retarded and schizophrenic, which he attributed to the initially undiagnosed PKU. His impetus to develop the newborn screening was that if PKU was detected early enough after birth, babies could be put on a special low-protein diet and go on to lead perfectly normal lives. On average, New York screens over 300,000 infants each year and identifies approximately 12 children with PKU. (In contrast, in a nine-month period from February 1, 1997, through October 31, 1997, of 185,540 births there were 779 infants born with maternal HIV antibodies.)

The state health department began collecting newborn HIV seroprevalence data on November 30, 1987. "What I recall quite vividly," said one of the study planners, "is that after the first two weeks we were taken aback by the results. They had quite an impact on us." Several earlier newborn studies conducted in municipal hospitals in New York City had revealed seroprevalence rates of 2.4% to 2.5%. The study planners expected to find similar data in high-risk neighborhoods and were stunned to find rates of 4% seroprevalence in Harlem, the South Bronx, and the Bedford Stuyvesant section of Brooklyn. "This meant that 1 of every 25 women [delivering a baby] was infected,'' noted a public health official, "and when we reported that we expected a big outcry, and a large media push, for us to immediately unblind the survey." To their surprise, newspaper coverage focused on the epidemiological significance of the findings—on the spread of HIV infection across the state and the depth of HIV seroprevalence in particular communities.

Within four weeks of starting the newborn seroprevalence study, the state health department had amended the contracts of state-regulated family planning programs and prenatal care clinics, which served over 300,000 women annually, requiring them to provide on-site HIV counseling and testing services. The state also stepped up its efforts to reach pregnant women in high-risk neighborhoods through its Community Health Worker program and through targeted education campaigns, and advised obstetricians and other physicians throughout the state of the compelling need to provide HIV counseling and testing services to women of reproductive age. In his State of the State message on January 6, 1988, Governor Mario Cuomo told the assembled legislators, "There is no greater tragedy than the birth of a child condemned to death, yet estimates indicate 1,000 infants will be born with the AIDS virus in 1988. … The initial results of the prevalence studies have only served to heighten our sense of urgency and to focus dramatically upon our most vulnerable populations. Results on the first 11,000 newborn blood specimens demonstrate an alarming statewide HIV seroprevalence rate of almost 1% among women of childbearing age."

At the same time that New York was beginning its seroprevalence studies, the CDC was initiating its Family of Surveys seroprevalence sample studies in 45 states. The CDC funded states to conduct anonymous seroprevalence studies on representative samples of injection drug users, STD and tuberculosis clinic patients, hospital admissions, patients at clinics serving women or reproductive age, and newborns. New York public health officials decided to conduct universal,



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