programs at the state or territorial level. The bulk of funding for HIV/AIDS services administered through state AIDS directors comes from the CDC. CDC prevention dollars are provided for testing, counseling, and outreach; Ryan White Title II dollars are provided with the requirement that community planning groups determine how funds are to be distributed; and state funds are provided at state discretion. State AIDS programs fund testing and counseling services, education, and outreach services in existing community-based service settings through grants and contracts; some testing and counseling centers are run directly by the state.

One of eight health agencies of the PHS, DHHS, the National Institutes of Health (NIH) is comprised of 24 separate institutes, centers, and divisions. In addition to supporting intramural research, NIH uses 81% of its funding to support the research of non-federal scientists in 1,700 research settings throughout the country and abroad, including universities, medical schools, hospitals, and research institutions.

Extramural research grants related to HIV are provided to institutions across the country to conduct peer-reviewed research. These research efforts offer women and children affected by HIV, who meet the protocol criteria, important opportunities to access care through participation in research protocols. One of the Ryan White Title IV program mandates is to assist women and children with HIV in accessing research protocols. The three major clinical trial networks are the Pediatric AIDS Clinical Trials Group (PACTG), the AIDS Clinical Trials Groups (ACTG), and the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). ACTG research focuses translating basic research discoveries into clinical research, while the PACTG evaluates interventions to prevent perinatal transmission and to improve the quality of life of HIV-infected infants, children, and adolescents. The CPCRA enrolls adults to studies in primary care settings. The two institutes noted below work closely together and provide the bulk of NIH-supported ACTG research for women and children.

In FY 1997, the National Institute of Child Health and Human Development (NICHD) budget dedicated almost $23 million to pediatric ACTG research in an independent network of 30 to 40 clinical centers located in 15 states, the District of Columbia, and Puerto Rico. A subset of eleven centers specifically conducts