y supported offering voluntary HIV testing and counseling to pregnant women. For those pregnant women who test positive, NIH and other public health institutions urged counseling and the use of zidovudine to prevent perinatal HIV transmission. Many federal, state, and medical organizations have since articulated positions in support of the task force recommendations and have taken initial steps towards implementation of perinatal HIV prevention programs. Several federal programs have provided funding to cover the cost of the zidovudine, and states have been urged to pay for HIV counseling, education, and voluntary testing programs. While many states have legislated the promotion of HIV counseling and testing, some have gone so far as to mandate that HIV tests are offered to all pregnant women and required in newborns.
As a result of these guidelines, a significant decrease in the pediatric HIV epidemic has been predicted. However, behavioral, ethical, and cultural factors impact both the implementation of mandated and voluntary testing programs and the administration of such preventive therapy.
The issue of mandated testing for pregnant mothers and infants is politically charged. In June 1996, the American Medical Association (AMA) endorsed mandatory testing of all pregnant women and newborns for HIV. While the AMA policy has no direct legal implications, the size of the organization (approximately half of the nation's doctors are members) makes it highly influential. Supporters of the endorsement based their position on the NIH clinical trial which demonstrated the potential for a significant reduction in risk of transmission, providing HIV-positive pregnant women are identified and comply with the course of therapeutic treatment. Those opposed express concerns that such a legal mandate would discourage those most at risk
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