years certainly represents great progress, yet it is far less than the ACTG 076 findings can offer.

Two years after the publication of the ACTG 076 findings, Congress addressed perinatal transmission issues in the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Amendments of 1996 (P.L. 104-146). This legislation set forth a series of conditions regarding routine practices leading to a determination by the Secretary of Health and Human Services that could make Ryan White CARE Act formula funds to the states contingent upon mandatory HIV testing of newborns. Nationally, more than $500 million (the 1998 appropriation for the Title II program, which supports health care and support services, continuation of health insurance, pharmaceutical treatments, and other services through the states) is at stake in this decision (HRSA, 1998a).

According to P.L. 104-146, the Secretary of Health and Human Services is required by October 1998 to determine whether HIV testing of all infants born in the United States whose mothers have not undergone prenatal HIV testing has become "routine practice." This is an important determination; if it is affirmative, all Ryan White funding to the states after April 2000 becomes contingent upon states demonstrating one of the following:

1. a 50% reduction (or a comparable measure for states with less than ten cases) in the rate of new AIDS cases resulting from perinatal transmission, comparing the most recent data to 1993 data;
2. at least 95% of women who have received at least two prenatal visits prior to 34 weeks of gestation have been tested for HIV; or
3. a program for mandatory testing of all newborns whose mothers have not undergone prenatal HIV testing.

4. To determine whether HIV testing of infants as described above has become "routine practice," the Secretary is required to consult with states and other public and private experts as to whether the following are routine practice in the United States:

   1. testing of infants whose mothers have not received prenatal HIV testing;
   2. release of HIV test results of newborns to parents, legal guardians, or health care providers;
   3. disclosure of HIV test results of pregnant women conducted by the state (such as anonymous seroprevalence surveys) to the pregnant women involved;
   4. provision of appropriate HIV counseling in disclosing test results under (2) and (3) and