A pregnant woman may be a bit reluctant to undergo testing for HIV/AIDS as she may be feeling that it is really not required. However, it is very essential that the women be actually educated and counseled about the need to conduct HIV testing. It is important that the women be demonstrated the risk factors through which HIV/AIDS can be caused. These include having unsafe sex with an infected person, sharing needles with an infected person, using contaminated blood and blood products and also from infected mother to the child.
The woman may not know the HIV status of her sex partner, and hence she could be at a risk of getting infected with the disease. In such a circumstance, testing for HIV/AIDS would be vitally required. The women should also be assured that following testing for HIV/AIDS she would not be discriminated or harmed in anyway. She should be told that testing is being done to protect her and her child from being affected with the virus.
Studies have shown that once a pregnant has been counseled about mandatory testing for HIV, she would definitely undergo the procedure and be ready to even receive treatment for the disease, as she would not like her child to suffer from the ill-effects (Erin Nicholson. 2002). Some of the women may also be ready to face the side-effects of treatment with Zidovudine, provided they are convinced that the drug would significantly reduce the chances of their baby developing the disease. According to the Constitution of the US, the states have the power of creating and enforcing any legislation so that public health and safety is guaranteed.
In case the rights of an individual clashes with the rights of the public, the rights of the public would prevail. As the women would be transmitting the disease to another person (that is her child), she could be putting public health at stake. The state has to give greater amount of priority for public health than for the health of a particular individual. However, in this case it can also be seen that once the health of the public is protected, automatically the health of that particular individual is also protected.
As pervious studies have shown that the vertical transmission of HIV/AIDS has reduced through appropriate testing, it should be considered as a public health measure. Studies have also shown that most women who test positive for HIV/AIDS would be willing to undergo treatment for the disease with ARV. Studies have shown that HIV/AIDS during childhood can have very severe effects. Most babies infected with HIV rarely survive beyond childhood. Hence, it is vital that the government ensures that babies do not get infected with HIV.
Besides, vertical transmission, babies do not have any other risk factors that would cause HIV. If this risk is reduced, then one segment of the population would automatically be protected from the disease. Besides, children are the future of any social group, and if their health is put at risk, it would have a serious ill-effect. In the US, about 280 to 370 children are born with HIV infection, annually. To ensure that these figures do not rise, it is essential that testing be conducted. In 1992, the figures were about 902 annually (CDC.
2001). This goes on to show that testing was able to reduce infection in children to a great extent. It would be advisable to reduce these figures further by ensuring mandatory testing for HIV infection continues. Many women may abuse the child during the pregnancy stage. Some women may continue to have unprotected sex with multiple partners and even consume illicit drugs. They would be using contaminated needles which would increase the risk of spreading the disease. Besides, such women may refuse medical care during the pregnancy period.
They may totally neglect their health, and the health of the child. Besides, some women may feel that there is a low risk for transmission of HIV and that their healthcare providers are not offering HIV testing services due to a perceived low risk. In order to prevent such abuse of the child, it is essential that mandatory testing of all pregnant women be conducted (CDC. 2001). The state has to take care of the child in case the mother abuses it. Once HIV testing is conducted more often, pregnant women population would perceive that such a screening procedure would ensure their health.
The procedure to undergo HIV testing should be simplified, which would certainly increase a positive response from the public. If testing is provided to all pregnant women on a universal basis, without taking into consideration whether the women has been exposed to any risk factor/s, then would the public response be truly positive. However, there have also been certain arguments against mandatory testing for HIV/AIDS in pregnant women. Zidovudine is known to cause several side-effects, and these could be very severe, especially in pregnant women.
Some of the toxic effects of Zidovudine include headache, anemia, bone marrow depression, nausea and vomiting. The virus can become resistant to the drug especially during the pregnancy period. Many people feel that Zidovudine should not be utilized in human beings as it can produce serious side-effects. The drug works by attacking the DNA synthesis. When the mother consumes Zidovudine during pregnancy, several birth defects may develop in the baby including development of defective limbs, abnormalities in the vital organs, etc.
However, it is very important in every case that the benefits and risks of treatment be measured, and only if the benefits outweigh the risks, should the drug be administered. Zidovudine can help prevent the development of a fatal disease, and would definitely benefit the developing baby if a high risk is present. Many physicians feel that these side-effects of Zidovudine may be transient, and the body may recover when the drug is stopped. At present very little data is available regarding the long-term effects of Zidovudine, and these need to be further researched (Erin Nicholson. 2002).
