intensive counseling programs similar to that of Harlem Hospital, which routinely persuaded over 90% of its obstetrical patients to accept HIV testing. Four physicians on the panel—the public health commissioner from Westchester County and three pediatricians—dissented. One of them, Dr. Lou Cooper, the head of the New York chapter of the American Academy of Pediatrics, told the New York Times, "Reliance on counseling that encourages voluntary testing ignores the unacceptably high failure rate of such an approach. In addition, it siphons off resources which could be focused more effectively for needed care."

Within days after the Blue Ribbon panel released its report, the Data Safety Monitoring Board of the NIAID interrupted AIDS Clinical Trials Group protocol number 076 (ACTG 076) when it became clear that ZDV administered to pregnant women and newborns could reduce vertical transmission of HIV by 69%. Citing the dramatic, incontrovertible value to intervening prenatally, Cooper reversed his position and sided with the majority view of the panel to focus prevention and case finding efforts on pregnant women rather than newborns.

On February 24, 1994, the AIDS Advisory Council adopted the Blue Ribbon panel's recommendation and advised the state to pursue universal voluntary testing. On the same day, a joint Senate-Assembly bill was proposed by Michael Tully, the chair of the Senate Health Committee and Assembly Speaker Sheldon Silver, calling for mandatory counseling and voluntary testing of pregnant women. The sponsors pointed to the recent reports of ZDV's efficacy as a clear mandate to focus efforts on enlisting pregnant women in the detection and care of their HIV-infected babies. The battle over Mayersohn's bill had clearly been joined.

Newsday columnist Jim Dwyer, who would later win a Pulitzer Prize for his series of columns on the Baby AIDS legislation, published a column in April, 1994, "A Silence that Kills Children," prompted by a conversation he had with Mayersohn that transpired after he had attended the funeral of a baby who died from AIDS complications (Mayersohn, 1994a). In the column, he quoted pediatrician Stephen Nicholas of Columbia Presbyterian Medical Center as favoring "routine newborn testing, the same we do for syphilis testing." Nicholas, who had been involved in the design and implementation of Harlem Hospital's much-touted High Risk Pregnancy Clinic, told the columnist that he felt that even 90% voluntary agreement to test was not sufficient, "because you're still missing 10%."

Throughout the early spring, there was considerable political discussion and negotiation over possible terms of compromise between the Silver-Tully sponsors and the Mayersohn-Velella sponsors. One compromise being considered was directed counseling that urged HIV testing and the written acceptance or refusal of testing at delivery. At the same time, the foster-care agency ABC had renewed its advocacy for allowing HIV testing of foster children without explicit consent of the birth parents, a policy that many saw as linked with the mandatory newborn testing proposals because both would amend the state's confidentiality statute and both would be undertaken on behalf of HIV-infected children. ABC



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