For Dr. Wilbert Jordan, the dilemma over mandatory HIV testing has no urgency--nearly all the women he sees already know they are HIV-positive.
"The ethical dilemma at my doorstep comes in the form of all the infected women who want to get pregnant, who want to have a baby," says Jordan, a busy infectious disease expert.
While a recent study showed that use of the antiviral drug AZT early in pregnancy may save many babies from AIDS, the medicine apparently does not provide total protection against mother-to-child transmission. And, of course, it has no way of guaranteeing how an infected mother's baby will fare.
"Give me 10 women today who come into my office (at King-Drew Medical Center) and at least half of the women will be wanting to get pregnant. That makes for some very sharp and poignant ethical issues," Jordan says. "I have a woman right now. She came in with her boyfriend. She is HIV-positive but healthy. I can't play God. She looks good. And with AZT, there is a good chance the baby can be born negative.
"We talk about that and she says to me, 'I want to have this child. (My boyfriend) loves me. The Lord is telling me to have this child.' I say you decide what you want and I'll help you with whatever decision you reach. What else can I say? It's troubling, but this is such a personal decision. . . ."
But Jordan, who heads the city's Black AIDS Consortium Commission, says he is not always so supportive. "It's a different story when a woman comes in with her boyfriend or husband and she's wanting to (bring up the baby) alone.
"These are very desperate women. Many of them have been abandoned by their families. What better way, they think, than to have a baby to love and love you?
"This burning desire to leave a legacy when you are faced with death yourself is not something affecting only African American women. Like many . . . who are trying to leave a mark here before they die, they feel the best thing they can leave is a baby."