with the state. In states with a high incidence of HIV, additional money is more likely to be provided. Thirty percent of the sites are dedicated, mostly anonymous, and are frequently linked to medical facilities; 30% are located in STD clinics, and the remainder are a mix of provider sites, including community health centers, hospitals, prisons, family planning clinics, drug treatment centers, and, occasionally, private providers.

Private Providers

The following providers are important sources of primary care and obstetrical care for women.

Obstetricians/Gynecologists

More than 37,000 physicians in the United States specialize in obstetrics and gynecology, 28,000 of whom are actively involved in providing obstetrical care. Obstetrician-gynecologists are often used by women for both specialty care related to reproductive health and primary care (Weisman et al., 1996). Ninety percent of obstetricians-gynecologists are affiliated with the American College of Obstetricians and Gynecologists (ACOG), a professional association.

ACOG has disseminated the PHS guidelines for counseling and antibody testing to prevent HIV infection and AIDS, as well as specific information to its members related to prevention of perinatal HIV transmission, including (1) an educational bulletin in January 1997 that discussed clinical, legal, and ethical issues and recommended that all pregnant women be counseled and encouraged to be tested by the provider; (2) ethical guidance for patient testing (October 1995); and (3) a Committee on Ethics "opinion" related to physician's responsibilities. ACOG has also produced patient education materials for providers, specifically recommending counseling and testing.9

Pediatricians

There are approximately 53,000 members of the American Academy of Pediatrics (AAP), an estimated 75% to 80% of board-certified pediatricians (not all of whom practice in the United States). Pediatricians are concerned with the physical and psychosocial growth, development, and health of the individual child beginning prior to birth throughout infancy, childhood, adolescence, and early adulthood. Surveys of academy membership indicate that 90% to 95% provide direct patient care and 75% provide health supervision or primary care for at least some of their practice time. Thirty-five percent of children visiting a

9  

Data and information provided by ACOG, April 10, 1998.



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