Legal and ethical principles mandate that informed consent be an integ
ral element of HIV-related education, counseling, testing, treatment,
and intervention. Minimizing patient counseling and education (for eco
nomic reasons or otherwise) is likely to backfire. The presumption tha
t a parent will act in her child's best interest, accepted in analogou
s contexts, should be foundational in the development of HIV policy in
the obstetric and gynecologic setting. Most women, when provided with
counseling, care, and confidentiality, consent to prenatal or perinat
al testing and, most important, engage their families in HIV-related c
are and services. Because of the changing terrain of knowledge about a
nd treatments of HIV disease, providers must thoroughly counsel women
regarding the risks and benefits of available treatment and interventi
on.