anonymous screening rather than sampled screening, since it was piggybacking the study on the universal Newborn Screening Program and the additional cost was warranted by the greater predictive power of conducting a universal test. The CDC contributed funding that covered half of New York's seroprevalence studies, and the state made up the difference (by 1996, the state was paying three-quarters of the cost of the seroprevalence surveys, and CDC one-quarter of the $2 million program).

As Novick was to write later (Novick, 1991), the newborn seroprevalence survey provided the state health department with three critical elements: currency, relevance, and focus. The "currency" allowed the state to monitor the real-time spread of the infection without having to account for the lag time between HIV infection and a reported AIDS case (and it enabled the state to conduct analyses of HIV trends over time without adjusting for the CDC's expanded definition of AIDS in 1993); the "relevance" of the universal screening test enabled the state to report actual, rather than projected, infection rates among childbearing women and to closely estimate the rate among all women ages 15–44; and the ''focus" derived from the small-area planning that could be conducted given the sociodemographic variables of maternal age, race/ethnicity, and zip code. The last was perhaps the most important to state public health officials, since it served as an early-warning system that alerted them to what communities the virus was moving into, and thereby provided an opportunity for targeted prevention and education efforts.

In March 1988, Commissioner Axelrod reconvened a special advisory committee to review the preliminary results of the newborn serosurvey. The committee (composed of Elaine Abrams and Margaret Heagarty of Harlem Hospital, NIAID's Richard Kaslow, the CDC's Timothy Dondero and Margaret Oxtoby, Myron Essex and Harvey Fineberg of Harvard School of Public Health, Keith Krasinski of Bellevue Hospital, Peter Selwyn of Montefiore Hospital, and Isaac Weisfuse of the New York City Department of Health) strongly recommended continuing the serosurvey, particularly for purposes of monitoring the epidemic.

Only days before the advisory committee met, an article in Newsday (a major New York daily) featured an interview with Dr. Rodney Hoff, the architect of the Massachusetts health department's blinded newborn survey. Even as he presented the rationale for the blinded serosurvey, "… so that we can monitor HIV infection trends in women," he did sound a cautionary note, saying that, "there is a trade-off here between the legal issue of consent and ethical issue of duty to inform." Since there was no accepted treatment at the time, Hoff said he considered it ethically acceptable to not identify individual patients (a position adopted by Bayer and others (1986), and by the journal Nature's editorialists in a 1987 article). "Once there is an effective treatment for infected infants," he concluded, "we will very quickly convert to a case-detection system."

Between 1988 and 1990, the New York State health department pursued a number of measures predicated on voluntary adherence to primary and secondary



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