Mandatory HIV testing of New York newborns

New York hospitals began mandatory HIV testing of newborns Feb. 1 in accordance with a state law passed last summer. The testing program, the first of its kind in the nation, requires hospitals to eliminate consent forms and to inform mothers if the test is positive for HIV.

Consent has been a troublesome issue in the new program, because HIV testing of newborns reveals whether the mother is infected. The test detects only the mother’s antibodies in the baby’s system because the HIV virus cannot be detected in the baby at birth.

Screenings of newborns began in New York several years ago, with hospitals conducting blind tests to collect statistical data. Last May, hospitals started asking for written consent to inform mothers of test results. However, the new legislation specifically exempts women immediately after childbirth from the public health law that requires informed consent for all medical tests.

Hospitals have expressed concerns that the new law will do more harm than good. Because hospitals must track down and inform women who test positive, officials worry that the testing could prompt high-risk women to avoid healthcare facilities.

Informed consent should have remained voluntary, according to Jeannie Cross, assistant vice president of the Healthcare Association of New York. “If a woman is afraid that testing will lead to drug investigations, or that she is at risk of her baby being taken away, then she won’t seek good prenatal care,” Cross said. “This is a misdirection of resources.”

In fact, healthcare leaders agree that prenatal testing offers a better opportunity to prevent the spread of HIV infection from mother to child than postdelivery screening. That’s because babies born to HIV-positive mothers who are treated with AZT prenatally and during delivery have only about an 8 percent chance of contracting the virus. A baby treated after delivery may benefit from the drug, but will likely remain infected.

New York State Health Department spokesperson Frances Tarlton said the mandatory newborn screenings should not replace prenatal testing and counseling, but should work as “a final safety net.”

Since HIV can be transmitted through breast milk, newborn testing that indirectly reveals a mother’s HIV status could influence the counseling she is given about breast-feeding. Data from August, September, and October 1996 reveals that 93 percent of mothers gave voluntary consent for receiving test results during that time, and 269 babies were born to HIV-positive mothers. Of those, 171 women had been tested before delivery, while another 53 learned of their HIV status through their newborns’ test results. Tarlton said the mandatory screening “has identified some babies who would have otherwise slipped through the cracks.”

Some hospital officials expect workload problems, increased overhead, and red tape with the new program. But Tarlton said that most hospitals may get only two to five cases of positive test results from the program each year, while inner-city locations may see three a month.

 

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