of the mother), unable to prevent transmission from mother to child, and seriously intruding on the privacy and autonomy of the mothers, whose HIV status is actually being determined.

New York's "Baby AIDS" law illustrates the need for flexible policies that can accommodate new scientific and clinical information. According to Appendix L, by the early 1990s, PCP prophylaxis had been shown to be effective in preventing pneumonia in HIV-infected newborns. The New York City Child Welfare Administration's policy, however, made it difficult to test children in foster care for HIV, even if it was suspected that they were infected. Given these circumstances, and the lack of evidence at that time that transmission could be prevented, "unblinding" the results made sense, as a response the foster care situation in New York City. By the time that the idea of unblinding the heel-stick test results overcame political opposition and became law, the AIDS Clinical Trials Group protocol number 76 (ACTG 076) results had already shown transmission could be prevented. The law, thus, may have been an appropriate response to the situation before 1994, when it was first conceptualized. With its focus on newborn rather than prenatal testing, however, the law does not reflect current public health and clinical preventive approaches.

Community Response to HIV Testing

The advocacy of articulate, politically sophisticated organizations in the gay community has had a tremendous impact on AIDS policies. With the shift in the epidemic toward African-American and Hispanic populations in recent years, current support for protections against discrimination and voluntary measures to control the epidemic may be seriously eroded. These minority groups have limited advocacy organizations and resources needed to protect their rights. As the epidemic continues to affect people living in poverty and people who have historically been disenfranchised, there is an increased risk that testing can and will be used to discriminate against people infected with, or even thought to be infected with, HIV and will further isolate people with AIDS. Thus, policy decisions must incorporate strong protections for those who are already suffering from discrimination.

The potential for such regressive policies is underscored by the epidemiology of perinatal HIV transmission, characterized by its disproportionate impact on African-American and Hispanic women, and the devastation to their lives, their families, and their communities. These women must be the focus of increased prevention and treatment efforts. The interaction of race, gender, and social class will continue to be critical factors to be addressed as new policies are developed, implemented, and evaluated.

Much of the voiced African-American opposition to HIV testing programs must be understood in the context of historical perceptions of mistrust and fear toward the public health and medical research establishment. This underlying



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