the risks for themselves and their infants. Ms. Kriebs noted that comprehensive HIV services are resource intensive, an issue that will need to be addressed particularly in an era of managed care.

Ethical Issues

Ms. Kriebs stated that in her opinion, it is not ethical to screen for a chronic, potentially fatal disease in a vacuum, or by imposing a gender bias in responsibility by testing only pregnant women. Rather, providers have a responsibility to empower women to make good decisions for themselves; then, virtually all will accept testing as part of good care for themselves and their children.

Discussion

Discussion focused on the similarities and differences between counseling and testing for HIV versus other diseases. Ms. Kriebs noted that HIV is different from other STDs because it is still life-threatening. HIV counseling should therefore be more extensive than for other STDs and more comparable to that for heart disease, diabetes, or other chronic, fatal diseases.

Association of Maternal and Child Health Programs

Deborah Allen spoke on behalf of the Association of Maternal and Child Health Programs (AMCHP), which represents state maternal and child health programs. Established under Title V of the Social Security Act, these programs are responsible for the health of all women and children in the state, including children with special health care needs. Responsibilities are met through assessment, policy and program development, and assurance of care.

Incorporation of PHS Guidelines

AMCHP has incorporated PHS guidelines into its policy on HIV counseling and testing, which supports early and routine counseling to enable all pregnant women and others of reproductive age to understand the risk of HIV infection and the benefits of early testing, identification, and treatment. In addition, the statement calls for voluntary testing with informed consent as the standard of practice.

Implementation

State MCH programs are engaged in planning and delivery of appropriate HIV/AIDS-related services through activities such as provider training; incorporation of HIV services into Title V clinical services for pregnant women and children; conducting outreach; providing family support services; and linking



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