1997; Mills et al., 1998; Walter et al., 1998). Instead, actual testing practice was based upon providers' assessment of maternal risk or the providers' perceptions of maternal risk (Mills et al., 1998; Walter et al., 1998). Providers noted that barriers to offering their pregnant patients HIV counseling and testing included the lack of provider time, legal requirements for counseling informed consent, the need for confidential record keeping, a lack of perceived risk, and lack of awareness of effective treatment among pregnant women (Hamm et al., 1996; Segal 1996; Ohio Department of Health, 1997). The committee's workshop and site visits also provided evidence that some providers do not offer HIV tests because they feel that discussing or even bringing up the matter with some patients would be too "embarrassing."

Acceptance of Prenatal HIV Testing

Pregnant women's use of HIV tests has increased significantly since the release of the 1995 PHS guidelines (studies of HIV test use are summarized in Table 6.2). According to preliminary data from CDC's Behavioral Risk Factor Surveillance System (BRFSS), HIV test use among pregnant women increased from 50% to 75% between 1993 and 1996 (Alderton, 1998). The BRFSS involves surveys in all states and these estimates represent the most recent national



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