strongly recommended in the 1997 guidelines and only two states had the full complement recommended (CDC, 1997f; Doyle et al., 1997).
The CDC's Division of HIV/AIDS Prevention enters into cooperative agreements with states and territories to support more than 10,000 counseling and testing sites and health education and risk reduction activities. The Division of STD Prevention funds 3,000 STD clinics, the primary source of HIV testing in public facilities. CDC's Division of Adolescent and School Health supports the development and implementation of HIV-related school policies and curricula to prevent HIV infection.
As a result of these programs, all states and territories have an AIDS program funded by both state and federal governments. The bulk of funding for HIV/AIDS testing, counseling, and outreach services comes from HRSA and the CDC. Although some testing and counseling centers are run directly by the state, most other services are arranged through grants and contracts with community-based providers.
The National Institutes of Health (NIH) funds HIV clinical research in institutions across the country through three diverse clinical trials networks, the AIDS Clinical Trials Group (ACTG), the Pediatric AIDS Clinical Trials Groups (PACTG), and the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Although the primary purpose of these networks is research, they provide important opportunities for women and children affected by HIV who meet the protocol criteria to access health care services. The Ryan White Title IV program assists in linking women and children to NIH research protocols.
Most of the agencies that fund primary and specialty services and HIV/AIDS-specific services also exercise general or specific authority over those who provide these services, whether in the private or the public sector. Private providers are responsible to licensing boards, must follow Medicaid requirements if Medicaid-certified, must consider the recommendations of their professional organization regarding standards of care if they are to avoid litigation, and must respond to the standards of the hospitals or managed care organizations with which they are affiliated. State and local public and private, nonprofit agencies frequently have multiple sources of funds and must meet the requirements established by each of these funders, as well as state and local governing bodies and boards.
By law and custom, responsibility in health affairs is shared by federal, state, and local authorities. Federal and state entities often try to avoid issuing too many regulations or might be perceived by their respective constituents as "excessive" guidance. Many of these authorities "recommend" rather than ''require." The degree