system of drug treatment facilities consists of approximately 10,000 treatment sites. Funds are distributed to 60 entities, including all states, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Trust, for the purpose of planning, carrying out, or evaluating related activities. States distribute the funds through a county or regional intermediary, which in turn distributes the funds to treatment facilities. The state is almost always a purchaser of care and sometimes a manager, but rarely provides the service directly, especially within a community.
Population served: 28% to 30% of those served are women. States are required to set aside a minimum of 5% of the funds for treatment of pregnant women and women with children. Pregnant women are also given priority enrollment in all treatment services, and states are required to maintain spending for treatment at the FY 1994 levels. All states with ten or more AIDS cases per 100,000 population must carry out one or more projects that make early intervention services for HIV infection available on-site.
Services provided: States are required to provide primary care, prenatal care, and child care to the women served under the 5% set-aside. Most grantees contract with primary care providers for such care. There is no requirement to do HIV testing and counseling, although many conduct risk assessments for tuberculosis (TB) and HIV as part of their protocol. In addition to the regular block grant activities, there are 54 demonstration projects specifically targeting pregnant and postpartum women, and in these projects, pre- and post-test counseling are required. Most of these projects are ending this fiscal year and the remaining 18 end in FY 1999.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has disseminated guidance regarding screening and assessment issues for projects focusing on specific populations. The Center for Substance Abuse Treatment (CSAT) has disseminated guidance related to HIV counseling and testing through a protocol developed for treatment providers and primary care providers (Series 11), a protocol for screening for infectious disease for patients in treatment (Series 6), and for a protocol improving treatment for drug-exposed infants (Series 5). The movement of Medicaid recipients into managed care has resulted in a reduction of coverage for substance abuse treatment services. There has also been an increase in cases of criminal prosecution for pregnant women who are substance abusing and in mandatory testing, reporting, and treatment (Chavkin et al., 1998).
Funding: Additional funding comes from Medicaid, other federal programs (Ryan White CARE Act and the Department of Justice), and private insurance.
Administered by state AIDS directors, approximately 10,000 testing and counseling centers (including anonymous testing sites) throughout the country receive the bulk of their funding from the CDC through a cooperative agreement