HIV-positive individuals, inform them of their risk, provide counseling, and direct them to testing and treatment centers. Rigorous confidentiality standards are required, and the identity of the index case may not be revealed to the partners who are traced. Furthermore, a special protocol would be developed for individuals at risk of domestic violence. In addition to the "duty to warn," the legislation also allows the commissioner to establish a named HIV registry similar to that in effect in 27 other states. Mayersohn's bill was tabled for further discussion in 1997 and passed both houses of the legislature in the closing days of the 1998 session. The bill was signed into law by Governor Pataki on the last day of the legislative session in June 1998. After regulations are drafted and comments received, the law will go into effect on January 1, 1999.

The combined partner notification-named HIV registry legislation signified a further breach of New York's exceptionalist HIV policy. With some notable exceptions—such as the development of Special Needs Plans for HIV-positive Medicaid recipients, rather than pooling them with the rest of the Medicaid managed care population—public health policy regarding HIV-positive individuals has tended toward the more traditional approaches of case finding, containment, and chronic disease management.

Under the Pataki administration, the composition of the AIDS Advisory Council has changed as well, since the governor can appoint 9 of the 17 council members. There is less representation from advocacy groups and community interests, and a greater voice of traditionalist public health as represented by several suburban health commissioners. The governor also appointed Mayersohn's legislative counsel, William Viskovitch, to serve on the council.

Mayersohn herself has continued to support her agenda on a national scale, through a growing electronic network that includes contacts in Delaware, a medical society in California, congressional staff, an Indiana-based children's publisher, and a number of physicians who treat HIV-positive patients.

The state health department's AIDS Institute is no longer entrenched in the HIV policy arena, as it was under Axelrod and, particularly, Rango's direction. As one observer pointed out about the AIDS Institute, "There is no policy agenda now." All policy matters department-wide have been consolidated under a single office reporting directly to the commissioner, such that there is no AIDS policy distinct from that of the entire department.

Although the legislative battle over mandatory newborn testing in New York State is over, the legal battle continues. The HIV Law Project, a legal advocacy service for low-income HIV-positive individuals in the Bronx and Manhattan, has pursued a dual strategy: (1) malpractice suits against providers and institutions whose failure to carry out timely and appropriate testing and notification represent an abrogation of the standard of care; and (2) a lawsuit against the state health department for failure to carry out the law fairly, equitably, and with adequate protections. Despite the fact that the former strategy targets individual providers, the objective—as in the latter—is to implicate the law. Since a ruling



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