HIV/AIDS: Panel Recommends Prenatal Testing
The medical and AIDS advocacy communities yesterday reacted swiftly to the Institute of Medicine's recommendation that pregnant women be routinely screened for HIV. Cathy Wilfert, scientific director of the Elizabeth Glaser Pediatric AIDS Foundation, wholeheartedly endorsed the IOM report. She said, "By making HIV testing a routine part of prenatal care, this new proposal could further reduce the number of children born with HIV and may even eliminate mother-to-infant transmission in the U.S. altogether." The foundation has conducted its own media campaign since 1994 encouraging pregnant women to request an HIV test, and persuading health care providers to make prenatal HIV testing the standard of care (Glaser release, 10/14). Rep. Tom Coburn (R-OK), sponsor of a federal HIV-notification bill, said he agreed with the recommendation. "We should have enacted this policy years ago. But because we have put politics above good public health, up to 8,000 babies that could have been saved since 1994 will needlessly suffer and die from the fatal AIDS virus." Coburn proposed legislation in 1995 mandating HIV testing for all newborns, and authored compromise legislation included in the Ryan White CARE Act that established the current voluntary testing policy and set a timetable for states to reduce perinatal transmission or be required to enact mandatory testing (Coburn release, 10/14).
Caveats On Counseling
Several groups were more wary of the recommendation -- endorsing its intended outcomes but voicing concerns about the methods that might be used to achieve them. AIDS Action expressed support for the IOM recommendation, but the group said would work for implementation of a plan that requires pre- and post-test counseling, ensures access to treatment and improves the physician-patient dialogue. Executive Director Daniel Zingale said, "Universal voluntary testing must be implemented thoughtfully and with intent of protecting the health of pregnant women, not tricking them into an HIV test." He cautioned that women may not feel comfortable "opting out" of the test when it is offered, resulting in "test coercion." Zingale added, "The key to making this plan effective is ensuring that it remain voluntary and the key to making it humane is ensuring proper counseling" (AIDS Action release, 10/14). Responding to the report's suggestion that the mandate for pre-HIV test counseling be weakened because they are too time-consuming, some experts were concerned that pregnant women might be tested without being fully informed of the implications of HIV testing and the options that follow. David Harvey, director of the Washington, DC-based AIDS Policy Center for Children Youth & Families, said, "We have concerns about the lack of informed consent, and the whittling away of the pre-test counseling standards. There's a high degree of suspicion and distrust between some patients and health care providers, and the way to build back trust is through the informed consent process" (Brown, Washington Post, 10/15). The Centers for Disease Control and Prevention issued a statement that "it was concerned about the counseling issue" and that "it would study the report's recommendations to see if it should modify its rules" (Leary, New York Times, 10/15).
A Standard Of Care
Marie McCormick of the Harvard School of Public Health, chair of the IOM committee that made the recommendation, said that the more widespread testing is, the less it will be perceived as singling out poor and minority women who are at higher risk for the disease. Prenatal testing, she said, "should become the standard of care." McCormick "said leaving the HIV test largely to the discretion of the obstetricians leads to stigmatization of the test. If every woman is tested, then the test can't be perceived as related to a doctor's judgement of a patient's HIV risk or lifestyle" (Wen, Boston Globe, 10/15). Click here for previous Kaiser Daily HIV/AIDS Report coverage of prenatal HIV testing and perinatal transmission. The online report is available at www.kff.org.