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HIV Testing of Newborns

[Religion News Service, August 8, 1995] 

A few years ago a small item appeared in the newspaper of the American Medical Association: some clinics in New York were secretly testing women for HIV, and refusing to give abortions to the ones they found positive. The motive: self-protection. One doctor said they were "unhappy about the risk. We’re being splashed with amniotic fluid and blood, and it scares us." Another said he was afraid the staff would contract HIV through exposure to the patients’ tears.

Tears. A pregnant woman who is HIV positive has many reasons to shed tears. All the same, few of the ones who know their condition choose abortion. With so much loss in her life, at least she can send a child as an arrow into the future. What’s more, though HIV can be transmitted from mother to unborn child, most babies don’t contract the disease. Though many test positive at birth due to antibodies from the mother’s blood, only 25% or so will actually turn out to have the condition. Odds are good that the child of an HIV positive mother will be healthy.

Odds just got much better. In December 1993 a study by the National Institutes of Health found that HIV positive women who took the medication AZT during pregnancy were far less likely to transmit the disease to their children. The rate of transmission dropped from 25% to 8%; there was now over a 90% chance babies would not contract HIV from their moms. The results were so startling that further testing was called off so that the life-saving treatment could be made available.

Other factors make the future still brighter for the children of HIV mothers. The unpleasant, expensive blood test can be replaced by a new saliva-based method that is 98% effective and only costs $3. For those babies whose AZT treatment didn’t begin during pregnancy it can start at birth; for some children this will prevent the disease, while for those who are HIV positive it can keep them healthy far longer, stretching lifespan into their teens (when, we can hope, new discoveries may give them yet more years). The mother found to be HIV positive can be cautioned not to breastfeed, thereby avoiding transmitting the disease the child missed in the womb. Precautions can prevent pneumonia in HIV babies who would otherwise be susceptible. For many reasons, the future for these supposedly-doomed children is growing brighter.

The key to all this lifesaving is determining which babies are at risk, and the only way to tell that is by testing: testing the mothers during pregnancy or the babies at birth. But therin lies the problem. A positive test for the baby discloses the mother’s HIV status. A haze of political resistance surrounds HIV testing, the result of years of fears that HIV means homosexuality, and homosexuality means discrimination. A positive result is imagined to reveal a whole lifestyle, one that people might prefer to keep private.This is absurd when the patients are newborn babies, but absurdity is not always sufficient corrective.

Privacy seems so precious that the National Organization for Women and the National Abortion and Reproductive Rights Action League oppose telling mothers the results of their babies’ tests. This knowlege would invade her privacy, they say, and in some unspecified and unimaginable way might undermine Roe vs. Wade. The Gay Men’s Health Crisis likewise fears that if the test results are allowed to the mothers, somehow the confidentiality of gay men’s tests will be breached. In the name of this vaunted privacy, mothers take home babies without knowing they are sick—babies who could be helped by AZT, and hurt by breastfeeding. Of course, privacy doesn’t last forever, and eventually the illness asserts itself till it cannot be concealed. By then it is too late.

Across the political divide, anti-abortion groups are suspicious of any kind of pre-natal testing. Much of routine testing aims to disclose conditions, like Down Syndrome, that cannot be treated, and as a result disabled babies are killed. Testing for HIV prompts fears that these babies might be aborted too. The problem is deceptive; after all, unborn babies that are discovered to have HIV might be saved with treatment. It does no good to smuggle them to birth by concealing their HIV status, only to have them die later of the disease.

Besides, abortion doesn’t seem to be the choice of these moms. Shepherd Smith of Americans for a Sound AIDS/HIV Policy says, "Guess how many women we have worked with who have aborted. Zero. They understand they don’t have much time left; they want to have the child."

When the House takes up the Ryan White CARE Act for AIDS funding in the coming weeks, it will consider an amendment sponsored by Tom Coburn (R-OK) to require testing of newborns who weren’t tested before birth. The amendment also encourages counseling, testing, and treatment of HIV positive women, and protects those tested from losing health insurance. The list of groups supporting the amendment includes all the major anti-abortion organizations, but the gay-rights and abortion-rights groups are absent. Here’s hoping that they, too, see the light.

Because a pregnant woman with HIV has many things to weep about. But worrying about a sick baby doesn’t necessarily have to be one of them.

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