Most states have laws governing disclosure of HIV test results. Thirty-seven states require reporting to the state health department. Other states permit disclosure to the person's spouse, or sexual or needle-sharing partner (26 states); to foster agencies or families (9 states); or to the newborn's pediatrician (15 states). Eight states regulate disclosure to insurers.

Six states have adopted laws or regulations on HIV testing, monitoring, or treatment of exposed newborns. Only New York State strictly mandates newborn testing; Texas requires it, but allows mothers to refuse. At least six states have provisions permitting testing of infants or minors without parental consent. In two states, a doctor may test a newborn for HIV if he or she determines it is medically necessary.

Virtually all states have programs to disseminate educational information to health care institutions (40 states), to providers (41 states), and to pregnant women and the public (31 states). These efforts are aimed at specific socioeconomic (10 states), ethnic (17 states), and age (19 states) groups, and 20 states distribute information in languages other than English. Thirty-seven states incorporate PHS guidelines into state-sponsored HIV programs, mostly through education and training of counselors and health care providers. Eighteen states have reviewed their contracts with managed care organizations regarding HIV issues, and nine states report having required changes in the covered programs to implement the PHS guidelines.

Although the issue has not been carefully studied, the committee has identified no evidence that the existence of state laws or policies mandating HIV testing for either pregnant women or newborns has had any effect on offering or accepting tests, or on avoidance of prenatal or other health care. Indeed, in the course of its site visits, the committee heard many instances of providers and patients who were unaware or confused about perinatal HIV testing laws and policies in their states. If many people are unaware of the policies, they are unlikely to change behavior.

Implementation Of The Guidelines By Professional Organizations

Most organizations representing professionals who provide prenatal or newborn health care have adopted positions that support universal counseling and voluntary testing of pregnant women. The American College of Obstetricians and Gynecologists (ACOG) advocates (1) routine counseling of all pregnant women as part of prenatal care; (2) voluntary testing with consent; and (3) documentation of refusal of testing in the patient's chart. ACOG recommends that pre-test counseling include information about risk behaviors, vertical transmission, availability and effectiveness of therapy, and the potential social and psychological implications of testing positive. The group also recommends, on a voluntary basis, contacting sexual partners of HIV-positive patients, as well as sharing testing



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