Mandatory HIV/AIDS testing for Pregnant Woman
Today, anti retroviral therapies are being developed by several manufacturers, in a bid to finally be able to reduce the number of instances of the transmission of HIV from mother to child. The drug AZT, for example, has been successful at bringing the rate of such direct transmissions down, and this has given rise to a widespread feeling that if testing of pregnant women for the presence of the dreaded AIDS virus were to be made mandatory, then perhaps many lives could be saved. It must be remembered that before the year 1994, when AIDS became renowned for its impact on the human body, not much was known about the disease, often referred to as ‘the scourge of modern man’, and nothing at all was known about the transmission of this disease from a mother to her unborn child.
It was in late 1994 that an American clinical trial known as ‘ACTG 076’ was able to prove the assumption that when a drug AZT was administered to a HIV positive pregnant woman, and also to her child immediately after its birth, it was able to lower the rate of transmission from a high of 25 % to a low of 8 %. The trial was based on the fact that the pregnant woman had to be given the drug during her pregnancy, during her labor, during her delivery, and for the newborn baby during his first six weeks of life.
Immediately after the results of this trial were published, the US Public Health Service recommended that all HIV positive pregnant women must be given the drug, especially to those women who demonstrated a likelihood of developing the disease. This was to include women who had never taken drugs of any kind against HIV AIDS. The administration of the drug, of course, involved an invasion of the woman’s basic privacy, and this was something that created a stir at the time. Such invasion of privacy was not to be tolerated. (Yovetich)
As stated earlier, making HIV testing mandatory for a pregnant woman, in the hope that the woman’s unborn child could be given a better and more productive and disease free life was not as simple an issue as it may have sounded at the time. There was much opposition from several different quarters. The main reason for the opposition was that the woman’s private life would be exposed, as HIV was a disease that was clothed in much secrecy, and it still is today. Defenders of privacy of a human being fought a long war to oppose mandatory testing of all pregnant women for the dreaded AIDS/HIV virus.
To test a woman against her will, and then inform her that she had AIDS, and that she must take the drug so that her unborn child would not develop the disease would be a rather intrusive method to follow, felt privacy defenders, even if such testing meant that the risk of transmission to others would be reduced, and many lives could be saved in the future. However, the several advances in science through the years until today have prompted many individuals to reconsider the issue today.
Several people ask themselves today, are the potential benefits of mandatory testing for AIDS/HIV in some contexts outweighing the privacy interests? Or, on the other hand, is such an invasion of privacy completely justified if the unborn child could be saved from a life of disease and eventual death?
It must be noted that several experiments and trials have been able to prove beyond a reasonable doubt that when a pregnant woman is tested for AIDS, and it is found that she is HIV positive, and she is then offered the drug that would combat the transmission of the disease to her unborn child, and she takes up the offer, then the chances of the unborn fetus being born with full blown AIDS would be reduced dramatically.
Statistics have revealed that such therapy would successful bring down the rate of transmission from a high of a one on four chance, to a one in fifty chance. Such evidence has prompted a rash of proposals on the part of the governments to make the testing of HIV/AIDS mandatory for a pregnant woman. To date, it must be noted that only the legislatures of New York and Connecticut have been able to sanction mandatory programs that would impose HIV tests on a pregnant woman, without her consent, wherein she would be able to turn down the ‘offer of testing’ put forth to her.
Although it may be true that at first glance, one would not be able to understand why anyone would wish to turn down an offer to save their unborn child, it is indeed a fact that science today has not yet advanced so far as to absolutely guarantee that the young pregnant woman would not pass on the disease to her child, like for example, statistics are able to prove that even if a pregnant woman has no medication at all for her AIDS, she still has only a one in four chance of transmitting the virus to her unborn child.
This is because of the simple fact that a mother transmits the disease to her child during the process of delivery, which is the time when the infant would be exposed to the blood of his mother, without the protection of the umbilical cord that has connected him to his mother all the nine months. In other words, statistics prove that intra-uterine transmission, that is, transference of the virus before delivery, of AIDS to the unborn infant is quite rare, and it does not take place in one out of four cases. AIDS and HIV can also be transmitted to the child after its birth, through breast feeding.
