Prenatal Testing for HIV

The transmission of HIV from infected pregnant women to their infants is a significant health problem in the United States and around the world. This discussion addresses a set of recommendations issued by a US Public Health Service task force (led by the National Institutes of Health and the Centers for Disease Control), urging that pregnant women be tested for HIV, counseled, and offered the option of zidovudine therapy, which has been found to significantly reduce the rate of HIV transmission during pregnancy and labor. This paper also explores the related legislative, ethical, and cultural issues surrounding mandated HIV testing of pregnant women and newborns.

The perinatal transmission of HIV has reached epidemic proportions. Perinatal transmission of HIV is now a major cause of death among children in the United States. Based upon data available as of the end of 1995, more than 90 percent of reported cases of pediatric AIDS were acquired through mother-to-infant HIV transmission (1:1664). During the past 20 years, more than 15,000 children have been infected, and more than 3,000 have died as a result of HIV infection. Without any therapeutic intervention, the rate of transmission is between 15 percent and 40 percent.

In 1994, the National Institutes of Health (NIH) announced results of a clinical trial that demonstrated the value of therapeutic intervention with zidovudine for HI

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nfected. Critics contend that the law will lead to forced testing of mothers, since a positive result in a newborn indicates that the child has the mother's antibodies. A positive result in the infant does not necessarily mean the infant is infected, but it does confirm that the mother is HIV-positive. Most AIDS advocates oppose the law on the basis that it violates privacy rights of pregnant women. Poor women fear that the information may lead to loss of custody of their children, housing, and other benefits. Apart from the ethical issues of testing and screening, the practical challenge of successfully administering zidovudine, especially in certain health care settings, remains substantial. In one study, zidovudine therapy offered to an impoverished population of pregnant women in an urban, HIV-endemic environment was not widely accepted (5:1504). In this study, all known HIV-infected pregnant women receiving prenatal care and delivering at Bronx Lebanon Hospital Center from February to August of 1995 were informed of the results of the NIH clinical trial and then were given the choice of participating in all or any part of the zidovudine course of therapy. Acceptance of the NIH recommendations and compliance with zidov
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Approximate Word count = 1916
Approximate Pages = 8 (250 words per page)

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