The proliferation of Acquired Immune Deficiency Syndrome (AIDS) among women and children represents one of the gravest health issues confronting contemporary society. Women, most of childbearing age, now constitute 11 percent of all cases, and the U.S. Public Health Service has projected over 3,000 cases of pediatric AIDS by the end of 1991. In the face of these sobering statistics, experts have been called upon to grapple with a difficult, compelling question: under what conditions, if any, should HIV testing of women and children be required? Also at issue are the surreptitious testing for HIV antibodies as part of routine prenatal and neonatal examinations, and whether such testing should be performed on all women and infants, or only those who belong to groups judged at "high risk". In this unique contribution to the debate about HIV screening and testing, Ruth Faden, Madison Powers, and Gail Geller have assembled perspectives from experts in public health, medicine, law, and ethics. Their wide-ranging treatment examines the history of prenatal and neonatal screening programs; informed consent; legal issues and confidentiality; reproductive decision-making; and numerous other aspects of HIV testing. Alternative policy options for both now and the future are discussed in detail. This volume provides a comprehensive analysis of these pressing medical, public health, legal, ethical, and social issues, and is essential reading for AIDS researchers and clinicians, public health specialists, ethicists, health policymakers and analysts, obstetricians, and pediatricians.

PART I: Introduction 1. Warrants for Screening Programs: Public Health, Legal and Ethical Frameworks, Ruth Faden, Nancy Kass, and Madison Powers PART II: Public Health and Medical Issues 2. Public Health and Clinical Aspects of HIV Infection in Women and Children in the U.S., John Modlin and Alfred Saah 3. A History of Prenatal and Neonatal Screening Programs: Lessons for the Future, Katherine Acuff and Ruth Faden 4. HIV Infection and Obstetrical Care, Timothy Johnson and John Repke 5. Pediatric HIV Testing: Social Issues, Larry Wissow and Nancy Hutton PART III: Legal Issues 6. Prenatal and Newborn Screening: State Legislative Approaches and Current Practice Standards, Katherine Acuff 7. Legal Issues in Nonvoluntary Prenatal HIV Testing, Anita Allen 8. Legal Issues in Voluntary Screening for HIV Infection in Pregnant Women, Patricia King 9. Legal Protections of Confidential Medical Information and the Need for Anti-Discrimination Laws, Madison Powers PART IV: Normative and Social Issues 10. Ethical and Legal Issues in Mandatory and Voluntary Neonatal HIV Testing, Ruth Faden and Judith Areen 11. Ethical Issues in HIV Testing During Pregnancy, LeRoy Walters 12. Informed Consent in the Context of Prenatal HIV Testing, Gail Geller and Nancy Kass 13. Reproductive Decision-Making in the Context of HIV: The Case for Non-Directive Counseling, Nancy Kass PART V: Conclusion 14. HIV Infection, Pregnant Women and Newborns: A Policy Proposal for Information and Testing

"Each chapter in this rich mine of 17 contributions is well worth reading, not only by those with special interest in the subject, but by those concerned about the appropriate role of health care professionals and government in influencing patient choices...first rate...broader perspective on a pressing clinical and social issue."--The Journal of the American Medical Association |k No