pre-test counseling is important, she says, but so is getting tested. She suggests a shortened version of pre-test counseling, covering only essential points.

A Ryan White-funded program in the Tampa area provides nurse case managers, and has 100% compliance with HIV testing in public settings. In contrast, 85% to 90% of the women in the private sector accept the test. The program also works with private sector physicians and group practices to improve compliance with the state law. The nurses visit offices, do chart audits, and make recommendations on how to improve testing rates. Only about ten group practices have been visited to date, but these were chosen because of the large number of births they are responsible for. The nurses are viewed partly as people who can help the practices with HIV testing and link them with specialized HIV care when necessary, and partly as government auditors. The program also provides services to pregnant women in the private sector. It provides case management services for private prenatal patients (two patients so far), programs to help the baby's transition into a Title IV program, and supplementary services in conjunction with care from their private prenatal providers.

Mandatory Newborn Testing

One participant suggested that mandatory newborn testing to detect babies whose mothers were not tested under the voluntary system be considered. Another responded that a colleague of hers from New York had said that the "unblinding" of newborn tests in that state was supposed to expand access to care for both mothers and babies, but that resources were not available for this purpose.

Undocumented Women

"Undocumented" women (illegal aliens) make up a substantial part of the prenatal HIV caseload. At the University of Miami Hospital, every woman giving birth is offered an HIV test, and many of the HIV-positive women identified in this way are undocumented women who were not tested in pregnancy. Such women do not seek out prenatal care because they presume that they are not eligible for services and, more importantly, they fear discovery of their status. In Miami, they are no longer covered by Medicaid. Some cities, however, are making an effort to provide care for undocumented women. Officials in Miami have found ways to get most of these women into care through Ryan White resources, drug companies' compassionate care programs, and charitable organizations. The Title IV program in Orlando brings undocumented women into care through community fund-raising, churches, the United Way, and so on. The Tampa program, in contrast, does not have resources to treat undocumented women.

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