about twice those in the northern part of the state. In general, the epidemic in the southern part of the state reflects a disproportional HIV/AIDS frequency among African-American women, while in the northern part of the state it is more an epidemic among white, homosexual men.

Through May 25, 1998, a total of 1,933 female HIV/AIDS cases were reported in Alabama. HIV/AIDS seroprevalence rates among childbearing women in the state are approximately 1/1,000, similar to the national rate. Among African-American childbearing women, however, the seroprevalence rate is 1/250, considerably higher than national rates. Thus, the state's racial disparity among HIV-infected women is particularly large. The rate of HIV/AIDS infection among women has increased steadily since 1986.

A total of 105 pediatric HIV/AIDS cases have been reported in Alabama since 1985. In contrast to trends for the adult population, the annual number of reported pediatric cases in Alabama peaked in the early 1990s (with 17 HIV/AIDS cases reported in 1990 and 16 in 1991), declined to 11 cases in 1995, and then to 4 cases in 1996 and 1 in 1997. It is important to note that reported pediatric HIV/AIDS cases have declined, even though the number of infants reported as perinatally exposed to HIV has continued to increase steadily—from 51 in 1994 to 67 in 1997. Among those infants known to be perinatally exposed, the proportion receiving zidovudine (ZDV) at delivery has increased from approximately 6% in 1994 to 63% in 1997. The number of infants receiving ZDV after delivery rose as well, from 20% in 1994 to 96% in 1997. These findings are consistent with the implementation of PHS recommendations for perinatal HIV exposure. One emerging trend cited by perinatal care providers is that over the past 18 months there has been an apparent increase in the number of HIV-infected women who choose to continue their pregnancies, rather than opt for termination.

In Alabama in 1997, the greatest percentage of reported HIV counseling and testing was performed in family planning clinics (41%), followed by STD (sexually transmitted disease) clinics (35%), and prenatal care sites (12%). Prisons accounted for only 3% of counseling and testing performed, community health centers for 2%; TB (tuberculosis) programs for 2%, and private physicians for only 4% of the total.

Data on receipt of prenatal care indicate that in 1996, 5.6% of live births in Alabama were to mothers who received inadequate prenatal care, as measured by the Kessner index. Adequacy of care varied considerably between the two counties visited by the committee, with 12% of births in rural Greene County considered to have had inadequate care, but only 4% of births in urban Jefferson County. These data are important in considering potential barriers to and solutions for improving perinatal HIV transmission rates.

Implementation Of PHS Guidelines

The site visit team sought information on the extent to which the July 1995 PHS recommendations for universal counseling and voluntary HIV testing of



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