as critical to ensuring a pregnant woman's compliance with the complex course of treatment needed for herself, her child, and possibly her older children.
The National Medical Association (NMA) position on HIV testing of pregnant women, presented by Dr. Rani Lewis, asserts that (1) all health care professionals should offer counseling and voluntary HIV testing to all pregnant women on a confidential basis; (2) health care professionals should offer ZDV therapy to pregnant women and newborns without attempting to coerce treatment; (3) amniocentesis, fetal scalp electrode placement, or measures that lead to prolonged rupture of the fetal membranes should be avoided, as should breast-feeding; and (4) confidentiality, while extremely important, should not extend to withholding test information from other health care workers, such as pediatricians, for whom the information has medical significance. Dr. Lewis also observed that women who refuse testing are most likely to refuse treatment for themselves and their children. Some low-income and minority women view testing as threatening because, in their eyes, the diagnosis and the hospital experience in general are equated with death. She expressed concern that mandatory testing would leave women who refuse treatment for their children vulnerable to allegations of child abuse. She also noted that the NMA is very concerned about heightening discrimination against a population that already experiences a disproportionate share of discrimination. In view of the public health emphasis on testing, she stressed the importance of providing equal emphasis on funding for counseling and treatment. The NMA position was developed by its AIDS Task Force and adopted by its Executive Committee. The NMA is a 175-year-old organization for physicians of color and physicians who primarily care for patients of color.
Most of the discussion centered on NMA's support for disclosure of test results to other health care professionals, despite the importance of confidentiality. Some participants claimed that disclosure would act as a deterrent to testing, to which Dr. Lewis responded that NMA accepted the fact that some women would be deterred, but felt that disclosure to the pediatrician was paramount.
Mr. Tim Westmoreland, the Washington representative of the Elizabeth Glaser Pediatric AIDS Foundation, served as the respondent to the panel of medical organizations. His foundation favors counseling and voluntary testing of all pregnant women. He pointed out that mandatory testing not only discourages women from testing, but also ushers in the possibility of mandatory treatment. He described mandatory testing of newborns as a bad opening to what necessarily will become a complicated relationship between the physician and the family. The test itself is the simplest part of the newborn's HIV diagnosis and treatment.