for HIV prevention in general, because many individuals fail to return for test results with conventional testing. In 1995, for example, 25% of individuals testing HIV-positive at publicly funded clinics did not return for their test results (CDC, 1997b). Sexually transmitted disease clinics and drug abuse treatment programs are among the sites that should introduce an accurate rapid testing program for the purpose of primary HIV prevention (CDC, 1998g).

The following section focuses on the issues involved with testing and coordinating care for HIV-positive pregnant women who are adolescents or immigrants. Another important special population is drug-using pregnant women, a topic covered later in this chapter. While there certainly are problems in the coordination of their care, the larger problem is drawing drug-using women into prenatal care in the first place. As documented in Chapter 6, drug users are substantially less likely than others to receive prenatal care. Women in prisons and jails are another population requiring special attention, and these issues have been taken up earlier in this chapter.

Adolescents are a critical, yet underrecognized, population that needs coordinated HIV services. An estimated 25% of HIV-infected adults nationwide acquired their infection as adolescents (Rosenberg et al., 1994). Among the barriers to accepting and complying with HIV treatment are the lack of linkages between testing and treatment programs; adolescents' perception of invincibility and difficulty understanding the abstract concepts of disease latency and probabilities of transmission. Adolescents may also be injection drug users, which makes them more likely to become HIV-infected, and more difficult to reach. In addition, some adolescents have chosen to leave their home or have been forced out. Apart from the multiplicity of problems created by homelessness, frequent changes of address or no home address jeopardize Medicaid eligibility.

A nationally recognized comprehensive treatment program for adolescents in New York City, the Adolescent AIDS Program of Montefiore Medical Center, has been successful in treating HIV-positive adolescents who are pregnant and reducing perinatal transmission of HIV. The program attributes its success in prevention of perinatal transmission to these features: labor-intensive outreach to adolescents and health care professionals to encourage testing with linkage to treatment; lack of financial barriers to testing and treatment through sliding fee scales and help with obtaining Medicaid and other public financing programs; accessibility to the program through subsidized transportation; a "one-stop shopping"