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Thousands of HIV-positive women give birth every year to HIV-positive infants. What can we do to eliminate this tragic and costly inheritance? This study evaluates the extent to which state efforts have been effective in reducing the perinatal transmission of HIV. The committee recommends that testing for HIV be a routine part of prenatal care and that health care providers notify women that HIV testing is part of the usual array of prenatal tests and that they have an opportunity to refuse.