Ms. Shannon made the following points. (1) Pre-conception counseling should be part of the clinical services offered to HIV-infected women. (2) Participation in clinical trials should be offered to all HIV-infected women, since some of the current investigations may further reduce vertical transmission of HIV and improve maternal health status. (3) Counseling of the HIV-infected pregnant woman should be non-directive regarding the continuation or termination of pregnancy and the use of antiretroviral therapy; ultimately, it is the woman's decision. Experience shows that judgmental or coercive counseling leads to alienation from care and mistrust of the health care system, thus delaying the initiation of therapeutic interventions. (4) HIV-infected pregnant women should be counseled and offered antiretroviral and other HIV therapy as determined by their disease status. The PHS guidelines for the use of antiretroviral drugs in HIV-infected pregnant women should be incorporated into the clinical care of these women. Clinicians with limited knowledge regarding these treatment strategies should establish ongoing collaborative relationships with specialists in the management of perinatal HIV. (5) Regionalization of perinatal HIV services should be seriously considered, so that all women have the opportunity to access state-of-the-art clinical care provided by perinatal experts and to enroll in perinatal clinical trials.
Mori Taheripour and Gail Kennedy provided a brief overview of the California Perinatal HIV Testing Project, funded by the California Department of Health, Office of AIDS, and the Health Care Financing Administration (HCFA) Medicaid Office in March 1997. A direct response to the California law mandating HIV counseling and promoting voluntary testing, the program combines the development and dissemination of provider resource materials with implementation assistance to providers, including managed care programs. It has succeeded in part because of buy-in from programs such as the state Maternal and Child Health Program, which has helped disseminate materials. The project is based on the understanding that for providers, a major barrier to offering counseling and testing is the lack of educational resource materials. The project's resource packet includes a flip chart for providers, a brochure that mirrors the flip chart (available in several languages), and testing and counseling guidelines. The project has been realistic about the limited amount of time providers have for counseling by providing a checklist for an abridged counseling session. Materials went out to approximately 7,000 providers in February 1998. Response has been very positive, with more than 300 requests for additional materials and for Spanish language versions. Work is now under way to help HMOs implement the program's guidelines. The program is being evaluated: data from a provider satisfaction