information with health care professionals, including pediatricians (ACOG, 1997; Hale and Zinberg, 1997).

The American Academy of Pediatrics (AAP) also calls for universal counseling and voluntary testing of pregnant women, and recommends testing of all newborns whose mothers either are HIV-infected or have unknown HIV status. The AAP's recommendations include these key points: (1) All pregnant women should receive routine HIV education and routine testing, with consent. Consent can take the form of the right of refusal in order to facilitate rapid incorporation of HIV testing into routine practice. (2) All testing programs should evaluate the percentage of women who refuse testing. In cases of poor acceptance rates, programs should analyze why and make changes. (3) Newborn testing should be performed, with maternal consent, when the mother's HIV status is unknown. If the newborn tests positive, the mother should be notified and should receive referral for her testing and treatment. (4) Results of maternal testing should be provided to the pediatric health care provider. (5) Comprehensive HIV-related medical services should be available to all infected mothers, infants, and other family members (AAP, 1995b).

The National Medical Association (NMA) position on HIV testing of pregnant women asserts that (1) health care professionals should offer counseling and voluntary HIV testing to all pregnant women on a confidential basis; (2) health care professionals should offer zidovudine (ZDV) therapy to all HIV-infected pregnant women and newborns without attempting to coerce treatment; (3) in HIV-infected women, amniocentesis, fetal scalp electrode placement, or measures that lead to prolonged rupture of the fetal membranes should be avoided, as should breast-feeding; and (4) confidentiality, while extremely important, should not extend to withholding test information from other health care workers, such as pediatricians, for whom the information has medical significance (Appendix C).

The American Academy of Family Physicians (AAFP) recommends universal HIV counseling and voluntary testing for all pregnant women, and has adopted as policy the section ''Guidelines for Counseling and Testing for HIV Antibody" from the CDC statement "Public Health Service Guidelines for Counseling and Antibody Testing to Prevent HIV Infection and AIDS" (CDC, 1987). In addition, HIV education is part of state association meetings, and the two AAFP publications also cover HIV issues.

The American Medical Association (AMA) is the only professional organization that supports mandatory HIV testing of all pregnant women and newborns, but this policy is not without controversy. In June 1995, the AMA Council on Scientific Affairs reviewed the available scientific data available and recommended that the AMA adopt a policy encouraging physicians to give a high priority to educating all women about HIV infection, and calling for prenatal HIV testing to be voluntary and its acceptance the responsibility of the woman (AMA, 1995). In June 1996, however, the AMA House of Delegates adopted a policy acknowledging that "mandatory testing for HIV of newborns at birth is too late to



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