Will NJ become 1st state to have Mandatory HIV Testing for moms, newborns?

Re (0.00 / 0)

I don't see how mandating a test - the results of which would be just as confidential as anything else in your medical record - violates your right to privacy.  The worst part is that it will throw away good money testing people who have no chance of being infected.  I'm hard-pressed to say that isn't a good way to waste money, though.

XT

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by: Thurman Hart @ Thu Mar 22, 2007 at 23:12:17 PM UTC

I Agree 100% (0.00 / 0)

The privacy argument is a total red-herring. Obviously confidentiality would be enforced.

And I'd be hard pressed to say that with 1 in 4 persons infected with HIV in this country unaware of his or her HIV status, that this wouldn't be an overriding state concern, especially given:

-New Jersey has the highest rate of HIV infection among women
-New Jersey has the third highest pediatric HIV rate
-New Jersey has the  fifth highest adult HIV rate and
-New Jersey has the ninth highest number of new HIV cases reported in 2005

Given all that, I'm wholeheartedly in support of this idea.

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by: Brian McGinnis @ Thu Mar 22, 2007 at 23:54:09 PM UTC

[ Parent ]

honestly (0.00 / 0)

My initial reaction is the same as the policy institute.  This does seem like an invasion of privacy.  I don't think that the state should be mandating stuff like this.  I wonder how many people would have a problem with mandated HIV testing of the entire population.  For women, it's similar to this.  If we choose to do something that is innate to our biology, and only our biology, and must be tested just because of something innate to our gender, it's simply unfair. What about mandated testing of men who wish to inpregnate a woman? 

As to Xpat's point.  The argument would be early notice/treatment will save money in the long run.

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by: morrisdem @ Thu Mar 22, 2007 at 23:36:06 PM UTC

Re (0.00 / 0)

Good point about not testing men.  Honestly, though, I don't know when such an opportunity would present itself.  Testing babies only would get around your concern - but I'm thinking the correlation between babies born with HIV and mothers who test positive would be fairly high.

I could see a complaint that it is unfair not to test men, but that's a long way from a privacy concern.  I'm just not sure how we'd manage that.  Too many fathers just aren't around when their child is born.  But if we want to mandate testing for both parents, when they are available, I'm open to that. 

XT

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by: Thurman Hart @ Thu Mar 22, 2007 at 23:40:30 PM UTC

[ Parent ]

Women's Bodies are their Own (0.00 / 0)

The larger issue is that once again, the government feels it has the right to make decisions about women's bodies.  Regardless of how good a reason, the government has no right mandating anything concerning a women's body. 

-pb

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by: princetonblue @ Thu Mar 22, 2007 at 23:50:58 PM UTC

[ Parent ]

It's a little different than that ... (0.00 / 0)

The government for the most part doesn't feel it has the right to make decisions about women's bodies.  That's why the vast majority of abortions and contraceptives are legal, and the radical right has only been able to ban specific instances and put some limits on it.  The government actually regularly protects a woman's right to choose, and it is under assault by  radical fringes. 

Second, in the case of an abortion you are discussing the woman's choice alone since the fetus is not a person yet.  But at the end of gestation when labor has begun there are two people in the mix -- the woman and the child.

The question is if the government has a reasonable duty to protect children from acquiring HIV during childbirth, and if that duty overrides the woman's right not to be tested for a certain disease.

You may answer no or yes to that question, but I think it is important to recognize that the question is there.

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by: huntsu @ Fri Mar 23, 2007 at 00:05:17 AM UTC

[ Parent ]

Re (0.00 / 0)

You're gonna have to explain your thinking there.  They aren't "controlling their bodies" they are "testing for an infection". 

In case you missed it, the government already mandates half a dozen tests and immunizations.  That argument seems more than a little hollow to me.

XT

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by: Thurman Hart @ Fri Mar 23, 2007 at 01:00:13 AM UTC

[ Parent ]

Why do they insist on the mandatory nature of public policy. (0.00 / 0)

The law already requires that providers offer HIV testing to pregnant women. I don't see any need to change that. I certainly don't see the need to have to request in writing that medical tests not be performed on my body.

 

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by: Mike Sedita @ Thu Mar 22, 2007 at 23:43:17 PM UTC

Because of the newborn ... (0.00 / 0)

The government's interest in this is not to find out if the woman has HIV, but to protect the newborn from acquiring it.  If the medical providers know that the woman has HIV, they can provide blockers that will be extremely effective in preventing the newborn from becoming HIV positive during birth.

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by: huntsu @ Fri Mar 23, 2007 at 00:06:48 AM UTC

[ Parent ]

the government's interest vs. privacy is certainly the issue (0.00 / 0)

Should the government mandate that pregnant women be tested for genetic disorders then? 

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by: Mike Sedita @ Fri Mar 23, 2007 at 01:15:20 AM UTC

[ Parent ]

That's a Different Question (0.00 / 0)

These are totally different situations, if I see where you are going.

Testing for genetic disorders in the woman at the time of birth is a total waste of time.  It will not help either the woman or the newborn, so the government has no interest in doing so to protect either one of them.  I assume you are suggesting that this genetic disorder test would be to determine if the woman could pass on a genetic trait to the fetus, and abort if it was a possibility.  In this picture you are talking about the interest only of the woman, since the fetus is not a person yet.

