Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA). Moreover, an array of federal, state, and local laws, regulations, policies, institutions, and financing mechanisms shapes the services in any given locality and determines who has access to those services.

The complex patterns of medical care, financing mechanisms, program authority, and organizations that influence care make it difficult to institute uniform policies for reducing perinatal HIV transmission. In addition, the multiple lines of funding responsibility and accountability have made it extremely difficult to educate providers and convince them of the necessity of testing all pregnant women, as called for in the PHS counseling and testing guidelines (CDC, 1995b).

The resulting structure of the health care system presents a number of barriers to the treatment of HIV-positive women, which include—using the prevention chain as a framework—

  • financial and access barriers that may discourage women from seeking prenatal care,
  • time constraints that may discourage physicians from counseling pregnant patients about the importance of testing,
  • prenatal care sites that may not have the staff to overcome the language and cultural barriers that may cause women to refuse testing, and
  • financial and logistical problems that may make testing and treatment difficult.

Implementation And Impact Of The Public Health Service Counseling And Testing Guidelines

Since the publication of the ACTG 076 findings in 1994, there has been a concerted national effort to bring the benefits of HIV testing and appropriate treatment to as many women and children as possible. Reviewing the results of these efforts, the committee must make a qualified response to its congressional charge to assess "the extent to which state efforts have been effective in reducing the perinatal transmission of HIV." The committee interprets this charge to include the efforts of national as well as state and local health agencies, and professional organizations at both levels. The data reviewed indicate that, on the whole,

  1. there have been substantial public and private efforts to implement the PHS recommendations,
  2. prenatal care providers are more likely now than in the past to counsel their patients about HIV and the benefits of ZDV and to offer and recommend HIV tests,
  3. women are more likely to accept HIV testing and ZDV if indicated, and
  4. there has been a large reduction in perinatally transmitted cases of AIDS.

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