The Texas Department of Health is the latest successor in a line of health-related state agencies, beginning with the Texas Quarantine Department, which was created by the Legislature on April 10, 1879. The primary concern of the Department at that time was to isolate and prevent epidemic diseases such as cholera, smallpox, and typhoid fever. In 1903, the 28th Legislature, in Senate Substitute Bill 168, assigned to the Department the task of maintaining birth and death records and changed its name to the Texas Department of Public Health and Vital Statistics to reflect its new role. Six years later, in 1909, the name was changed again to the Texas State Department of Health, as growing concern over the safety and purity of food and water supplies resulted in new legislation at both the federal and state levels. The enforcement responsibilities were given to the local public health agencies.

The responsibilities of the Department continued to grow during the course of the 20th century. During the Depression, new federal laws encouraged the states to provide limited kinds of medical and dental care for the poor; in 1946 the U. S. Hospital Survey and Construction Act began providing matching federal funds for hospital construction and renovation under the Hill-Burton program in coordination with state health agencies; and more recently the Texas Department of Health has developed a variety of disease-prevention programs. In 1975, in House Bill 2164, 64th Legislature, Regular Session, the Texas Health Planning and Development Act added the responsibility of overall planning of all health facilities and services in the state, and the State Department of Health became the Texas Department of Health Resources, governed by the Board of Health Resources. Two years later, in 1977, their names were changed to the Texas Board of Health and the Texas Department of Health.

In 1983, the 68th Legislature, Regular Session, by Senate Bill 98, redefined the powers, duties and composition of the Board and the Department. The Texas Board of Health was composed of eighteen members, appointed by the governor with concurrence of the Senate, in overlapping six year terms. The Board of Health has general supervision and control of all matters pertaining to the health of the citizens of Texas. The Board is responsible for the adoption of policies and rules, and for the government of the Department of Health. By 1993, however, the number of Board members had been lowered to six.

Since 1991, the Department of Health has acted under the budgetary oversight of the Health and Human Services Commission, which acts as an umbrella organization to integrate the strategic planning and budget request processes for the state's major health and human services agencies.

The Texas Department of Health consists of the Commissioner of Health, the administrative staff, and the chest hospitals at San Antonio and Harlingen. As of 1999, the Commissioner of Health oversaw an Executive Deputy Commissioner and four deputy commissioners. The deputy commissioners led Community Health and Prevention with six subsidiary bureaus, Health Care Financing with nine subsidiary bureaus, Public Health Sciences and Quality with ten subsidiary bureaus, and Administration which provided support services, legal services, and management and administrative services. Additionally, the Department is associated with the Texas Medical Disclosure Panel, the Texas Radiation Advisory Board, the Council of Sex Offender Treatment, the Toxic Substances Coordinating Committee, and the Health Professions Council. The agency currently has over 5500 employees and an annual budget in excess of $6 billion (including federal funds).

The Bureau of Human Immunodeficiency Virus (HIV) and Sexually Transmitted Disease (STD) Prevention is a part of the Texas Department of Health. The mission of the Bureau of HIV and STD Prevention is to prevent, treat, and/or control the spread of HIV, STD, and other communicable diseases to protect the health of the citizens of Texas. In keeping with this mission, the Bureau procures, allocates, and manages fiscal and human resources to: provide HIV/STD education and information; collect, interpret, and distribute data relating to HIV and STD; provide guidance to those who oversee, plan for, or provide HIV and STD services; and provide medication and supplies to prevent, manage, and treat communicable diseases. The Bureau is composed of three divisions: HIV/STD Epidemiology Division; HIV/STD Health Resources Division; and HIV/STD Clinical Resources Division.

