AIDS Testing for Pregnant Women Urged : Health: An expert committee says voluntary screening should be offered in areas with high prevalence of the human immunodeficiency virus.
The AIDS antibody test should be offered to all pregnant women who live in areas where there is a high prevalence of the deadly disease, an expert committee of the Institute of Medicine recommended Tuesday.
But such screening for infection with the human immunodeficiency virus should be strictly voluntary and only occur with written informed consent, said the committee, a part of the National Academy of Sciences.
Screening for pregnant women “can be an important health care tool” allowing early identification and treatment of HIV infection with drugs that have been shown to delay the onset of fully developed AIDS. Further, the information will enable women to make a “more informed decision” regarding reproduction, the committee said.
“Ultimately, the woman must decide whether to continue or terminate an existing pregnancy in the face of HIV infection,” the panel said.
Of the 154,791 AIDS cases reported in the United States as of the end of November, 15,133 have occurred among women and 2,734 among children, according to the federal Centers for Disease Control.
More than 80% of the children with AIDS acquired the infection during gestation or at the time of delivery, the panel said. AIDS is expected to become one of the five leading causes of death among women of reproductive age if current trends continue, the CDC has said.
Because diagnosis of HIV infection “can have powerful psychological and social consequences,” the committee emphasized that women should have the right to refuse to be tested.
“Prenatal HIV screening should not be mandatory because of the multitude of costs involved,” said Dr. Marie C. McCormick, committee chairwoman and associate professor of pediatrics at the Harvard Medical School. “There are great psychological and social costs to women who test positive for HIV, including the threat of discrimination in health care, employment and access to housing.”
The HIV antibody test “does not qualify as a benign, routine medical test that may be performed under the conditions of general or presumed consent,” which is the case with many routine medical tests, the panel said in its report.
The National Academy of Sciences is a congressionally chartered, private organization that advises the federal government. The Institute of Medicine has previously issued several highly regarded reports that address responses to the decade-long AIDS epidemic.
The panel recommended against routine testing of newborns, saying such screening “cannot be justified at present” because such tests are inconclusive in newborns.
The committee also opposed newborn screening on the grounds “that it is tantamount to involuntary maternal screening.”
“Using newborn HIV screening to identify HIV-infected mothers would also mean that postpartum women currently would be the only civilian, non-institutionalized adult population not given the opportunity to consent to or refuse HIV testing, an outcome that is ethically unacceptable,” the panel said.
However, the committee strongly endorsed continued anonymous screening of newborns for research purposes.
This approach provides “unbiased epidemiological data for monitoring national and local trends in the distribution of HIV infection, particularly among childbearing women,” the panel said.
