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 immuno-
deficiency 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. TAY-
LOR of Mississippi, and Mr. THOMPSON of Mississippi) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the Public Health Service Act with respect to 
testing pregnant women and newborn infants for infec-
tion with the human immunodeficiency virus.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Women and Children’s 
HIV Protection Act of 2003’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows:
(1) Perinatal transmission is the leading cause 
of pediatric HIV infections, including AIDS cases. 
(2) The Centers for Disease Control and Pre-
vention (‘‘CDC’’) estimates that nearly 7,000 HIV-
infected women give birth in the United States each 
year and as many as 400 babies continue to be born 
with HIV infection each year. 
(3) Medical advances have made it possible to 
nearly eliminate perinatal HIV transmission. 
(4) Research studies have demonstrated that 
the administration of antiviral medication during 
pregnancy, during labor, and immediately following 
birth can significantly reduce the transmission of 
HIV from an infected mother to her baby. Cae-
sarean section further reduces the risk of trans-
mission. 
(5) Even if treatment begins shortly after birth, 
antiretroviral therapy can substantially reduce the 
chance that an HIV-exposed infant will become in-
fected. 
(6) Breastfeeding by HIV-infected mothers 
poses additional significant risk of infection to ba-
bies. 
(7) The Institute of Medicine (‘‘IOM’’) has rec-
ommended the adoption of a national policy of uni-
versal HIV testing, with patient notification, as a 
routine component of prenatal care. However, 15 
percent of HIV-infected pregnant women receive no 
prenatal care according to the IOM. 
(8) The CDC has recommended since 1995 that 
all pregnant women be counseled and offered vol-
untary HIV testing. Yet nearly half of pregnant 
women are still not tested according to the CDC. 
The CDC has found that mandatory testing of 
newborns and universal HIV testing of pregnant 
woman are the best approaches for identifying, 
treating, and preventing HIV among pregnant 
women and children. 
(9) The American Medical Association rec-
ommends mandatory HIV testing of all newborns 
with appropriate treatment for affected mothers and 
children. 
(10) Testing newborns whose mothers’ status is 
unknown ensures that every child at risk for HIV is 
identified. 
(11) More than a third of the HIV infections 
that occur annually among newborns in the United 
States could be prevented with routine HIV testing 
of pregnant woman or newborns according to a 2002 
report by the Inspector General of the Department
of Health and Human Services. This represents over 
100 babies born every year that are needlessly in-
fected. 
(12) The provision of testing of pregnant 
women and newborns with appropriate counseling 
and treatment can significantly reduce the number 
of pediatric HIV infections, including AIDS cases, 
can improve access to and medical care for the 
woman and children, and can provide opportunities 
to further reduce transmission among adults. 
(13) The provision of such testing, counseling, 
and treatment can reduce the overall cost of pedi-
atric HIV infections, including AIDS cases. 
(14) New York State has required mandatory 
HIV counseling and voluntary testing for pregnant 
women and mandatory HIV testing of all newborns 
since February 1997. As a result, the perinatal HIV 
transmission rate in the State has dropped from 25 
percent to an all time low of 3.5 percent and over
99 percent of HIV-infected women and their chil-
dren have been linked to care. 
(15) For the foregoing reasons—
(A) universal routine HIV testing of preg-
nant women and newborns should be the stand-
ard of care; and
(B) the relevant medical organizations, as 
well as public health officials, should issue 
guidelines making such testing, counseling, and 
treatment the standard of care. 
SEC. 3. GRANTS REGARDING COUNSELING AND TESTING 
OF PREGNANT WOMEN AND NEWBORN IN-
FANTS. 
Subpart II of part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–33 et seq.) is amend-
ed by inserting after section 2625 the following section: 
‘‘SEC. 2625A. GRANTS REGARDING COUNSELING AND TEST-
ING OF PREGNANT WOMEN AND NEWBORN 
INFANTS. 
‘‘(a) IN GENERAL.—Of the amounts appropriated 
under section 2677 for a fiscal year for carrying out this 
part, exclusive of amounts available for grants under sec-
tion 2618(a)(2)(I), the Secretary, subject to subsection 
(b)(2), shall reserve $82,875,000 for making grants to 
each State that demonstrates that the law or regulations 
of the State are in accordance with the following: 
‘‘(1) That all pregnant women receiving pre-
natal care in the State be offered counseling and 
testing regarding HIV disease. 
‘‘(2) In the case of prenatal testing for such 
disease that is conducted in the State, that the re-
sults of such testing be promptly disclosed to the 
pregnant woman involved. 
‘‘(3) In the case of newborn infants who are 
born in the State and whose biological mothers have 
not undergone prenatal testing for HIV disease, that 
each such infant undergo testing for such disease. 
‘‘(4) That the results of such testing of a new-
born infant be promptly disclosed in accordance with 
the following, as applicable to the infant involved: 
‘‘(A) To the biological mother of the infant 
(without regard to whether she is the legal 
guardian of the infant). 
‘‘(B) If the State is the legal guardian of 
the infant: 
‘‘(i) To the appropriate official of the 
State agency with responsibility for the 
care of the infant. 
‘‘(ii) To the appropriate official of 
each authorized agency providing assist-
ance in the placement of the infant. 
‘‘(iii) If the authorized agency is giv-
ing significant consideration to approving 
an individual as a foster parent of the in-
fant, to the prospective foster parent.
‘‘(iv) If the authorized agency is giv-
ing significant consideration to approving 
an individual as an adoptive parent of the 
infant, to the prospective adoptive parent. 
‘‘(C) If neither the biological mother nor 
the State is the legal guardian of the infant, to 
another legal guardian of the infant. 
‘‘(D) To the child’s health care provider. 
‘‘(5) That, in disclosing the test results to an 
individual under paragraph (2) or (4), appropriate 
counseling on HIV disease and appropriate referrals 
for health care be offered to the individual (except 
in the case of a disclosure to an official of a State 
or an authorized agency, or to a health care pro-
vider).’’. 
‘‘(b) DATE CERTAIN FOR MAKING GRANTS; LIMITA-
TION ON RESERVATION OF FUNDS.—
‘‘(1) DATE CERTAIN FOR MAKING GRANTS.—
Not later than the end of the three-month period be-
ginning on the date on which appropriations first be-
come available for a fiscal year for grants under sec-
tion 2611, the Secretary shall make grants under 
subsection (a) for such fiscal year to all States that 
seek such grants and meet the condition described in 
such subsection for the grants.
‘‘(2) 
LIMITATION
ON
RESERVATION
OF 
FUNDS.—Effective upon the expiration of the period 
described in paragraph (1) with respect to a fiscal 
year, the unobligated portion of the amount reserved 
under subsection (a) for the fiscal year is available 
for grants under section 2611 for the fiscal year. 
‘‘(c) AMOUNT OF GRANTS.—Each grant under sub-
section (a) for a fiscal year shall be made in the amount 
of $1,500,000, except that the amount of such a grant 
for a territory of the United States shall be $375,000. 
‘‘(d) AUTHORIZED EXPENDITURES.—A grant under 
subsection (a) may be expended for any purpose for which 
a grant under 2611 is authorized to be expended. 
‘‘(e) DEFINITIONS.—For purposes of this section, the 
terms ‘State’ and ‘territory of the United States’ have the 
meanings that apply to such terms for purposes of grants 
under section 2611 (including the meanings that apply for 
purposes of section 2618).’’.
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