genetic counseling and was driven by various consumer movements promoting both patients' rights and autonomy, and a shared medical decision making model that regarded the patient as an active partner along with his or her health care provider.

The state health department codified its strategy in two key planning documents: (1) the January 1989 five-year interagency plan, "AIDS: New York's Response," which introduced a number of new initiatives aimed at education (such as HIV/AIDS education incorporated into the core curricula of all public schools and colleges), voluntary counseling and testing, expansion of health services, and preservation of human rights through antidiscrimination legislation and adherence to the principles of informed consent; and (2) the "New York State Principles for the Care of Women and Children with HIV Infection," (New York State AIDS Institute, 1990) drafted after a three day symposium in 1990 at the Mohonk Mountain House in New Paltz, and thereafter known as the "Mohonk Principles.'' The Mohonk symposium, led by the AIDS Institute's Nick Rango, brought together key staff from a number of state agencies, as well as health professionals involved in AIDS-related services and women affected by the epidemic. The document clearly stipulated the state's voluntarist approach. The consensus document urged "routine counseling and voluntary testing of all women of reproductive age," which should be provided in all health care settings; it asserted each woman's right to make her own reproductive choices; and it recommended a program of routine counseling and voluntary testing of postpartum women who may not have received adequate counseling or testing opportunities prior to giving birth. The document further clarified a consensus position opposing mandatory newborn screening, arguing that involuntary testing of the mother (the practical consequence of newborn testing) must be weighed against the state's interest in safeguarding the health and welfare of the infant. It presented the criteria that had to be met before unblinding the newborn screening: "(1) substantial clinical benefit of treatment in HIV-infected newborns has been demonstrated; (2) appropriate clinical services are available to all HIV-infected family members regardless of family resources; (3) a definitive laboratory test becomes available allowing for the detection of HIV infection in newborns (as opposed to the presence of maternal antibodies), or the indicated clinical intervention for infants with HIV infection has been proven to be sufficiently nontoxic to uninfected infants who would receive it because of the presence of maternal HIV antibodies; and (4) a system of voluntary counseling and testing of all women of reproductive age has failed to be effective."

The voluntary counseling and testing program at family planning clinics and prenatal care programs was emblematic of this approach. The state intended that every woman of reproductive age seen in a state-regulated facility would be provided with sufficient information to protect herself from being infected and that every woman would also voluntarily take the HIV test in an effort to inform reproductive choices (such as whether to have an abortion or to pursue future



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