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OCR Page 1 of 30212 734 - 7800
THE WHITE HOUSE
Carol Harilton
WASHINGTON
&
March 6, 1996
MEMORANDUM FOR SUSAN BROPHY
FROM:
Patsy Fleming
SUBJECT: Ryan White CARE Act Conference and Coburn amendment
Background
The major issue before the CARE Act conferees is that of mandatory testing of all newborn
infants. This issue has been pressed in Congress and in several state legislatures (especially
New York and California) and intensified following the release of the results of an NIH-
funded study that found that use of AZT during pregnancy, childbirth, and a baby's first six
weeks of life can reduce the chance of perinatal HIV infection by 67 percent. The success of
the intervention is directly related to the mother taking AZT during the prenatal period and
delivery and the newborn being given AZT just after birth. Thus there is some question as
to the value of newborn testing to prevent transmission of HIV, since the critical intervention
may well be required before birth.
As a result, the Centers for Disease Control and Prevention has advocated routine counseling
and voluntary testing of pregnant women. Such voluntary programs have a proven success
rate. It is feared that mandatory testing might drive at-risk women away from prenatal care,
resulting in fewer people getting AZT during pregnancy, and thus diminishing the value of
this new intervention.
During consideration of the Ryan White CARE Act, the House passed a Coburn-Waxman
amendment that requires the Secretary of Health and Human Services to determine if HIV
testing of newborns is the standard of care when the HIV status of the mother is unknown.
If it is the standard of care, the Secretary must then determine that newborn testing is
occurring voluntarily in 95 percent of the infants born to mothers who have not been tested.
If the Secretary determines that 95 percent of such newborns have not been voluntarily
tested, then mandatory HIV testing of newborns would be required in those states not in
compliance. The states would have three-and-a half years to reach the 95 percent level
through voluntary testing.
During Senate consideration of the Ryan White CARE Act, an amendment offered by
Senator Kassebaum was approved that would require states to adopt the Public Health
Service's guidelines making routine counseling and voluntary testing of all pregnant women
the standard of care. It authorizes $10 million to help states implement the guidelines. The
emphasis on the prenatal period, of course, has the greatest potential for preventing
transmission to newborns.