Development and dissemination of policy goals will not, in and of themselves, achieve universal testing and optimal treatment—a comprehensive infrastructure is needed. Maintaining this infrastructure requires federal funding, a regional approach, and an ongoing surveillance program.
Successful perinatal HIV centers consistently rely upon federal funding for research and for services through HRSA's Ryan White program to maintain the infrastructure they need to succeed. The efforts called for in the earlier recommendations in this chapter will require similar or higher levels of investment. Thus,
The committee recommends that federal funding for state and local efforts to prevent perinatal transmission, including both prenatal testing and care of HIV-infected women, be maintained.
The administration and Congress should examine current budgets thoroughly for adequacy, particularly in light of the expanded programs recommended by the committee. Maintaining current program levels is the minimum requirement. The Ryan White CARE Act Amendments of 1996 (section 2625), for instance, authorized $10 million per year in grants to the states to carry out a series of outreach and other activities that would assist in making HIV counseling and testing available to pregnant women. Congress, however, never appropriated funds for this purpose. Doing so now would go a long way toward building the infrastructure needed to lower perinatal transmission rates.
As discussed in Chapter 1, The Ryan White CARE Act Amendments of 1996 set up a decision-making process that could result in states losing significant amounts of AIDS funding unless they demonstrate substantial increases in prenatal HIV testing or a substantial decrease in HIV transmission rates, or institute mandatory newborn testing. If the national goal is to prevent HIV transmission from mothers to children, the federal government should support prenatal testing and other state-based prevention efforts. The Ryan White CARE Act Amendments of 1996, paradoxically, could actually undermine them.
HRSA currently funds a system of "HIV Programs for Children, Youth, Women and Families" through Title IV of the Ryan White CARE Act. Federal research funds in these and other centers also provide for both direct care and an infrastructure to support it. Many of these programs serve as de facto regional