to overcome pregnant women's concerns about HIV testing and treatment; and efforts to increase utilization of prenatal care, as described above. The chapter also includes recommendations regarding the resources and infrastructure needed to implement these approaches, and for preventing perinatally transmitted HIV through means other than prenatal testing and treatment.

The Committee's Approach

The committee's analyses and recommendations are based on a wide variety of quantitative and qualitative information. The committee began by reviewing the major official reports and scientific and medical articles relating to perinatal HIV diagnosis and treatment, HIV testing and screening, and related subjects from the United States and abroad. Prominent among these are government and medical association practice guidelines for testing and treatment of pregnant women, infants, and others, as well as a variety of scientific articles dealing with diagnosis and treatment of HIV, the consequences of HIV testing, and ethical issues. The committee also reviewed a 1991 IOM report on prenatal and newborn HIV screening (IOM, 1991). Although the report's conclusions are outdated because of developments in the intervening seven years, its analytical and ethical framework remain useful.

The committee has also reviewed a variety of statistical reports on HIV/AIDS trends, especially relating to women and perinatal transmission, from the Centers for Disease Control and Prevention (CDC) and other sources. For information on laws, regulations, and the implementation of perinatal transmission prevention efforts at the state level, the committee relied upon a survey and analysis of relevant state policies and laws prepared by CDC and the Georgetown Law Center (Gostin et al., in press). In addition, the committee reviewed information from many state health departments and HIV/AIDS programs on the implementation and effect of the voluntary testing guidelines.

To further add to the knowledge base for this report, the committee commissioned background papers in the following areas: a history of prenatal and newborn HIV testing in New York State; a history and analysis of screening for sickle cell disease; a report on the context of services for women and children affected by HIV/AIDS; and a report of the experiences of an HIV-positive peer counselor for pregnant women and new mothers. In addition, the committee solicited and received informal reports from a large number of knowledgeable individuals.

Finally, the committee organized a series of workshops and field visits to discuss the issues with the people affected by and concerned with the current and proposed policies: women who are HIV-infected or at risk of HIV infection, health care providers, and state and local policy makers. In particular, the committee convened workshops in Washington, D.C., on February 11 and April 1, 1998. Groups of committee members and staff made site visits to New York City and Newark, New Jersey; to Birmingham and rural Greene County, Alabama;



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