Participants noted, however, that there are instances in which confidentiality makes a critical difference; for example, in one case where a woman was murdered by her boyfriend after finding out she was infected with HIV. Dr. Simonds reported that PGEP will have some data on adverse events such as loss of job, loss of relationships, and domestic violence.

Hrsa Data

Michael Kaiser and Karen Hench presented information from the Health Resources and Services Administration (HRSA), including an overview of HRSA-funded AIDS prevention and treatment; essential components of a care system to reduce perinatal HIV transmission; findings from a range of HRSA-funded projects; and a more detailed review of the Women's Initiative for HIV Care and Reduction of Perinatal Transmission project (WIN). HRSA is the service branch of the Department of Health and Human Services (DHHS), that reaches historically underserved populations, including low-income populations, and racial/ethnic minorities. Among the HRSA programs are Maternal and Child Health Services Block Grant Programs, Healthy Start, Community and Migrant Health Centers, Health Care for the Homeless, Rural Health Programs and HIV/AIDS Programs. Among HRSA's HIV/AIDS Programs are the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Programs (Titles I–IV), Special Projects of National Significance (SPNS), and AIDS Education and Training Centers (AETCs), which provide training on implementation of PHS guidelines.

While HRSA does not have surveillance data, it does have site-specific service delivery findings that complement surveillance findings presented by CDC. Overall, data from HRSA-funded project sites across the country indicate that (1) with adequate counseling, women accept HIV testing, particularly during pregnancy; and (2) significant advances have been made by HRSA-supported programs in reducing perinatal HIV transmission through voluntary, non-regulated HIV counseling, testing, and perinatal ZDV prophylaxis. Examples were given from select HRSA-funded project sites where 93% to 97% of HIV-infected pregnant women accepted ZDV and where perinatal transmission had been reduced so dramatically that at least three of the project sites have reported no cases of perinatal transmission for periods ranging from six months to four years.

Essential Components of the Care System

Similar to the chain of prevention events noted in CDC's presentation, HRSA outlined ''essential components" of the care system to reduce perinatal HIV transmission. These include early identification of HIV infection for women of childbearing age, providing HIV counseling and voluntary testing, linking HIV testing



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