Thanks to scientific advances, we have the means to protect most newborns from the HIV virus. The question has become: Do we have the will?
By taking AZT during her pregnancy, an HIV-positive mother can dramatically reduce _ by two-thirds _ the risk that her fetus will be infected, a breakthrough study told us two years ago. The stronger "protease inhibitor" drugs approved earlier this year hold out the promise of even better results.
Now comes the latest encouraging news from this month's Vancouver AIDS-prevention conference: Reducing a mother's time in labor after her water has broken and delivering by Caesarean section can also reduce the risk of prenatal transmission.
But this bounty of good news means nothing if the mother does not know she is infected.
Most of the 1,114 Florida children infected with the virus contracted it from their mothers during pregnancy. The Centers for Disease Control and Prevention continues to urge that pregnant women and their newborns be tested for the virus. Rightly, Florida doctors are now required by law to counsel and offer the test to their patients.
While voluntary programs are good, they are not good enough. For various reasons, many women refuse to be tested. By doing so, they doom children who otherwise could likely be saved. Pregnant women and newborns have long been tested for a variety of potentially life-threatening conditions. Hasn't the time come to require them to be tested for HIV, too?
The American Medical Association, for one, thinks so. The group _ which has favored only voluntary testing in the past _ just endorsed mandatory HIV testing for all pregnant women and their newborns. For most members, the new breakthroughs tipped the scales.
"We have learned enough about the disease to know that the differences in those who are treated versus those who are not treated cuts by two-thirds the risk to the unborn child," said Dr. Robert McAfee.
Until now, mandatory testing proposals have fallen under the weight of concerns over the mother's rights of privacy and personal choice. Opponents have argued that women, who might be subjected to discrimination, should have full say over their pregnancies. Since privacy is always fundamental, those concerns held sway when treatment was much less successful. But medical breakthroughs have since rendered that balance unjustifiably irresponsible and needlessly deadly.
Privacy claimed at the expense of an infected child is tragically ironic. A pregnant woman who decides not to be tested cannot avoid knowing her own and her child's HIV status for long. Sooner or later, the virus will make itself known.
Nat Hentoff, a nationally renowned civil rights advocate, is among those pushing for mandatory testing. He makes his view on the privacy argument plain: Mothers who do not take the test "will keep their privacy intact. But their children will have the privacy of the grave."