I 

108TH CONGRESS 

1ST SESSION H. R. 2049

To amend the Public Health Service Act with respect to testing pregnant 

women and newborn infants for infection with the human immunodeficiency virus. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 9, 2003

Mr. ACKERMAN (for himself, Mr. WELDON of Florida, Mr. HINCHEY, Mr. 

MCNULTY, Mr. WYNN, Mr. RANGEL, Mr. TERRY, Mr. FROST, Mr. TAYLOR of Mississippi, and Mr. THOMPSON of Mississippi) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act with respect to 

testing pregnant women and newborn infants for infection with the human immunodeficiency virus.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Women and Children’s 

5 HIV Protection Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) Perinatal transmission is the leading cause 

2 of pediatric HIV infections, including AIDS cases. 

3 (2) The Centers for Disease Control and Pre4 vention (‘‘CDC’’) estimates that nearly 7,000 HIV5 infected women give birth in the United States each 

6 year and as many as 400 babies continue to be born 

7 with HIV infection each year. 

8 (3) Medical advances have made it possible to 

9 nearly eliminate perinatal HIV transmission. 

10 (4) Research studies have demonstrated that 

11 the administration of antiviral medication during 

12 pregnancy, during labor, and immediately following 

13 birth can significantly reduce the transmission of 

14 HIV from an infected mother to her baby. Cae15 sarean section further reduces the risk of trans16 mission. 

17 (5) Even if treatment begins shortly after birth, 

18 antiretroviral therapy can substantially reduce the 

19 chance that an HIV-exposed infant will become in20 fected. 

21 (6) Breastfeeding by HIV-infected mothers 

22 poses additional significant risk of infection to ba23 bies. 

24 (7) The Institute of Medicine (‘‘IOM’’) has rec25 ommended the adoption of a national policy of uni-
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1 versal HIV testing, with patient notification, as a 

2 routine component of prenatal care. However, 15 

3 percent of HIV-infected pregnant women receive no 

4 prenatal care according to the IOM. 

5 (8) The CDC has recommended since 1995 that 

6 all pregnant women be counseled and offered vol7 untary HIV testing. Yet nearly half of pregnant 

8 women are still not tested according to the CDC. 

9 The CDC has found that mandatory testing of 

10 newborns and universal HIV testing of pregnant 

11 woman are the best approaches for identifying, 

12 treating, and preventing HIV among pregnant 

13 women and children. 

14 (9) The American Medical Association rec15 ommends mandatory HIV testing of all newborns 

16 with appropriate treatment for affected mothers and 

17 children. 

18 (10) Testing newborns whose mothers’ status is 

19 unknown ensures that every child at risk for HIV is 

20 identified. 

21 (11) More than a third of the HIV infections 

22 that occur annually among newborns in the United 

23 States could be prevented with routine HIV testing 

24 of pregnant woman or newborns according to a 2002 

25 report by the Inspector General of the Department 
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1 of Health and Human Services. This represents over 

2 100 babies born every year that are needlessly in3 fected. 

4 (12) The provision of testing of pregnant 

5 women and newborns with appropriate counseling 

6 and treatment can significantly reduce the number 

7 of pediatric HIV infections, including AIDS cases, 

8 can improve access to and medical care for the 

9 woman and children, and can provide opportunities 

10 to further reduce transmission among adults. 

11 (13) The provision of such testing, counseling, 

12 and treatment can reduce the overall cost of pedi13 atric HIV infections, including AIDS cases. 

14 (14) New York State has required mandatory 

15 HIV counseling and voluntary testing for pregnant 

16 women and mandatory HIV testing of all newborns 

17 since February 1997. As a result, the perinatal HIV 

18 transmission rate in the State has dropped from 25 

19 percent to an all time low of 3.5 percent and over

20 99 percent of HIV-infected women and their chil21 dren have been linked to care. 

22 (15) For the foregoing reasons—

23 (A) universal routine HIV testing of preg24 nant women and newborns should be the stand25 ard of care; and 
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1 (B) the relevant medical organizations, as 

2 well as public health officials, should issue 

3 guidelines making such testing, counseling, and 

4 treatment the standard of care. 

