Food and Nutrition Service, U.S. Department of Agriculture (USDA), funds are provided directly to state health agencies which, in turn, distribute them to local agencies. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs are located in every state, most Indian Reservations and in all U.S. territories. There are 1900 local agencies and approximately 10,000 clinic sites. Local agencies often have multiple satellite sites throughout the community.

Population served: Eligibility is based on nutritional risk and an income less than or equal to 185% of FPL. This includes 7.4 million to 7.5 million infants, children, and women, of whom approximately 1.7 million were pregnant or postpartum women. Approximately 20% of all pregnant women in the United States are in WIC, 40% of whom enroll within the first trimester of pregnancy. Two-thirds of participants live at or below the poverty line and one-third do not participate in other federal assistance programs.

Services provided: These include a food package determined by the participants' specific needs and designed to provide high levels of protein, iron, calcium, and vitamins A and C. For women who cannot or should not breast-feed, iron-fortified infant formula is available for their infants. WIC also provides nutrition education and counseling, and referrals for pre- and postnatal health care (such as HIV testing), drug abuse education, and promotion of immunizations.

The USDA is expecting to issue formal (written) directives on working with HIV-positive women sometime this year, in addition to a policy document issued by the USDA and DHHS in November 1997 on the contraindications to breast-feeding. The National Association of WIC Directors (NAWD) is also in the final stages of drafting a policy paper on working with HIV-positive women and is expecting to finalize it in the fall of 1998. New York and New Jersey have established specific guidelines related to HIV for WIC programs in their state that have been used as models in a recent conference for WIC programs. Both the guidelines developed by USDA and NAWD will suggest that WIC agencies advise women to know their HIV status, and if HIV-positive, not to breast-feed.

Sexually Transmitted Disease Clinics

Funded in partnership between CDC's Division of Sexually Transmitted Disease (STD) Prevention and state and local health agencies, more than 3,000 clinics provide dedicated services to prevent and treat STDs. Although some are located at family planning clinics and hospitals, most are located in state and local public health departments. These clinics are the primary source of HIV testing in public facilities. Authority is shared by CDC and state and local health agencies.

Population served: This includes both men and women, although men use these clinics in far greater numbers than women. The population is most often poor, uninsured, and experiencing symptoms.

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