Another argument that needs to be considered is that there may be a high number of false positive cases with the HIV tests. Usually ELISA is performed, which is a preliminary test for HIV infection. The number of false positive cases with this test is high. There have been about 4000 false positive tests for the virus (Erin Nicholson. 2002). This test only detects the presence of antibodies to the HIV antigen in the blood. It actually does not detect the presence of the HIV antigen or the virus. In several circumstances, HIV antibodies may actually be present in the blood, but the individual may not actually be infected.
Such a situation exists when the maternal antibodies present in the maternal blood cross over into the placenta and enter fetal blood. Such babies may actually turn out to be HIV positive through the ELISA test when their HIV status is determined at birth. However, after sometime, the may turn out to be HIV negative (once the maternal antibodies disappear). Hence, it is very important to conduct confirmatory tests for HIV, once the preliminary tests actually suggest a positive result (Erin Nicholson. 2002).
The Westergen Blot test is a confirmatory test for HIV which actually determines the presence of the HIV antigen in the blood. This is a highly sensitive and specific test. Before starting with ARV therapy, it is essential that HIV status of the mother be confirmed with the Westergen Blot test (Erin Nicholson. 2002). Only if the mother is positive through this test, should the ARV therapy be started. Many people feel that even though three-fourths of the babies who test positive for HIV at birth may become negative later, the need for Zidovudine treatment is actually not needed.
However, it should be said that as the ultimate HIV status of the child cannot be predicted, it would be difficult to classify those women who are indicated for treatment and those who are not (Erin Nicholson. 2002). Many women feel that mandatory testing of HIV could lead to discrimination and further problems for them at the healthcare unit, society, home and the workplace. However, it is important to mention that, the physician and the healthcare organization would have to keep the information of the woman’s HIV status confidential as per the laws.
Any discrimination against the HIV positive patient is a violation and can handled according to the laws. Other women feel that there may soon be a crackdown of the legislation against the HIV positive patients, and the lawmakers may start making laws such that it really harm the interests of the HIV patients. However, it is important to note that no law would be initiated unless there is a strong scientific backing. Even if the laws framed by the legislation seem to violate an individual’s or a group of individuals’ fundamental rights, they could be challenged in a Court.
From my study of the laws required to prevent spread of HIV infection from the mother to child, I do feel that the initiation of such legislation is best done in the interest of the pregnant woman and her child. This law is based on strong scientific backing and does not tend to discriminate a HIV positive patient. The mother should be guaranteed that her fundamental rights would be protected and all information regarding her HIV status would be kept confidential. The mother should also keep in mind that if the interests of her baby are being maintained, automatically would her interests also be maintained (CB Smith.
2007). Thus she should cooperate and accept mandatory testing. The risk of transmitting HIV to the child would be below 2 % if mandatory testing is conducted and ARV therapy initiated on time (CDC. 2001). Mandatory testing of HIV may be required to ensure that such test can be simplified and be conducted on a routine basis, in the near future. At present a visible alternative to mandatory testing and subsequent ARV therapy may seen unrealistic. No other study has shown as effective results as mandatory testing along with ARV during pregnancy.
Hence, at least in the present world, mandatory testing for pregnant women for HIV should continue. Research in the field of HIV should be conducted to determine a more effective solution. Vertical transmission of HIV is the only way a newborn can be affected with the disease (CDC. 2006). To prevent this form of transmission, mandatory testing is definitely required.
References:
CB Smith, MP Battin, LP Francis et al. “Should rapid tests for HIV infection now be mandatory during pregnancy? Global differences in scarcity and a dilemma of technological advance. ” Developing World Bioeth.7. 2 (2007): 86-103. Center for Disease Control. “What is AIDS? ” 2005. CDC. 12 Jul. 2007. http://www. cdc. gov/hiv/pubs/faq/faq2. htm Center for Disease Control. “What is HIV? ” 2005. CDC. 12 Jul. 2007. http://www. cdc. gov/hiv/pubs/faq/faq1. htm Center for Disease Control. “Acquired immunodeficiency Syndrome (AIDS). ” 2005. CDC. 12 Jul. 2007. http://www. cdc. gov/travel/diseases/hivaids. htm Center for Disease Control. “Mother-to-Child (Perinatal) HIV Transmission and Prevention. ” 2006. CDC. 12 Jul. 2007. http://www. cdc. gov/hiv/resources/factsheets/PDF/perinatl. pdf