routine HIV testing with notification of all pregnant women at the first prenatal visit and during delivery, except for those who specifically opt out. Counseling is supposed to be offered and pamphlets about HIV/AIDS from the Texas Department of Health given to all women in prenatal care.

The participants saw a number of benefits of the law. Most importantly, more women, especially those considered at low risk, were getting tested. However although more women were being tested, the participants cited several gaps in the law's implementation. First, there is no tracking system to know which and how many women stayed away from care because of the testing policy. Second, although the law requires counseling, no funds are set aside for counseling nor is counseling tracked. Third, although testing is required, there is no enforcement of the law. Remarkably, many providers and patients, even those interested enough in perinatal HIV to attend the committee's site visit, seemed ignorant of the law's specific provisions.

Special Populations
Undocumented Women

Because of Texas' close proximity of the Mexican border, many Mexican women cross the border to deliver their babies in South Texas. Many of these women have not received prenatal care because they are ineligible for Medicaid.

Several dilemmas may arise for these women. One is providing care for other sick family members who are not U.S. citizens. According to one participant, there was a case where an HIV-infected Mexican woman delivered her baby in the United States. The woman has six other children who are not U.S. citizens, all who have tested positive for tuberculosis (TB), and one who is HIV-positive. The provider must then decide between treating other sick family members despite their lack of U.S. citizenship or not treating them at all, which may lead to death or in the cases of the TB infected individuals, be a threat to others. In these situations providers must be creative, often relying on limited charity funds, in finding solutions to treat sick family members.

Another dilemma arises when providing care for a baby who is a U.S. citizen and dealing with a mother who is not. In one such situation, there was a choice between deporting the mother along with the baby, thereby depriving U.S. care for the HIV-infected baby or deporting only the mother and leaving the baby behind to be enrolled into a drug trial. Luckily, the baby was able to remain in the United States with her grandmother.

South Texas also has a large migrant population. To access health care and since they do not have a permanent address, migrants must return to the state where they originally applied for Medicaid. If they access their health care elsewhere they risk losing their Medicaid eligibility. Thus, pregnant migrant women living in Texas who are HIV-infected must deliver in the state where they originally applied for Medicaid. That state may not have routine HIV testing during



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