antibody status for the effective medical management of her pregnancy and her own health care, as well as for the careful monitoring of her child's condition; the treatment options currently available to her and her infant; and the potential untoward social consequences that may result from being identified as HIV positive. In addition, the woman should be informed of the current availability of follow-up services and be forewarned of the possible barriers she may encounter in gaining access to them. (See the later discussion of the development of services for HIV-infected women and children.)
A variety of approaches can be used to present the above material—for example, educational brochures, videotapes, face-to-face dialogue, or some combination of these methods. At a minimum, however, some individual face-to-face counseling should precede the test, in particular to assess the woman's emotional and psychological readiness to cope with a positive result and to answer any questions or concerns the woman may have about the test and its clinical and psychosocial implications.
HIV test results should be communicated to the individual during a face-to-face discussion. This posttest encounter also permits whoever is performing the counseling to reinforce any HIV risk reduction and prevention messages presented earlier. The extent and length of such posttest counseling for seronegative pregnant women may be tailored to their risk status and emotional state. For instance, women at increased risk of infection may require more extensive counseling and educational reinforcement. At a minimum, however, seronegative women should receive a brief personal communication of their test results and additional written information (e.g., pamphlets and brochures) about HIV infection and its prevention (including risk-associated behaviors and ways of reducing the risk of becoming infected).
Individual posttest counseling for a seropositive pregnant woman is crucial, not only to discuss her test results and their meaning but also to give her emotional and psychological support as she assimilates this information and faces potentially difficult reproductive decisions. During such counseling, the counselor has an opportunity to review the implications of HIV infection for her pregnancy, including the risks of transmitting the virus to her child and what is known about the possible effects of pregnancy on disease progression. Thorough examination of the reproductive options available to an HIV-infected pregnant woman is an important task of the posttest counseling session. Traditionally (i.e., in the context of genetic screening), counselors have assumed a nondirective or neutral posture toward reproductive counseling, and the committee found no compelling reason to recommend a change in this stance in the context of HIV screening. The committee affirms that reproductive counseling should validate the woman's right to make the reproductive choice that