Reducing the Odds Preventing Perinatal Transmission of HIV in the United States (1999) / Chapter Skim
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C Workshop I Summary
C Workshop I Summary
Pages 190-202
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From page 190... ...
guidelines for universal counseling and voluntary testing of pregnant women for HIV (CDC, 1995~. This summary covers workshop topics on the origin of the PHS guidelines; the positions of medical organizations; state policies and laws to implement the PHS guidelines; and the history and implementation of a mandatory newborn testing law in New York State.
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From page 191... ...
The PHS adoption of voluntary, as opposed to mandatory, testing was recommended for the following reasons: the policy had widespread support, particularly from patients for whom adherence to a demanding drug regimen is essential for prevention of transmission; mandatory testing was thought to be a deterrent to prenatal care; the risks of testing positive (e.g., discrimination and domestic violence) would outweigh the benefits in some cases; and experience had indicated that a high rate of acceptance was achievable since more than 90% of women accept testing when offered in several reported studies.
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From page 192... ...
They began by considering a resolution to rescind mandatory testing, but, again after heated debate, the recision resolution was successfully reversed to reaffirm the need for mandatory testing. The AMA's position on mandatory testing is an outgrowth of its earlier policy that testing should be voluntary, unless the benefits of newborn testing are demonstrated sufficiently to warrant mandatory testing.
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From page 193... ...
During the discussion, Dr. Gwendolyn Scott was asked why the AAP favored voluntary testing and what evidence it considered about the deterrent effects of mandatory testing for women seeking health care.
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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.
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Finally, he observed that support for mandatory testing provides a false sense of accomplishment for policy makers, because it may absolve them of responsibility to address the more complicated issues of financing research, treatment, and other forms of patient care. STATE LAWS AND POLICIES ON HIV TESTING OF PREGNANT WOMEN AND NEWBORNS Preliminary results were summarized from a survey of state laws and policies to implement the PHS guidelines or prevent perinatal transmission through other measures.
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From page 196... ...
representative observed that implementation of the PHS guidelines to reduce perinatal transmission requires coordination at many levels and between providers and payers. State laws that require providers to offer HIV counseling and testing to pregnant women may be more effective if there are laws or requirements to report on compliance.
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From page 197... ...
Ms. Mayersohn saw the situation as "criminal to deny the most innocent and the most helpless victims of the epidemic the care to which they are entitled." She successfully advocated for mandatory newborn testing, but she did not support mandatory testing of pregnant women.
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From page 198... ...
He framed the question of mandatory versus voluntary newborn testing as one that weighs the potential harm to the mother, in terms of her privacy and autonomy, against the interests of the child. He preferred voluntary testing, performed in the prenatal setting and with consent, to mandatory newborn testing.
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From page 199... ...
One of the women whom Ms. McGovern represents, a 25-year-old woman who is also the mother of a six-month-old daughter, relayed her own experiences with the mandatory newborn testing program in New York.
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Dr. Etzioni argued that programs to educate providers and pregnant women were likely to be more expensive than New York's newborn testing program, but the costs alone should not determine whether the approach is voluntary or mandatory.
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U.S. Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women.
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From page 202... ...
202 REDUCING THE ODDS American College of Obstetrics and Gynecology Michael Greene American Academy of Pediatrics Gwendolyn Scott National Medical Association Rani Lewis Reactions Pediatric AIDS Foundation Tim Westmoreland 1 :00-2:00 Lunch 2:00-3:15 State policies/laws regarding prenatal/newborn HIV testing and counseling Presentation of survey results Zita Lazzarini Reactions AIDS Policy Center for Children, Youth and Families David Harvey Health Care Financing Administration Theresa Rubin National Alliance of State and Territorial AIDS Directors Joseph Kelly 3:15-3:30 Break 3:30-5:00 History and implementation of New York's newborn testing law New York State Assembly Nettle Mayersohn New York AIDS Institute Guthrie Birkhead New York Academy of Medicine Alan Fleischman HIV Law Project Theresa McGovern George Washington University Amitai Etzioni 5:00 Adjourn
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