infected. This information provides the background for an understanding of the rationale for the committee's recommendations and should assist in their implementation. Appendix B contains more details on the issues covered here and full references.

Community-Level Sources Of Care For Women, Children, And Adolescents

The current mix of service delivery structures available on the community level can be organized into two somewhat arbitrary categories—public and private nonprofit providers and private providers—neither of which is purely private nor exclusively public. Some private providers receive differing amounts of public funding for their patients, and many public and nonprofit providers use a combination of public and private providers to deliver services.

The majority of women of childbearing age and their children receive their health care, and, potentially, testing for and treatment of HIV/AIDS, in a private provider's office (Weisman, 1996). While most of these providers are physicians, including obstetricians, family physicians, internists, and pediatricians, a significant number of women receive care from nurse practitioners and nurse midwives. Private providers may be in a solo or group practice, and a large and growing percentage are affiliated with managed care organizations.

Some women and children are not served by private providers because they do not have health insurance, there are no private providers locally, or those available do not accept public insurance. These women and children rely on a variety of public and private, nonprofit facilities, often referred to as ''the safety net." These facilities include clinics operated by state or local health departments, community or migrant health centers, public and private, nonprofit hospitals, and family planning clinics operated by Planned Parenthood affiliates and other private nonprofit groups. Safety net facilities may provide maternity, family planning, STD (sexually transmitted disease), nutrition, and other non-reproductive-related services to women, as well as well-child supervision and illness and specialty care to children. Many of those served in these facilities are at high risk for HIV infection because they are poor and come from disadvantaged communities with a high rate of HIV infection. Most adolescents receive their health care at community teen clinics, school-based clinics, community family practices, private family practices, and private pediatric practices (Blum et al., 1996). More than 900 school-based or school-affiliated health centers provide a range of preventive and primary care services to adolescents.

A number of other programs serving women of childbearing age and young children offer opportunities for reducing the risk of perinatal transmission of HIV. At any point in time, approximately 120,000 women are inmates in prisons and jails throughout the country and have access to limited care within these facilities. Increasingly, prisons and jails also contract with private or public providers



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement