Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, February 22, 1991                   TAG: 9102220627
SECTION: EDITORIAL                    PAGE: A-7   EDITION: METRO 
SOURCE: MARIE C. McCORMICK
DATELINE:                                 LENGTH: Medium

WOMEN AND CHILDREN/ DON'T MANDATE AIDS TESTS

More than 14,000 cases of AIDS among women were reported as of October in this country. The large majority of women with AIDS are between the ages of 15 and 44, which helps explain the increase in the number of children born infected with HIV, the virus that causes AIDS.

Society must act decisively to prevent additional suffering from AIDS. But one thing we should not do, and which some health experts have suggested, is mandate routine screening of all pregnant women and newborns for HIV.

Not that screening is bad; it can be extraordinarily valuable in identifying patients who need treatment. Pregnant women infected with HIV who have severely depressed immune systems can benefit from current AIDS therapies. Women who learn they are infected also can make more informed reproductive choices.

So the problem is not "screening" but "routine." A committee of the Institute of Medicine at the National Academy of Sciences has concluded that the HIV test is unlike most routine medical tests because a positive result can carry such profound psychological and social consequences. Individuals should take it only by choice.

Routine does not mean mandatory. In theory, women would retain the right to refuse a routine HIV test. Yet, in reality, many women might not know they can refuse the test. It is essential that HIV screening remain voluntary and that women be tested only after providing written informed consent.

The reason for caution is that many women now infected with HIV face discrimination in employment, housing, and access to health care and insurance, as well as in obtaining reproductive health services. It is unethical to mandate screening if needed counseling and follow-up services cannot be ensured for those who test positive. In many instances, such a guarantee is impossible.

With confidentiality safeguards in place, voluntary HIV testing should be offered to all pregnant women in areas where HIV is highly prevalent. Women who have not been tested prenatally should be offered testing at the time of delivery, or soon thereafter, with appropriate counseling before and after the test.

Not every state will choose to provide this service. Rates of HIV infection among women vary widely across the United States, and some states - particularly those with few cases of infection - may decide to spend their resources on other health services. But those who do decide to offer HIV screening must be committed to developing adequate health and social services for HIV-infected women and their children.

The case for routine HIV screening is even less compelling for newborns. Although an infant's own blood is examined, the test reveals only whether the child's mother is infected with the virus. If so, there is roughly a one-in-three chance the infant will be infected. Treating all infants born to HIV-infected mothers would result in all uninfected infants being exposed to toxic therapy without deriving any medical benefit. Also, newborn screening is tantamount to involuntary maternal screening, which is ethically unacceptable.

What is acceptable, and already being done across the country, is something quite different - anonymous HIV screening of newborns by public-health researchers tracking the course of the epidemic.

The calculus of routine screening could change. The argument for it becomes more convincing as the certainty of the benefits to those who test positive - in the form of treatments or a cure - increases.

For now, however, the only routine thing about HIV screening should be that it remain anonymous for newborns and strictly voluntary for pregnant women.