HIV infection, pregnant women, and newborns: a policy proposal for information and testing

Article Abstract:

The incidence of infection with human immunodeficiency virus (HIV) is increasing among women, children, and infants. Women accounted for 10 percent of AIDS cases reported to the Centers for Disease Control (CDC), and it was estimated that children will account for 3,000 cases of AIDS by the end of 1991. Most of these children will have contracted HIV infection from their mothers during childbirth. With this increased incidence of AIDS in women and children, there is growing interest in programs to screen pregnant women and newborns for HIV infection. The presence of HIV antibodies, or immune proteins that specifically attack HIV, in the newborn indicates only that HIV antibodies produced by the mother were passed via the circulation to the infant. Hence, screening for HIV confirms HIV infection in the mother but not necessarily in the infant. Only 30 percent of HIV-infected mothers transmit HIV to their newborns infants. The prevalence of HIV infection in women is greater in certain ethnic groups. The CDC reported that over 70 percent of cases of AIDS occurred in Afro-American and Hispanic women, who usually contract the disease by intravenous (IV) drug use or sexual intercourse with an IV drug user. The decision to screen pregnant women and children should be made after consideration of moral, legal, and policy issues. Some groups have argued for mandatory screening, whereas others have advocated offering testing to high-risk or all pregnant women. It has also been suggested that HIV-infected women should be offered counseling to discourage them from becoming pregnant or bearing children. A 10-point policy program for HIV screening, which was developed by the Working Group on HIV Testing of Pregnant Women and Newborns, is described. The program advocates informing all pregnant women and new mothers about the AIDS epidemic and the availability of HIV testing. In addition, voluntary screening is favored, and counseling and screening policies that interfere with the reproductive rights of a woman or that unfairly stigmatize certain social groups are discouraged. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ethical aspects, Medical screening, Health screening, Pregnancy, AIDS (Disease), AIDS (Disease) in pregnancy

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The HIV-testing policies of US hospitals

Article Abstract:

Concern about possible exposure of hospital staff to HIV-infected patients has recently increased, leading to a situation of potential conflict between staff members' need to know whether patients are infected, and patients' rights to confidentiality. To learn more regarding HIV-testing policies in acute-care hospitals, a random sample of 561 private and public hospitals was studied. The chief administrator of each facility received a letter explaining the study, followed some time later by a 15-minute telephone interview. The questions concerned the hospital's history with respect to the admission of AIDS patients, its HIV-testing policies, and the origin of those policies. Results showed that 83 percent of the institutions had admitted at least one patient with AIDS. Fewer than 10 percent had admitted more than 20 AIDS patients during 1988. Slightly more than 83 percent of the hospitals had a written HIV-testing policy, and the factor that had been most influential in developing such a policy was staff members' fear of being infected. A detailed presentation of the elements of the hospitals' testing policies appears. Many (78 percent) required that the patient's informed consent be obtained before testing for HIV; however, notification of the patient in the event of a positive result was required in only three out of four hospitals. Half the hospitals required that test results be placed in patients' charts, to "protect" insurers. Certain policies, such as review of treatment plans for HIV-positive patients, could result in substitution of a less dangerous for a more dangerous procedure; more administrators said such reviews were commonly made because of staff fears of infection (25 percent) than because of potential benefit to the patient (23 percent). Balancing patients' rights against the rights of health care providers is not an easy task for institutions in the face of the AIDS epidemic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Surveys, HIV patients, Hospital patients, Medical policy, Health policy, Hospital administrators

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HIV counseling and testing services, public and private providers - United States, 1990

Article Abstract:

A survey of 40,513 US residents during the 1990 National Health Interview Survey found that 24% of those surveyed had been tested at least once for HIV infection. Almost half of those with one or more risk factors had been tested at least once. Of those who volunteered to be tested, 45% said they had received counseling prior to the test, and 31% said they had received counseling after the test. Two-thirds were tested at a private facility such as a doctor's office, hospital emergency room or an employer clinic. Individuals at risk were more likely to be tested at a public facility such as a public health department or AIDS clinic. This was also true for blacks and Hispanics, individuals on a low income and those with little education. Physicians and hospitals should provide counseling to individuals before and after their test, and be prepared to refer them for appropriate treatment and other social services.

Services, Medical offices, Voluntary health agencies

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