Bill Targets Transfer of HIV to Infants

Doctors would be required to offer a voluntary HIV test to all pregnant women in California -- even those in stable marriages -- under a bill the Legislature sent to Gov. Gray Davis earlier this month.

The bill’s purpose is to prevent the human immunodeficiency virus from being transmitted from mothers to their babies. There have been 44 confirmed cases of babies being born with HIV in California since 1998, according to the state Department of Health Services.

It is now up to individual doctors to offer voluntary HIV tests to their patients. If the bill becomes law, all pregnant women must be offered an HIV test during prenatal exams and a short counseling session about why the test is important. A woman could turn down the test and face no repercussions.

The test would be done using a blood sample that is currently taken to determine blood type and check for hepatitis B. Preliminary results for HIV could be delivered to the woman in 20 to 30 minutes if doctors use a new rapid HIV test introduced earlier this year.

“If you prevent one child from being HIV positive it’s a worthy test,” said Assemblyman John Dutra (D-Fremont), who wrote the bill, AB 1676.

Davis has not yet decided whether he will sign the bill, said Davis spokesman Russ Lopez. Davis vetoed a similar measure last year that would have allowed doctors to perform an HIV test during a pregnancy unless a woman refused.

Last year, Davis said his rationale for the veto was that the tests would be perceived as mandatory. Therefore, he said, women in high-risk groups for HIV -- such as drug users -- might shy away from prenatal care for fear of being reported to authorities if their test were positive.

The Dutra bill is widely backed by doctors’ groups, including the California Medical Assn., the American College of Obstetricians and Gynecologists and the American Academy of Pediatricians.

A pregnant woman can pass HIV to her baby while it is in the womb, during birth or by breast feeding.

Nationally, medication and voluntary testing has helped reduce the number of babies born with HIV from about 1,760 in 1991 to 280 in 2000, according to the U.S. Centers for Disease Control and Prevention. If HIV is detected before birth, doctors can virtually eliminate any chance of transmission with the use of highly effective medications.

This past spring, the CDC issued a recommendation that all pregnant women be tested for HIV unless a woman specifically refuses.

Some doctors already routinely offer such tests to their patients, but it’s unclear exactly what percentage of women are tested during their pregnancies. One recent study in Ohio by the Medical College of Ohio in Toledo that found only 42% of physicians offered HIV tests as part of their standard prenatal exams.

Officials with the Los Angeles-based AIDS Healthcare Foundation, one of the largest AIDS organizations in the country, said the Dutra bill would result in few additional women being tested because it’s still a voluntary measure.

The group argues that a procedure requiring a patient to opt out of a test rather than volunteering for one would result in more women being tested.

“This [bill] is just a very slight variation on the current situation,” said Michael Weinstein, the foundation’s president. “A lot of doctors will talk to women and say ‘You don’t need this. You’re not at risk.’ ”

Some doctors, though, believe that more people would take the tests if they were offered alongside the many other tests that women undergo as part of their prenatal exams.

“The key is that HIV testing should be routine,” said Dr. Andrea Kovacs, the director of the Comprehensive Maternal-Child and Adolescent HIV Management and Research Center at Los Angeles County-USC Medical Center.

“The onus starts with the doctor offering the test.”