5 SEC. 3. GRANTS REGARDING COUNSELING AND TESTING 

6 OF PREGNANT WOMEN AND NEWBORN IN7 FANTS. 

8 Subpart II of part B of title XXVI of the Public 

9 Health Service Act (42 U.S.C. 300ff–33 et seq.) is amend10 ed by inserting after section 2625 the following section: 

11 ‘‘SEC. 2625A. GRANTS REGARDING COUNSELING AND TEST12 ING OF PREGNANT WOMEN AND NEWBORN 

13 INFANTS. 

14 ‘‘(a) IN GENERAL.—Of the amounts appropriated 

15 under section 2677 for a fiscal year for carrying out this 

16 part, exclusive of amounts available for grants under sec17 tion 2618(a)(2)(I), the Secretary, subject to subsection 

18 (b)(2), shall reserve $82,875,000 for making grants to 

19 each State that demonstrates that the law or regulations 

20 of the State are in accordance with the following: 

21 ‘‘(1) That all pregnant women receiving pre22 natal care in the State be offered counseling and 

23 testing regarding HIV disease. 

24 ‘‘(2) In the case of prenatal testing for such 

25 disease that is conducted in the State, that the re-
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1 sults of such testing be promptly disclosed to the 

2 pregnant woman involved. 

3 ‘‘(3) In the case of newborn infants who are 

4 born in the State and whose biological mothers have 

5 not undergone prenatal testing for HIV disease, that 

6 each such infant undergo testing for such disease. 

7 ‘‘(4) That the results of such testing of a new8 born infant be promptly disclosed in accordance with 

9 the following, as applicable to the infant involved: 

10 ‘‘(A) To the biological mother of the infant 

11 (without regard to whether she is the legal 

12 guardian of the infant). 

13 ‘‘(B) If the State is the legal guardian of 

14 the infant: 

15 ‘‘(i) To the appropriate official of the 

16 State agency with responsibility for the 

17 care of the infant. 

18 ‘‘(ii) To the appropriate official of 

19 each authorized agency providing assist20 ance in the placement of the infant. 

21 ‘‘(iii) If the authorized agency is giv22 ing significant consideration to approving 

23 an individual as a foster parent of the in24 fant, to the prospective foster parent. 
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1 ‘‘(iv) If the authorized agency is giv2 ing significant consideration to approving 

3 an individual as an adoptive parent of the 

4 infant, to the prospective adoptive parent. 

5 ‘‘(C) If neither the biological mother nor 

6 the State is the legal guardian of the infant, to 

7 another legal guardian of the infant. 

8 ‘‘(D) To the child’s health care provider. 

9 ‘‘(5) That, in disclosing the test results to an 

10 individual under paragraph (2) or (4), appropriate 

11 counseling on HIV disease and appropriate referrals 

12 for health care be offered to the individual (except 

13 in the case of a disclosure to an official of a State 

14 or an authorized agency, or to a health care pro15 vider).’’. 

16 ‘‘(b) DATE CERTAIN FOR MAKING GRANTS; LIMITA17 TION ON RESERVATION OF FUNDS.—

18 ‘‘(1) DATE CERTAIN FOR MAKING GRANTS.—

19 Not later than the end of the three-month period be20 ginning on the date on which appropriations first be21 come available for a fiscal year for grants under sec22 tion 2611, the Secretary shall make grants under 

23 subsection (a) for such fiscal year to all States that 

24 seek such grants and meet the condition described in 

25 such subsection for the grants. 
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1 ‘‘(2) LIMITATION ON RESERVATION OF

2 FUNDS.—Effective upon the expiration of the period 

3 described in paragraph (1) with respect to a fiscal 

4 year, the unobligated portion of the amount reserved 

5 under subsection (a) for the fiscal year is available 

6 for grants under section 2611 for the fiscal year. 

7 ‘‘(c) AMOUNT OF GRANTS.—Each grant under sub8 section (a) for a fiscal year shall be made in the amount 

9 of $1,500,000, except that the amount of such a grant 

10 for a territory of the United States shall be $375,000. 

11 ‘‘(d) AUTHORIZED EXPENDITURES.—A grant under 

12 subsection (a) may be expended for any purpose for which 

13 a grant under 2611 is authorized to be expended. 

14 ‘‘(e) DEFINITIONS.—For purposes of this section, the 

15 terms ‘State’ and ‘territory of the United States’ have the 

16 meanings that apply to such terms for purposes of grants 

17 under section 2611 (including the meanings that apply for 

18 purposes of section 2618).’’.

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