TOPWA is Florida's Targeted Outreach for Pregnant Women program — peer-based outreach that finds people who are pregnant, using substances, and living with or at risk of HIV, then connects them to prenatal care, HIV testing, ADAP, and Medicaid[3]. It is written into state law at Fla. Stat. § 381.0045[1] and funded in eight counties. Call 850-245-4422 or your county health department.
What the law actually says
TOPWA's statute is Fla. Stat. § 381.0045, "Targeted outreach for pregnant women," which may be cited as the Targeted Outreach for Pregnant Women Act of 1998. Its stated purpose is outreach to pregnant people at high risk who may not seek proper prenatal care, who experience substance use or mental health problems, or who have acquired HIV, and linking them to services and information[1]. Statutory history: chapter 98-307, chapter 2001-62, and chapter 2022-71, the most recent amendment[1].
A correction worth making: TOPWA is sometimes described as sitting in "chapter 384, part IV." It does not. Chapter 384 is Florida's sexually transmissible diseases chapter and contains a different requirement — prenatal testing — covered further down this page[2].
The statute directs the Department of Health to contract with organizations where the target population is likely to be found; to deliver outreach that is peer-based, culturally sensitive, and nonjudgmental; to encourage HIV and STI testing; to give pregnant people living with HIV information about antiretroviral medication for their newborns and how to get medication after hospital discharge; to link people to substance use and mental health treatment; to act as liaison with Healthy Start coalitions, Children's Medical Services, and Ryan White-funded providers; and to provide continued oversight of any newborn exposed to HIV until final status is determined[1].
What TOPWA does on the ground
TOPWA was created in 1999, under that 1998 law, to reach pregnant people who have HIV and pregnant people at high risk who are not receiving services, and to help them access the medical and social services that lower their risk of substance use and of acquiring or transmitting HIV[3].
The model is street-level: outreach workers "go into untraditional venues/locations in high-risk communities to identify and enroll pregnant women who have not yet accessed adequate care and treatment"[4]. Eligibility is broad — TOPWA serves people who are pregnant and using substances and who are living with or at risk of acquiring HIV[4].
Enrollees get help accessing prenatal care, HIV testing, family planning, enrollment in ADAP, enrollment in Medicaid, and HIV prevention education[3]. The program's own contracting documents frame it as outreach, enrollment, and linkage[8] — that is the honest description. TOPWA is not formal Ryan White medical case management; if you need an assigned case manager, ask your county health department or Ryan White lead agency for Patient Care case management alongside TOPWA[10].
The eight funded counties
FL DOH funds TOPWA in eight counties: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, Pinellas, and St. Lucie[3][4]. You may see older write-ups claiming twelve counties, or listing Volusia; those are out of date. FL DOH also publishes a TOPWA map and a TOPWA provider contact list on its perinatal prevention page, plus a Ryan White Part D provider list[3], and a Baby RxPress program description and voucher is listed there as well.
Seven of the eight TOPWA counties are also Florida's CDC Ending the HIV Epidemic priority counties — all except St. Lucie[9]. The funding follows where perinatal HIV risk concentrates.
If you are pregnant outside those eight counties, you are not out of options. Your county health department still provides prenatal HIV testing and can refer you to Ryan White Part D services for women, infants, children, and youth[10]. Start with the FL DOH HIV/AIDS Section at 850-245-4422[5].
The separate prenatal testing law — and your right to refuse
Florida law requires that every physician, licensed midwife, or other attendant caring for a pregnant person during gestation and delivery cause her to be tested for sexually transmissible diseases, including HIV, at a CLIA-certified laboratory. She must be informed of the tests that will be conducted and of her right to refuse testing. If she objects, a written statement of objection signed by her goes in the medical record and no testing may occur[2].
The implementing rule, F.A.C. 64D-3.042, requires testing for chlamydia, gonorrhea, hepatitis B, HIV, and syphilis at the initial prenatal exam and again at 28–32 weeks. People with documented HIV need not be retested during that pregnancy. Anyone who arrives at delivery, or within 30 days after delivery, with no record of prenatal care or testing — or no test after the 27th week — must be tested for hepatitis B surface antigen, HIV, and syphilis before discharge[3].
Knowing your status during pregnancy is how transmission to a baby gets prevented. But the right to refuse is real and written down. If anyone tells you a test is mandatory with no choice, that is not what the statute says[2].
Why it matters — Florida's numbers
Among 409 infants born in Florida in 2023 with perinatal HIV exposure, there was 1 HIV diagnosis and no AIDS diagnoses — down from 8 perinatally acquired diagnoses in 2022[6]. That is what outreach, prenatal testing, treatment during pregnancy, and infant follow-up produce together.
