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Should we test for HIV status in pregnant women?
June 03, 1999Dr Lorraine Sherr, Professor Chris Hudson, and colleagues from several UK and European medical schools, have been studying the way other European countries are handling the problem, and found that the major variations between countries reflect the complexity of the ethics involved.
HIV can be transmitted from a mother to her child both during pregnancy and after the baby is born. However, transmission can largely be prevented if the mother knows she is HIV seropositive, and if she benefits from interventions. These include undergoing anti-retroviral therapy in late pregnancy, labour and delivery; opting for a Caesarean Section, and avoiding breastfeeding.
Establishing the HIV status of all prospective mothers should, in theory, enable doctors to advise on appropriate treatment. Many children would therefore avoid being unnecessarily infected with the virus. Blood samples are taken for standard antenatal tests, and it would be easy to test for HIV seropositivity at the same time. However, testing for HIV raises issues of confidentiality, discrimination, and minority rights. When the rights of an unborn child are involved, the ethics of testing are even more complicated.
Does a pregnant woman have the 'right not to know' her HIV status, when the information is relevant to the health of her unborn child?
Does a new mother have the 'right not to know' whether she is HIV positive? Once born, her child has his/her own legal rights to 'optimum care', but an HIV test on the baby would still be an indirect test of the mother.
Dr Sherr and her colleagues looked at the antenatal testing policies of 15 EC countries, and found that each country approached the problem in a slightly different way. Procedures varied from universal mandatory offers of testing, to no official policy at all.
Universal testing has been successful in some countries where it has been made a normal part of the standard antenatal tests. By contrast, in parts of the UK which operate an 'opt-in' policy, the team reports:
"the acceptance rate has been so low as to render the programme scarcely worthwhile, leaving an inevitable legacy of HIV-infected children which could largely have been avoided".
Royal Society of Medicine
Does a pregnant woman have the 'right not to know' her HIV status, when the information is relevant to the health of her unborn child?
Does a new mother have the 'right not to know' whether she is HIV positive? Once born, her child has his/her own legal rights to 'optimum care', but an HIV test on the baby would still be an indirect test of the mother.
Dr Sherr and her colleagues looked at the antenatal testing policies of 15 EC countries, and found that each country approached the problem in a slightly different way. Procedures varied from universal mandatory offers of testing, to no official policy at all.
Universal testing has been successful in some countries where it has been made a normal part of the standard antenatal tests. By contrast, in parts of the UK which operate an 'opt-in' policy, the team reports:
"the acceptance rate has been so low as to render the programme scarcely worthwhile, leaving an inevitable legacy of HIV-infected children which could largely have been avoided".
Royal Society of Medicine
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