County Weighs HIV Tests of Pregnant Women

The Los Angeles County Board of Supervisors today will weigh in on the emotional issue of HIV testing of pregnant women, considering a proposal that would require doctors at county clinics to discuss the availability of such tests with their patients and, even more controversial, probing the legality of forcing all pregnant patients at county facilities to undergo the tests.

Of the 29,961 AIDS cases reported in Los Angeles County at the end of September, 174 have occurred among children. In 106 of the pediatric AIDS cases, the virus was transmitted by the mother.

Noting the steep rise of such cases in recent years, county health officials had already initiated a program, scheduled to begin Jan. 1, that would offer HIV testing at 40 clinics that provide prenatal services.

But Supervisor Mike Antonovich, who is pushing the testing plan, feels that the program should be expanded to require that discussion of AIDS testing becomes a vital component of the doctor-patient dialogue, even with women who are not at high risk of contracting the virus.

*

“It’s great the test is going to be available, but if women don’t know if they are at risk for HIV, they won’t know whether they need a test or not,” said Antonovich deputy Kathryn Barger. “We think a discussion of HIV testing should become a part of the routine treatment of pregnant women at county facilities; it’s in their best interest.”

County health officials offered guarded support for the proposal but said it could raise problems.

“It was our intent all along that women be offered the test and be advised of the pluses and minuses,” said John F. Schunhoff, director of the AIDS program in the Department of Health Services. “But whether we can mandate that all doctors bring up HIV testing is something we’ll have to discuss with county counsel. There might be instances where a physician for one reason or another might not think it’s appropriate. It’s something we’ll need to talk to the medical staff about.”

Antonovich’s proposal comes at a time of growing debate over how far authorities should go to check the spread of AIDS. Because of its rising incidence, the disease is expected to become one of the leading causes of death among women of reproductive age if current trends continue.

Los Angeles County is home to one-third of all HIV-positive babies born in the state, according to county health officials. Health officials have concluded that more widespread HIV testing of pregnant women can be an important health care tool.

Those conclusions have been supported by recent studies that found that giving the drug AZT to HIV-infected pregnant women can dramatically reduce the transmission of the virus to the fetus.

Based on these studies, Antonovich wants a legal opinion from counsel as to whether county health facilities can force women at high risk for AIDS to be tested, an idea that has generated heated opposition.

“If you consider the costs of providing AZT to the mother versus the costs of treating babies with full-blown AIDS and you can prevent these babies from being born HIV-positive, then it’s well worth fighting to get that test,” Barger said.

But mandatory testing of pregnant women has found little support in the AIDS community.

“I don’t support it,” Schunhoff said. “There is still a stigma attached to AIDS and you run the risk of driving people away.”

Others point out that California law already prohibits mandatory AIDS testing, unless ordered by a court.

“They don’t need to seek an opinion from county counsel; they can’t do it,” said Phill Wilson, director of public policy for AIDS Project Los Angeles, a nonprofit organization.

Wilson argued that the recent AZT studies should not be used as an instrument to force testing on pregnant women.

“While we are pleased with the possibilities that the outcome of the studies offer to populations that could be impacted, the studies are limited to a narrowly defined group of people and cannot be used to make a broad-based argument for mandatory testing,” Wilson said.

An attorney with the American Civil Liberties Union of Southern California called the Antonovich proposal a “political ploy.”

“It’s politics playing with public policy,” said Jon Davidson. “What evidence is there that women who may be HIV-positive are rejecting the HIV testing that is being offered? It seems to me to be a typical Antonovich response.”