Should HIV Testing for Pregnant Women Be Mandatory?
General Reference (not clearly pro or con)
Candace Johnson Redden, PhD, Associate Professor in the Department of Health Sciences at Brock University, wrote in her Spring 2002 article for Polity titled “Health as Citizenship Narrative”:
“Bioethical issues such as mandatory HIV testing for pregnant women and newborns require a delicate and difficult balance between public health interests and respect for individual privacy. The stigma attached to HIV positive status is grave and vilifying. This makes the privacy of individuals of paramount importance… But this concern for individuals and their privacy – as a means of preserving their freedom – does not amount to a workable strategy for the welfare of a community…[This] type of bioethical dilemma… was directly recognized to be a matter of national importance by Canada’s National Forum on Health, and indirectly has received similar attention in the United States through the National Institutes of Health… Of course, the opening of such a discussion is politically dangerous, as views tend to be polarized and held passionately. This often means that governments neglect deliberation altogether, or try to farm it out to more ‘neutral’ organizations or leave the issues to be debated within the confines of organized medicine and academe.” Spring 2002
Elyse Levinsky, MD, Gynecologist at New York’s Mount Sinai Hospital, wrote the following position in the July 2003 Parkhurst debate “Mandatory HIV Testing: Should Screening in Pregnancy Be Compulsory?,” published on the Parkhurst Exchange website:
“The primary prevention strategy is to maximize prenatal HIV testing of pregnant women… Clearly, the ideal situation is compliance with voluntary testing. Unfortunately, this isn’t always feasible.[Mandatory] action fulfills the beneficience principle for the mother by enabling her to get help and initiate antiretroviral therapy, and for the fetus by decreasing the risk of transmission. Testing would prevent further spread of infection to other individuals in society. Compulsory screening may also reduce the negative economic impact that infections such as HIV and AIDS have on society.” July 2003
David Horowitz, Founder of the David Horowitz Freedom Center, wrote the following position in his Aug. 21, 2001 Salon.com article “Unnecessary Deaths from AIDS”:
“This march of death is made possible by the surrender of public health authorities to the pressures of political groups opposed to what once had been the standard procedure for fighting epidemic diseases like AIDS: testing. Without testing of at-risk individuals and groups, there is no way to insure that individuals will know their lives are in danger, or that they are endangering the lives of others. Yet irresponsible zealots have successfully removed mandatory testing from the government’s arsenal of weapons available in the battle against AIDS…
AIDS activists have long threatened that if testing is made mandatory, at-risk groups… drug-addicted pregnant women, visitors to clinics, or residents of neighborhoods with a high incidence of the disease… will seek to avoid both tests and treatment… And yet belief in this absurdity is killing nearly 1,000 young people in this country every week of every year. It is this obstructionist attitude by people who claim to be leaders of the battle against the disease that has created the present situation.”Aug. 21, 2001
Amitai Etzioni, PhD, Founder and Director of The Communitarian Network at George Washington University, wrote in his Nov. 1997 paper “HIV Testing for Infants and Pregnant Women: A Case Study in Privacy and Public Health,” published by The Communitarian Network at www.gwu.edu:
“It should be noted… that privacy is not an absolute value, and does not trump all other rights or concerns of the common good…
While it is true that… other diseases [do not] carry the same stigma as HIV, and hence do not raise the same privacy concerns, the main concern involves both the health of the baby and the mother… In fact, when health officials implemented mandatory testing of infants for sickle cell disease, many of the same objections facing unblinded HIV testing were raised…
I already suggest that the child’s right to life and health takes precedent over the mother’s right to privacy… Allowing children to develop a severe illness or die, when these outcomes can be avoided, is demeaning to the community… [W]e are not merely right-bearing individuals but also members of communities that have responsibilities for others.”Nov. 1997
Nettie Mayersohn, New York State Assemblywoman, wrote in an article published in the Apr. 1997 issue of Liberty and Limits:
“Opponents have argued that we should focus on counseling and voluntary testing during the prenatal period, rather than mandatory testing… However, prenatal counseling and testing are useless for those babies whose mothers never access prenatal care, an all too common scenario for HIV-infected women who may also suffer from other societal problems such as poverty and drug abuse.
