Preventing Perinatal HIV Transmission-Reply

In Reply.  —We share the interests of Drs Goldstein and Sever in promoting prenatal HIV testing. Indeed, the concern that many HIV-infected women and their children were not receiving needed care because their HIV infections remained undiagnosed was a primary impetus toward developing the US Public Health Service guidelines for the universal offering of prenatal HIV counseling and voluntary testing.¹ Our main disagreement with Goldstein and Sever is in the best way to accomplish this goal.An often unspoken tenet of arguments and policies favoring mandatory prenatal HIV testing is that many women will not be tested if testing is voluntary. However, several studies have demonstrated that voluntary HIV testing programs can achieve high rates of testing and of initiating care.^2,3 To our knowledge, no data are available to assess whether mandatory testing can be an effective strategy for ensuring that HIV-infected women and their children receive appropriate care.Prenatal