The HIV/STD Epidemiology Division is responsible for collecting and analyzing data to determine the extent and trends of HIV infection, AIDS, syphilis, gonorrhea and other sexually transmitted diseases (STDs) and for maintaining centralized automated STD, HIV and AIDS surveillance morbidity data systems. It is also responsible for collecting information required by disease reporting rules and regulations and information that is submitted as a result of contractual agreements with local agencies. Longitudinal research to determine the natural progression of HIV disease in children and adults is also conducted by Division staff, as well as numerous seroprevalence and behavioral surveys on HIV, AIDS and STDs. Epidemiology Division staff are responsible for the analysis, evaluation and dissemination of this information to program and agency staff, community planning groups, HIV services consortia and other entities. This ensures that planning efforts, grant justifications, and funding allocations are informed by the most recent and sophisticated data available. Dissemination duties extend to providing assistance in the interpretation of epidemiologic data to members of the general public and the media.

The HIV/STD Health Resources Division is responsible for primary and secondary STD and HIV prevention activities. Primary prevention activities include the provision of information and education about sexually transmitted diseases including HIV, and risk reduction/prevention counseling. This information is tailored as needed to age, language, race/ethnicity, cultural groups, and to those practicing high risk behaviors that may transmit these diseases. Secondary prevention activities include: disease intervention services such as counseling, testing, early medical intervention, (including prophylactic treatment for certain sexually transmitted diseases, or for opportunistic infections in the HIV infected population), and case management and partner notification for persons with syphilis or HIV. The Health Resources Division is also responsible for statewide assistance to local HIV consortia that plan comprehensive health and social services for individuals with HIV. Division activities are implemented by Division staff, by public health region program staff, and through contractual agreements with local health departments and community-based organizations.

The Clinical Resources Division (CRD) is composed of three programs: the Texas HIV Medication Program (THMP); the Clinical/Case Management and Administrative Compliance Program; and the Early Intervention Program (EIP). The CRD is also responsible for administering the HIV/AIDS Interagency Coordinating Council. The primary mission of the CRD is to enhance the lives of individuals with HIV disease or other STD by providing life-sustaining HIV medications or curative medications to treat other STD conditions, and to ensure high-quality clinical and case management services are available and accessible.

The Texas HIV Medication Program (THMP) is responsible for the purchase and distribution of medications for the treatment of HIV disease and other sexually transmitted diseases. The Program also provides medications for the treatment of opportunistic infections for people with HIV disease. Medications for the treatment of HIV disease are provided to clients through a network of pharmacies statewide. The HIV Medication Advisory Committee is also administered by the THMP.

The Clinical/Case Management and Administrative Compliance Program is responsible for conducting quality assurance reviews of: State funded grantees that provide clinical and/ or case management services to individuals with HIV disease, and Providers of STD clinical services. To accomplish this, the Program staff conduct periodic site reviews, provide technical assistance by telephone and on-site as needed, develop and distribute minimum clinical and case management standards and conduct investigations into allegations of client abuse and neglect. The Program also provides consultation regarding HIV disease and other STD's to health care professional and the general public as requested.

The Early Intervention Program provides HIV services to individuals with HIV disease. The primary focus of the Program is to initiate diagnosis and treatment (secondary and tertiary prevention) early in the disease process in an effort to prevent complications from HIV. Currently there are eight EIP projects funded Statewide.

The HIV/AIDS Interagency Coordinating Council was established by the Legislature to facilitate communication between agencies and associations involved in providing HIV/AIDS services to individuals, families and communities. The Council is also responsible for coordination of agency programs relating to the prevention of HIV/AIDS and the provision of services to people infected with HIV or who have AIDS, and for submitting an annual report to the Governor with recommendations and plans regarding coordinated activities to address issues and problems affecting this population. The Council is composed of one representative appointed from each of the following: Texas Health and Human Services Commission; Texas Department of Health; Texas Department of Mental Health and Mental Retardation; Texas Department of Human Services; Texas Commission on Alcohol and Drug Abuse; Texas Rehabilitation Commission; Texas Youth Commission; Texas Department of Criminal Justice; Texas Commission for the Blind; Texas Commission for the Deaf and Hearing Impaired/Hard of Hearing; Texas Department of Protective and Regulatory Services; Texas Education Agency; Texas State Board of Medical Examiners; Board of Nurse Examiners for the State of Texas; Board of Vocational Nurse Examiners; State Board of Dental Examiners; and Texas Juvenile Probation Commission.

For further information please see the Bureau's website at http://www.tdh.state.tx.us/hivstd/default2.htm