If you are pregnant and living with HIV, the practical asks are: start or stay on antiretroviral treatment, keep your appointments, and make sure someone has planned your baby's post-delivery medication and follow-up testing before you leave the hospital — the statute puts that oversight duty on the program[1].
Clinicians and patients can both use Florida's consult lines: the Perinatal HIV/AIDS line, 888-448-8765, and the Prenatal HIV line, 1-800-451-2229[7]. For TOPWA specifically, the FL DOH HIV/AIDS Section at 850-245-4422 handles Patient Care, ADAP, HOPWA, and TOPWA[5].
Florida context: how to actually reach TOPWA
There is no public TOPWA hotline. The route in is the FL DOH HIV/AIDS Section, 850-245-4422, which covers TOPWA along with Patient Care, ADAP, and HOPWA[5], or your county health department in one of the eight funded counties. The Florida HIV/AIDS Hotline, 1-800-352-2437 can also route you (Spanish 1-800-545-7432; Haitian Creole 1-800-243-7101).
Ask for "TOPWA outreach" by name. Also ask FL DOH's perinatal prevention page for the TOPWA provider contact list, which names the funded organizations county by county[3]. If you are already in prenatal care, your prenatal provider or a Healthy Start coalition can make the referral for you[1].
Related questions
Who is eligible for TOPWA in Florida?
TOPWA serves people who are pregnant and using substances and who are living with or at risk of acquiring HIV. There is no income test published. It is funded in eight counties: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, Pinellas, and St. Lucie.
What does TOPWA actually provide?
Outreach, enrollment, and linkage — help getting into prenatal care, HIV testing, family planning, ADAP, Medicaid, and HIV prevention education. It is not formal Ryan White medical case management, so ask separately about a case manager if you want one assigned.
Can I refuse HIV testing during pregnancy in Florida?
Yes. Florida law requires that you be informed of the tests and of your right to refuse. If you object, a written statement of objection signed by you is placed in your medical record and no testing may occur. The offer is required; the test is not compelled.
Is TOPWA available in every Florida county?
No — eight counties are funded. Outside them, your county health department still provides prenatal HIV testing, and Ryan White Part D services for women, infants, children, and youth may be available. Call the FL DOH HIV/AIDS Section at 850-245-4422 for a referral.
Related from RiseUpToHIV
References & Sources
- Fla. Stat. § 381.0045 — Targeted outreach for pregnant women. The TOPWA statute, citable as the Targeted Outreach for Pregnant Women Act of 1998: purpose, department duties, peer-based outreach requirement, newborn oversight, liaison with Healthy Start and Ryan White providers, and statutory history through chapter 2022-71. ↩ ↩ ↩ ↩ ↩ ↩
- Fla. Stat. § 384.31 — Testing of pregnant women; duty of the attendant. The separate prenatal testing requirement in Florida's sexually transmissible diseases chapter, including the duty to inform and the signed written right to refuse. ↩ ↩ ↩
- Florida Department of Health — Perinatal HIV Prevention. TOPWA created in 1999, the eight funded counties, the services enrollees can access, the TOPWA map and provider contact list, and rule 64D-3.042 testing requirements. ↩ ↩ ↩ ↩ ↩ ↩ ↩
- Florida Department of Health — HIV Prevention. TOPWA's outreach model in nontraditional venues, program eligibility, and the eight funded counties. ↩ ↩ ↩
- Florida Department of Health — HIV Case Management Guidelines (PDF). Confirms 850-245-4422 as the HIV/AIDS Section line covering Patient Care, ADAP, HOPWA, and TOPWA. ↩ ↩ ↩
- Florida Department of Health — State of the HIV Epidemic, 2023 (PDF). 409 infants born with perinatal HIV exposure in 2023, with 1 HIV diagnosis and no AIDS diagnoses, compared with 8 perinatally acquired diagnoses in 2022. ↩
- Florida Department of Health — HIV/AIDS consult lines. Perinatal HIV/AIDS consult line 888-448-8765 and prenatal HIV line 1-800-451-2229. ↩
- Florida Department of Health — TOPWA Request for Applications RFA20-003 (PDF). Contracting document describing TOPWA's scope as outreach, enrollment, and linkage rather than medical case management. ↩
- CDC — Ending the HIV Epidemic: jurisdictions and plans. Florida's seven EHE priority counties, seven of which overlap with the eight TOPWA counties. ↩
- HRSA Ryan White HIV/AIDS Program — Available Care and Services. Medical case management as a Ryan White core service, and Part D services for women, infants, children, and youth. ↩ ↩
Community publications like POZ, Positively Aware, and TheBody inform framing and lived-experience context on RiseUpToHIV. Every clinical, epidemiological, or public-health claim above is anchored to a primary source.