WIN is collaborative effort between the Bureaus of Maternal and Child Health and Health Resources Development (part of the Health Resources and Services Administration). Its goals and objectives are to:

• facilitate early identification of HIV through models of care that enhance outreach, HIV counselling and voluntary testing services for women of childbearing age (especially during pregnancy)
• facilitate access to and utilization of a comprehensive care system that includes ZDV prophylaxis to reduce perinatal transmission
• promote communitybased consumer education
• train providers, based on their assessed needs, in those communities where women (especially pregnant women and women at risk for or infected by HIV) seek care
• evaluate the efficacy of strategies and models for potential replication.

It was in this context that WIN undertook the creation of a multi-site, multi-agency network. First, exploratory research was carried out to identify essential components for expanding HIV counselling and testing so that the "consumers" -pregnant women living with HIV - can be identified at an early stage and be provided with ZDV prophylaxis. To elicit opinions, the process included focus groups with consumers (e.g., a group of 15 HIV-positive women), four key informant meetings (with care providers, consumers, policy-makers, ethicists and government representatives) and telephone surveys (with sites implementing ZDV prophylaxis). These studies showed that significantly more support services would be needed to ensure that women who learn of their HIV status during pregnancy would have access to and could stay in comprehensive care.

Based on the data collected, agencies were invited to present proposals on developing models of care that focused on one or more of the following elements:

• outreach to women of childbearing age
• expanded HIV counselling and testing for pregnant women
• long-term care for pregnant women living with HIV
• protocols for offering ZDV prophylaxis
• consumer involvement in individual decision-making and programme development
• care provider education.

The projects were organized into a network in June 1995 for sharing strategies, overcoming barriers, exchanging educational and other materials and to circulate new clinical information and policies. The WIN Steering Committee has 29 voting members, including a project director and consumer from each of the 10 sites as well as representatives of other involved agencies. The Steering Committee communicates through conference calls and meets facetoface every six months.

Several sub-committees work on issues such as enhancing consumer involvement, counselling and testing, development of a multi-site evaluation system, and clinical managment. All minutes from each committee meeting are circulated to all Steering Committee members.

A major success of the Initiative has been the exchange of information, reducing the amount of "re-inventing the wheel" since many sites have already dealt with issues another site is about to face (e.g., mandatory testing which is decided on a state basis in the USA).

Consumer involvement has been another important achievement. At each site, consumers are either paid, volunteer staff or both. They might work as a member of the multi-disciplinary team providing counselling to clients or as staff in the waiting rooms to help new clients negotiate the system, stay in care and cope with their disease. The consumers also do outreach into the community and public speaking. Here, too, the network has proved useful, enabling projects to share information on how they deal with problems specific to consumer staff (e.g., turnover, illness, overburdening, confidentiality and salary).