woman and the prevalence of HIV in pregnant women is 2 per 10,000, the committee's calculations in Appendix K show that the cost of routine prenatal testing is $15,600 per HIV-positive woman found. Even if the cost of the test is $5 and the prevalence 1 per 10,000, the cost per case found is $51,100. Taken in the context of the cost of caring for an HIV-infected child, even though not all women found to be HIV-positive will benefit, these figures indicate the clear benefits of routine prenatal HIV testing.

Second, universal screening is the only way to deal with possible geographic shifts in the epidemiology of perinatal transmission. Although perinatal AIDS cases are currently concentrated in eastern states, particularly New York, New Jersey, and Florida, there have been shifts in the prevalence of HIV in pregnant women, including an increase in the South in the early 1990s. Changes in the regional demographics of drug use can also lead to changes in the distribution of HIV infection in pregnant women. Given the uncertainty of these trends, the committee considered universal testing the most prudent method to reduce perinatal transmission despite possible regional fluctuations.

Third, it would help to reduce stigmatization of groups by calling attention to a communicable disease that does not have inherent geographic barriers or a genetic predisposition. Focusing on the communicable disease aspect may allow national education programs that would otherwise be difficult, discouraging infected individuals from hiding themselves and thus not benefiting from care, and discouraging a "blame the victim" mentality.

Incorporating Universal, Routine HIV Testing into Prenatal Care

The following changes in health systems and public policy are needed by state health departments, health systems, and professional organizations to bring about the major change called for in the committee's central recommendation. The committee believes it is also important that these approaches be evaluated carefully, and that successful models be disseminated widely in the professional community.

Education of Prenatal Care Providers

One way to achieve the goal of universal HIV testing in prenatal care is for federal, state, and local health agencies, professional organizations, regional perinatal HIV research and treatment centers, AIDS Health Education Centers, and health plans to increase efforts to educate prenatal care providers about the value of testing in pregnancy. In particular,

The committee recommends that health departments, professional organizations, medical specialty boards, regional perinatal HIV centers, and health plans increase their emphasis on education of prenatal

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