Furthermore, it is important to remember that when an infant is born to an HIV-positive mother, HIV-antibody tests carried out on the newborn will always turn out to be positive, for the simple reason that the baby has would have inherited the HIV antibodies of its mother automatically during the birth and delivery processes, and this cannot be taken to mean that the newborn is infected with AIDS and HIV. In these cases, the antibodies that the baby has inherited would stay in his body for the first few months of his life, after which it would be replaced with his own. If the HIV testing is done on the infant at this stage, it would reveal the actual status of the child, rather than if it were to be done immediately after birth, which would often mislead the persons involved. (The ACLU on HIV testing of pregnant women and newborns 2001)
It is a sad fact indeed that the data on AIDS in America and in Canada indicated that almost 766 out of 824 pregnant and HIV infected women from twenty five states of the United States of America were aware of their HIV status much before their deliveries, yet there are about 280 to 370 peri-natal HIV transmissions in the country, every year. Researchers and scientists state repeatedly that the only way in which to control this dismal state of affairs would be to make HIV/AIDS testing mandatory for pregnant woman, despite opposition from several quarters.
In Canada, for example, three different HIV testing approaches have been assayed, and medical records and relevant data have shown without doubt that the so called ‘opt-in’ or voluntary testing approach, in which a pregnant woman is offered pre-HIV test counseling, and must give her consent voluntarily to an HIV test is generally related with lower testing rates than the ‘opt-out’ voluntary testing approach, in which the woman, who has had HIV/AIDS counseling, may choose to refuse HIV testing. As a matter of fact, even the mandatory newborn HIV testing approach proved to be ineffective, and the testing rates were much lower than expected, although they were better than the ‘opt-in’ testing method. (HIV testing among pregnant women, United States and Canada 1998 to 2001 2002)
Today, with the governments across the world, especially in developed countries responding to the HIV/AIDS epidemic, women seem to be at the center of all the attention, and increasingly, global efforts at AIDS prevention seem to center on women, especially pregnant women who may transmit the dreaded AIDS virus to their unborn child, either before or after delivery. Most governments are taking advantage of the fact that medicines and drugs are available today, which would be able to effectively block the transmission of the virus to an infant, and these governments are using the drugs to make sure that the AIDS virus would not spread far and wide. One such government initiative is the ‘PMTCT Program’, or the ‘Prevention of Mother to Child Transmission Program’.
It must be stated here that although the benefits of this and other similar programs may be tremendous, it is very important that the government takes into consideration the experiences of a pregnant woman who lives with AIDS, and the trauma that she undergoes as a direct result. The government must also learn to adopt a human rights perspective when it deals with a pregnant woman, and issues that concern her privacy. As a matter of fact, several governments seem to have forgotten, state human rights personnel, about the woman with AIDS, so keen are they on the prevention of the transmission of AIDS to the unborn child.
Herein lies the crux of the issue: if the woman were to be treated as a patient, who is suffering from a dreaded and fatal disease, who needs treatment for the disease, and who has human rights as an individual, then it would be infinitely easier to deal with the issue. In other words, if the governments were to respect the woman who is harboring the AIDS virus, and treat her with basic human dignity and respect, it would ensure that her unborn child who is the future citizen of the country, and the future of his family would be better served.
When this is taken in light of the fact that women are three times as likely as men to develop HIV/AIDS, and that a woman is physiologically more susceptible than a man to developing the infection through vaginal intercourse, it would seem that according a woman the deference that she deserves would be the best approach to the problem. In certain under developed countries, women have been reported to say that when they were diagnosed with AIDS, they were asked to abort their unborn fetuses, as they supposedly ‘had no right to pass on the infection to their unborn baby’. In such cases, it is evident that the feelings and the rights of the woman were not considered in any way, and this is by no means uncommon.
Although PMTCT Programs have today gained in popularity, and it is being touted across the world as being the one surefire method to control AIDS, these programs do implicate a certain invasion of the privacy and dignity of the woman concerned, especially in countries where the woman is denied the right to give informed consent to HIV/AIDS testing and treatment, probably because of a lack of education, and she is also denied her right to confidentiality. When this is taken in context of the stigma associated with AIDS in several countries, it is obvious that the program must be refined and restated, if it were to be a success. (Pregnant woman living with HIV n.d)
To conclude, it must be said that although mandatory testing for HIV/AIDS may be an excellent idea and that it would help prevent the transmission of the virus to a woman’s unborn child, the program must be implemented while keeping in mind the human rights, the right to confidentiality, and the basic human rights of the woman suffering form the disease. If this were to be done, then one can look forward to a world in which the awful HIV/AIDS virus would be eliminated, and the world would be a safe place once more.
Yovetich, Tasha “Making it mandatory, should HIV tests be required for pregnant women?” The Canadian Women’s Health Network (1999) 13 December 2007
“The ACLU on HIV testing of pregnant women and newborns” HIV testing of pregnant women and newborns (2001) 13 December 2007
“HIV testing among pregnant women, United States and Canada 1998 to 2001” MMWR Weekly (2002) 13 December 2007
“Pregnant woman living with HIV” Reproductive Right.org 13 December 2007 (n.d)