Alberta Reappraising AIDS Society

David R. Crowe, President
Phone: +1-403-289-6609
Fax: +1-403-206-7717

Roger Swan, Treasurer
Box 61037, Kensington Postal Outlet
Calgary, Alberta T2N 4S6
Phone: +1-403-220-0129

Mandatory HIV Testing for US Mothers

David Crowe
Mothering Magazine
September/October, 2003

The US is slipping closer to mandatory HIV testing. Only two states (Connecticut and New York) have explictly mandatory testing, but the CDC is encouraging other states to move from voluntary testing after counseling to ‘opt–out’ testing without counseling. [MMWR, 2003] If a women refuses to be tested, doctors are now encouraged to test the baby.

Women will be encouraged to think of the HIV test as just another ordinary test that every responsible woman should have, even if they do not think that they are at risk.

What happens after a positive HIV test to a pregnant woman is anything but normal. She will be pressured to take the antiretroviral drug AZT to reduce the risk of HIV transmission to her baby, she will be told not to breastfeed, possibly to have a caesarean section, and she will be pressured to give antiretroviral drugs to her baby.

They are unlikely to be told that “AZT is a Genotoxic Transplacental Carcinogen in Animal Models” [Olivero, 1997] nor of the horrifying list of side effects associated with this drug [aras, 2003]. AZT is a defective replacement for Thymidine, one of the building blocks of DNA, and acts as a random DNA chain terminator in the nucleus or the mitochondria (the cell’s energy regulators). It is particularly damaging when rapid cell division is occurring, such as in a fetus.

HIV–positive mothers are also unlikely to be told that there has never been a study showing that health risks due to the possibility of HIV transmission by breastfeeding (which is estimated to occur in 1/7th of breastfed babies) outweigh the considerable risks of formula feeding by all babies of HIV–positive mothers.

If women refuse any of these interventions they may well face legal action. In the Tyson case in Oregon [Wolf, 2001] the parents refused to formula feed and use AZT, were taken to court, and lost.

Most women may conclude that they are not at risk, taking the test is just going to prove that they do not have HIV. But, this is playing Russian Roulette. Assuming that the test used is 99% accurate, 1% of tests in people without HIV will come up positive. If only 1 out of 1,000 people in a low–risk population are actually positive, false positive tests will outnumber true positives by 10 to 1. With the OraQuick rapid test that the CDC is promoting [CDC, 2002] 1 out of 14 women with previous pregnancies falsely showed positive [FDA, 2002]. The use of Western Blot tests as confirmation will reduce this, but one recent paper showed a 3% error rate on this test. There is no way to unambiguously detect infectious HIV in the body, so there is no way to distinguish between a true and a false positive. [Daar, 2001]

A woman may feel that the HIV test is a modern morality test. Accepting the test is proof that she has led a blameless life. Refusing the test indicates that she has something to hide. But, if she succumbs to the pressure, rolls the dice and finds herself in the small minority who test positive, she will have entered a system from which it is difficult to escape.

Further Reading

[aras, 2003] AZT: Unsafe at Any Dose?

[CDC, 2002] HIV/AIDS Surveillance Report; U.S. HIV and AIDS cases reported through December 2001. CDC. 2002; 13(2).

[Daar, 2001] Daar ES et al. Diagnosis of primary HIV–1 infection. Ann Int Med. 2001 Jan 2; 134(1).

[FDA, 2002] Premarket approval information – OraQuick Rapid HIV–1 Antibody Test. FDA. 2002 Nov 7.

[MMWR, 2003] Advancing HIV prevention: new strategies for a changing Epidemic – United States, 2003. MMWR. 2003 Apr 18; 52(15): 329–332.

[Mahe, 2002] Mahe C et al. Human immunodeficiency virus type 1 Western blot: revised diagnostic criteria with fewer indeterminate results for epidemiological studies in Africa. Int J Epidemiol. 2002 Oct; 31(5): 985–90.

[Olivero, 1997] Olivero OA et al. AZT is a Genotoxic Transplacental Carcinogen in Animal Models. J Acquir Immune Defic Syndr. 1997 Apr 1; 14(4): A29.

[Wolf, 2001] Wolf LE et al. When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency Virus Transmission. Arch Pediatr Adolesc Med. 2001; 155: 927–33.