voluntary basis, contacting sexual partners of HIV-positive patients, as well as sharing test information with health care professionals, including pediatricians. ACOG policies are developed by one of its standing committees, which then forwards its recommendations to the ACOG executive committee for a vote to establish policy. ACOG members provide an estimated 85% of all obstetrical care in the United States; the remainder is provided mostly by midwives and family practitioners.
Discussion of the ACOG position focused on why some obstetricians appear to be failing to routinely counsel pregnant women. While ACOG does not monitor obstetrician practices in relation to its policies, Dr. Greene speculated about the possible reasons: obstetricians view counseling as time- and resource-consuming and as engendering unnecessary patient anxiety among many patients at low risk. They also may not have developed channels of referral to specialty care for those testing positive. One participant pointed out that screening for alpha-fetoprotein testing for birth defects provides a model, embraced by practicing obstetricians, of pre- and post-test counseling and linkages to genetic counseling and specialty care.
The American Academy of Pediatrics (AAP) favors universal counseling and voluntary testing of pregnant women. It also recommends testing of all newborns whose mothers either are HIV-positive or have unknown HIV status. The AAP's recommendations include the following key points: (1) Routine HIV education and routine testing, with consent, should be performed for all pregnant women. Consent can take the form of the right of refusal in order to facilitate rapid incorporation of HIV testing into routine practice. (2) All testing programs should evaluate the percentage of women who refuse testing. In cases of poor acceptance rates, programs should analyze why and make changes. (3) Newborn testing should be performed, with maternal consent, when the mother's HIV status is unknown. If the newborn tests positive, the mother should be notified and receive referral for her testing and treatment. (4) Results of maternal testing should be provided to the pediatric health care provider. (5) Comprehensive HIV-related medical services should be available to all infected mothers, infants, and other family members (AAP, 1995). These recommendations were developed by a standing committee, the Committee on Pediatric AIDS. The AAP committee's recommendations were forwarded to the executive committee of the AAP and were approved for publication.
During the discussion, Dr. Gwendolyn Scott was asked why the AAP favored voluntary testing and what evidence it considered about the deterrent effects of mandatory testing for women seeking health care. She replied that personal experience, rather than hard data, was pivotal in persuading the AAP committee to embrace voluntary testing. The committee viewed voluntary testing