them of the results and giving them a list of consortium centers and providers that could take care of HIV-infected women. In August 1995, North Carolina passed a law requiring providers to counsel women as early in pregnancy as possible, and to offer testing.
Several recent evaluations indicate that around 70% of pregnant women in North Carolina are tested for HIV during pregnancy. Data from the Pregnancy, Infection and Nutrition (PIN) study—a prospective cohort study, based on a sample of women attending prenatal clinics in North Carolina teaching hospitals and health department clinics—indicate that 89% of women interviewed were offered an HIV test during pregnancy. Based on study findings, the researchers project that had testing been universally offered, the proportion tested would have increased from 68% to 75%. PIN data also show that women's perceptions of provider recommendations clearly influence the decision to accept or reject testing. Women who perceive that their provider thinks it is important to get tested are much more likely than others to accept testing. Reasons women gave for refusing testing include the following: they did not believe they had HIV/AIDS (68%); had been tested recently (24%); or did not want to know results (5%). Very few women gave fear of the consequence of getting a test as a reason. Finally, PIN study findings indicate that women are not naive about testing prior to the index pregnancy. In fact, 67% in the study sample were tested prior to pregnancy.
Findings from a July 1995 provider survey (conducted prior to passage of the North Carolina law) indicate that while providers said they supported universal offering of testing, their practice varied from this ideal. More specifically, while 93% of respondents said they support universal offering of testing, only 82% of practices had a policy of offering testing to all; 67% of providers reported that they offered testing to all women; and only 54% said they would recommend testing to women with no identifiable risk. The 1995 survey also indicated that providers' HIV testing recommendations and practices are influenced by practice setting and patient's insurance status. Private providers and HMOs were least likely to recommend testing; public health providers were most likely, followed by providers at tertiary care centers. Providers were most likely to recommend testing to public/uninsured and self-pay patients and least likely to recommend testing to privately insured patients.
Sindy Paul, medical director of the Division of AIDS Prevention and Control, New Jersey Department of Health, presented an evaluation of implementation in her state. In addition to CDC surveillance data, findings from four other