by the Ryan White CARE Act Amendments of 1996, that they have appropriate partner notification activities in place for known HIV-infected individuals.
New York has the highest pediatric AIDS caseload in the nation. The State of New York passed legislation in June 1996 mandating that all newborns be tested for HIV. The sponsor of the legislation, Assemblywoman Nettie Mayersohn, described its origins. From 1987 to the mid-1990s, Centers for Disease Control and Prevention (CDC) had established a surveillance system for monitoring the spread of HIV among heterosexual women and infants. This system included anonymous testing of all newborns in New York and other states. Even after CDC terminated the program, New York continued the surveillance system with its own funds until 1997, when the program was converted from monitoring/surveillance function to a programmative function involving mandatory newborn testing. Prior to the legislation, about 1,500 to 1,800 newborns had tested positive each year, out of approximately 185,000 births. Neither the mother nor the health professionals knew of the mother's infection. According to Ms. Mayersohn, the HIV-positive newborns were being discharged without referral for treatment that could have prolonged or saved their lives. Ms. Mayersohn saw the situation as ''criminal to deny the most innocent and the most helpless victims of the epidemic the care to which they are entitled." She successfully advocated for mandatory newborn testing, but she did not support mandatory testing of pregnant women.
Dr. Guthrie Birkhead of the New York AIDS Institute described implementation of the New York legislation. All women in the state are required to be informed in the labor and delivery setting of the imminent HIV testing of the newborn. When the woman's HIV status is unknown, full-fledged pre-test counseling is required. Newborn test results are returned to the hospital by two to three weeks after birth. If the women are identified then, there is sufficient time to begin newborns on Pneumocystis carinii pneumonia (PCP) prophylaxis at four to six weeks of age, but insufficient time to advise women against breast-feeding. New York has established a referral network of AIDS centers where newborns and mothers can be treated. Of the more than 185,000 newborns tested over a nine-month period from February 1997 to October 1997, 60 HIV-positive infants were born to mothers who were unaware of their infection. Before the legislation was implemented in 1997, New York State instituted, by regulation, a consented testing program. This earlier program had two components: (1) voluntary notification to mothers of their newborn test results, and (2) mandatory prenatal counseling (with recommended HIV testing) in all state-regulated facilities (e.g., hospitals, clinics, and staff model HMOs, but not in private offices of physicians). While the subsequent mandatory newborn testing legislation superseded the first