THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, July 25, 1995 TAG: 9507250001
SECTION: FRONT PAGE: A10 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 62 lines
Each year, 4 million American women become pregnant. Of those 4 million, according to the federal Centers for Disease Control and Prevention estimates, 7,000 are HIV-positive. Of their babies, 2,000 will be HIV-infected at birth. Studying what prevents most babies from contracting HIV from their mothers may help direct science to a cure. Meantime, a recent study indicates that the drug AZT, administered during pregnancy and through labor and delivery, reduces the chances of HIV transmission from mother to baby from about 25 percent to about 8 percent.
So CDC now recommends that counseling about HIV and offering an HIV test become routine in public and private prenatal care. Fine. Counselors who educate women in the ways HIV is contracted can more fully advise them about their pregnancy and their general health.
A coalition of AIDS organizations and religious groups is lobbying for a further step. They want mandatory HIV testing of all newborns included in the reauthorization of the Ryan White Care Act, which funds AIDS treatment.
But is mandatory testing, at public or private expense, necessary for all those millions of newborns necessary? Particularly in a time of budget constraints in the public and the private sectors, is that the wisest use of health-care dollars?
Fewer than .002 percent of pregnant women are HIV-infected. Their numbers are not distributed evenly through the population. Some groups are far more at risk of HIV infection than others. Isn't testing, particularly at public ex-pense, better directed at those populations primarily at risk?
In women as in men, AIDS is overwhelmingly a behavior-based disease. The latest year for which CDC has data is 1993, a year in which the definition of AIDS was widened to include symptoms that may precede AIDS in women:
Of the 12,789 new cases of AIDS in American women, 72% were African American (7,171 cases, or 56%) and Latino (2,091/16%).
Of those 12,789 infections, 63% were contracted from injecting drug use (5,983/47%) or sex with an injecting drug user (2,042/16%); 18% were contracted from heterosexual sex, primarily unprotected and-or anal sex.
New cases among females ages 13-19 rose 275 percent, from 57 to 157.
New cases among females ages 20-29 rose 116 percent, from 1,370 to 2,962. New cases among females ages 30-39 rose 125% from 2,715 to 6,131. New cases among females ages 40-49 rose 102%, from 1,245 to 2,523.
Most of this population is low-income. The greater burden for testing newborns for HIV infection would fall on public funds. But the presumption that all women of child-bearing age who receive Medicaid are at risk for AIDS is repugnant. So is a presumption against asking them about risky behaviors and counseling them about AIDS' consequences and treatment for women and babies.
A cost-effective national policy will distinguish between the infected and the uninfected, and target certain groups of women (and men) to discourage behaviors that facilitate HIV transmission and encourage measures that prevent it. A national policy that pretends pregnant women are equally at risk of AIDS might spare some feelings. But scarce public funds are better spent on the basis of facts than feelings. by CNB