July 16, 1998

Not so long ago, you could reasonably argue that it wasn’t fair to demand that pregnant women get tested for AIDS. The infringement on the woman’s freedom of choice in the matter could be called a greater risk to society than the potential benefit to the unborn child.

Now that equation has been completely turned around. At the recent international AIDS conference in Geneva, a study by Jennifer Reed of the National Institutes of Health found that women who combine weeks of pre-delivery AZT with an elective cesarean have less than a 2 percent risk of passing the disease on to their infants. The study of 8,533 pairs of infants and mothers also showed that the risk of transmission was reduced to 5 percent when the women took AZT but delivered vaginally. Typically, newborns of HIV-positive women who neither take AZT nor have a cesarean have a 25 percent chance of getting HIV.

An incredible advance. But it’s only of value if women and their healthcare providers know the mothers-to-be are HIV-positive in time to begin the AZT treatment and to plan for the cesarean before their membranes break.

Yet consider the policy implications. Since experts now say that AZT and a cesarean can virtually guarantee a newborn an HIV-free childhood, we could mandate that women be tested for the disease when they seek prenatal care. Some will argue—as they have for years—that such a move would drive women away from getting prenatal care out of fear of learning they are HIV-positive or having someone else find out. Yet what would be worse for the fetus: running the risks of not having prenatal care or being born with a 25 percent chance of being HIV-positive?

It’s a touchy issue, especially since people with HIV and AIDS have real concerns about health coverage and potential discrimination. Any time the government mandates a blood test or a treatment it smacks of Big Brother.

But it’s not just the woman’s own health that’s at stake. There’s an 8- or 9-month-old fetus that is almost without exception going to be walking and talking in about 13 months. If AZT and a cesarean can almost be sure to give the baby a life without HIV, the restriction of the woman’s right to avoid the test and the treatment seems a relatively small price to pay. It’s time to make HIV testing for mothers-to-be a mandatory and routine part of prenatal care.

What price is a healthy baby worth to society? What do you think?

Barbara Bronson Gray, MN, RN
Editor in Chief

Illustration by Malcolm Garris/PhotoDisc

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