'Mandatory' HIV testing during pregnancy

New Jersey has recently made it law that all pregnant women must be tested for HIV with the hope of making the test as 'routine as ultrasound' (and you all know what I think about ultrasound already). The testing is 'mandatory' as it is in a number of states and will be active in six months. Illinois and New York already require HIV testing for newborns. According to the new law, women will only be permitted to refuse testing on the basis of religious reasons. “Early detection is the key,” Senator Loretta Weinberg, a Democrat from Bergen County who sponsored the bill, said in a statement. “This measure is a huge step forward in terms of protecting all babies while helping to educate mothers.”

I have a huge problem with this new scheme. No one wants to see babies infected with HIV (or mothers for that fact), however, this new bill seriously impacts upon pregnant women's autonomy and is tantamount to the same issues of fetal rights American women have been experiencing since Roe v. Wade. Whilst testing is referred to as the best step in preventing the spread of maternal-fetal HIV transmission, American lawmakers have not fully thought out the implications of testing and treatment. In essence, this method of umbrella testing is incomplete treatment. Once women have the information that they are HIV positive for example, what happens next? Is the New Jersey state government going to spring for retroviral drugs? If the baby is born with HIV as well will the medical costs be covered?

Women who are forced to be tested will not necessarily seek out treatment on their own and cannot be forced to be treated for the disease or to take special precautions against transmitting the disease during pregnancy to the fetus. So what is the point of mandatory testing? In fact, forced testing, like forced treatment, is medical intervention without consent. A study in Michigan (where testing is also mandatory) examining the effects of the new law found that "fewer than half of the women felt very comfortable refusing testing, and one in five did not feel at all comfortable refusing HIV testing." Women who were unemployed, had fewer contacts with the health care system, and were younger were still less comfortable refusing the test. In Arkansas, which also has an opt-out testing program that doesn't require written consent, another study found that "16% of women tested did not even know that they had been tested for HIV." This is a serious problem for all women let alone minority groups, women who do not speak English and poor women with limited access to quality medical care.

I am not necessarily disputing the public health benefit in diagnosing the mother, but in the possibility of preventing infection outright in the fetus. But establishing a right for the fetus to have the mother tested is very scary. "Testing during pregnancy, labor or right after birth, tests the woman's status, not the baby's, and thus should only be done with her informed consent - it shouldn't be mandatory," observes Jennifer Rudinger, executive director of the ACLU in North Carolina. "We would far prefer legislative efforts to increase access to comprehensive prenatal care - including HIV testing - during pregnancy, at a time when the woman can make informed decisions about her health, can choose to take certain medications during pregnancy, and can arrange ahead of time to have a C-section to reduce the risk of transmission." And the New Jersey bill, ACLU chapter executive director Deborah Jacobs, argues, "needlessly sacrifices the rights of women and parents" and "deprives women of their moral authority to make decisions for themselves and for children."

If such programs are to be introduced, continuing medical care, including highly active antiretroviral therapy, must be provided and pregnant women must have reasonable alternatives to compulsory testing and treatment.

Source: http://www.nytimes.com/2007/12/27/nyregion/27hiv.html?ref=nyregion