In addition, any woman who enters a hospital to give birth understands that the baby may be born with medical problems. What she does not need is for special interest groups with other agendas to decide what information she can cope with and how much should be withheld. Only in the world of AIDS has privacy and secrecy been given a higher priority than prevention and treatment. This is not good medical care – this is insanity!”Apr. 1997
The American Civil Liberties Union (ACLU) wrote the following position in its Jan. 1, 2001 article, “The ACLU on HIV Testing of Pregnant Women and Newborns,” published on its website www.aclu.org:
“Proposals for mandatory HIV testing of vulnerable populations have always met strong resistance from defenders of privacy. Testing people against their will and then telling them their HIV status is hardly the best way to offer effective treatment or persuade people to take steps to reduce the risks of transmission to others…[I]f the state has the power to force a test, does it have the power as well to force unwanted treatment? What about taking away a parent’s right to decide the treatment for her child? Mandatory testing of pregnant women can only make sense when the state is willing to do all three, because without the treatment, testing may be a hollow gesture…
The science can make a compelling case that early testing of pregnant women, with counseling about the benefits of treatment, is a very good idea. But it’s not so compelling that the tests should be mandatory… [I]ntervention without the cooperation of women throughout the course of treatment and care for the child will not help reduce transmission, and is likely only to worsen womens’ trust in the health care they do receive.”Jan. 1, 2001
The HIV Law Project, a New York based nonprofit legal organization, wrote the following position in its article “HIV Testing: Pregnant Women and Newborns,” published on its website (accessed July 25, 2010):
“[T]he personal stories of pregnant women and women who have just given birth are too diverse, and the passion and fear associated with HIV are still too intense, to rely on compulsory testing as a successful solution…
A woman experiencing intimate partner violence, for instance, might well fear that an HIV diagnosis would trigger an escalation of violence. Another woman may reasonably fear that her job will be in peril if she learns that she has HIV. Others may fear that estrangement from family and community would flow from an HIV diagnosis, and might choose ignorance over isolation.
For these women, coercion is neither an appropriate nor effective basis upon which to build a provider-patient relationship, or to begin the process of long-term care and treatment. It is precisely in those cases where women fear testing that mandatory or coerced HIV testing drives a wedge between patient and health care provider.”July 25, 2010
The Council on Scientific Affairs of the American Medical Association (AMA) issued a report, updated in July 2002, titled “Universal, Routine Screening of Pregnant Women for HIV Infection,” published on the American Medical Association’s website, in which it stated:
“When mandatory premarital HIV testing was implemented in Illinois, the number of marriage licenses issued greatly declined. Thus, mandatory testing may actually reduce the number of pregnant women seeking prenatal care, especially those in high-risk populations…
If pregnant women are required to be tested for HIV… ethical and legal questions will then arise concerning a state’s ability to force a woman to submit to antiretroviral therapy for the benefit of her infant even if she does not want such treatment. Antiretroviral therapy is extremely complex, especially during pregnancy, and requires the active participation of both the patient and her physician. Finally, states would also have to consider the ethical and legal ramifications of whether or not to punish a woman who refuses HIV testing, antiretroviral therapy, or both…
Mandatory programs would have the greatest direct costs and place the greatest burden on women’s constitutional rights… [T]he benefits of mandatory testing are minimal and may lead to avoidance of prenatal care to elude mandatory testing.”July 2002
The Body, an online HIV/AIDS resource, in an Aug. 2000 paper titled “Striking a Balance: HIV Testing for Pregnant Women and Newborns,” published at its website, wrote:
“A testing policy that doesn’t allow a woman to make informed decisions violates her right to be an active participant in her own healthcare. Coercive HIV testing also runs the risk of alienating women from HIV testing and appropriate follow-up care. This may be especially true for certain groups of women, including immigrants.
In the worst cases, coercive, involuntary, or poorly handled testing could cause a woman to leave care altogether. If the goal of public health efforts is to ensure that every pregnant woman is able to access and use the information and care that will benefit her and her unborn child, efforts to mandate testing or treatment should be defeated.”Aug. 2000