But a test for HIV in the pregnant woman at the time of birth allows for treatments that can prevent the transmission to the newborn with no damage to either person.  There are two people, one of whom is helpless to make decisions or protect itself and the government has an interest in protecting that person.

[By the way, I do not like the idea of terminating pregnancies solely on the basis of potential genetic issues, especially if the government would mandate it.  Seems a bit like eugenics to me.  However, I wouldn't stop a woman who wanted to terminate for that reason, even if I disagreed.]

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by: huntsu @ Fri Mar 23, 2007 at 11:03:51 AM UTC

[ Parent ]

Re (0.00 / 0)

There is someone else to consider in the equation - healthcare workers.  One of my twins kicked when the nurse was changing his IV and she got stuck with a dirty needle.  We gave consent for the baby to be tested for HIV and gave the nurse a good bit of peace of mind.  But we didn't have to do so.

Nurses and doctors, I believe, also have some rights.  They don't sign up to become infected with HIV.  At the very least, they have the right to know if they are being exposed.

XT

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by: Thurman Hart @ Fri Mar 23, 2007 at 00:58:51 AM UTC

[ Parent ]

I don't agree with this one ... (0.00 / 0)

I considered that when I was deciding if I agreed or disagreed.  I don't think that the healthcare workers' rights to know if they are at risk outweigh the patient's right to determine their own course of care.

The odds of a newborn or mother being HIV positive combined with the odds on an accident happening combined with the odds of that accident transmitting HIV are infinitesimally small.  I don't think the government has a compelling interest in this, though it would be good for the health workers to know what they were facing.

Whereas the odds of a pregnant woman having HIV combined with the odds of transmitting that to a newborn during birth are comparatively high.  The government has a compelling interest to protect newborns who are unable to protect themselves.

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by: huntsu @ Fri Mar 23, 2007 at 11:07:32 AM UTC

[ Parent ]

HIV Is Transfered During Birth (0.00 / 0)

If the physicians know that the woman has HIV they can prevent transmission to the baby in something like 95 percent of all cases.

The baby -- and at this point I think we can call it a baby -- has no choice whether to be protected from this infection or not.  You have to balance the rights of the woman to privacy and make her own medical decisions with the right of the child not to be infected with HIV.

I think the right not to be infected with an incurable disease that will cost millions of dollars in treatment over the person's lifetime outweighs the right to privacy or to make their own medical decisions.

We already ban abortions after two trimesters (or so) except when it risks the woman's life.  If you want to talk intrusions, that is far greater an intrusion on the woman than drawing some blood for a test.

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by: huntsu @ Fri Mar 23, 2007 at 00:00:26 AM UTC

HIV can be transmitted during birth (0.00 / 0)

but just so we're on the same page - it isn't always transmitted.  It happens in something like 25% of cases.  Following the medical protocols reduces this risk to something like 10% transmission rate. 

It isn't just mandatory testing at issue.  Presumably, if a woman tests positive for HIV those who support the mandatory testing would also require her to go through the medical protocols to reduce the risk of transmission without her consent as well.  I just don't see how forcing procedures and medication is good policy.  It can't be good for the doctor-patient relationship. 

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by: inkling @ Fri Mar 23, 2007 at 14:34:46 PM UTC

[ Parent ]

Why pick on women? (0.00 / 0)

Why pick on women?  Why not make testing mandatory for men too?  Making the test mandatory for women and not men is discriminatory.  Make the test mandatory for pregnant women and the men who got them pregnant; then you get twice as many HIV positive people informed of their conditions and you don't discriminate.

Restricting the law to pregnant women is just the same old state-sanctioned paternalism that the women's movement has been fighting for a hundred years or so, going back to when women didn't have the vote (which was far less than 100 years ago).  If you want to protect society from a disease, don't discriminate against women on account of that disease.  The disease doesn't discriminate.  It attacks women and men.

DBK

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by: DBK @ Fri Mar 23, 2007 at 12:06:43 PM UTC

Re (0.00 / 0)

There are two ways to be discriminatory - one is to pretend differences exist when they don't and the other is to pretend differences don't exist when they do.  A man's experience in the birth of a child is very different than a woman's.  How are you going to account for the times when the father isn't available or even known?

XT

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by: Thurman Hart @ Fri Mar 23, 2007 at 13:20:08 PM UTC

[ Parent ]

Faux argument (0.00 / 0)

That's a faux argument.  If you can't find the father then you can't find the father.  How tough is that?  As for the experience being different, what difference does that make?  Both the mother and father can spread the Human Immuno-virus, and what are we really talking about here?  We're talking about identifying individuals who carry the virus for the purpose of protecting the public health.  Only protecting public health can justify a mandatory testing program to begin with, so why would you want to test only women?  I thought, when I wrote that the virus can attack men as well as women, that was clear.

As a man, I might have to sue the state for discrimination because it would, by testing only pregnant women, discriminate against men.  Rather than seeing the testing as an unwarranted intrusion into our personal lives, we could just as easily view it as an attempt to protect the public health and to find better care for those parties who have HIV and don't know it.  Not testing men leaves men at a disadvantage.

Why does XT hate men?

DBK

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by: DBK @ Fri Mar 23, 2007 at 13:43:56 PM UTC

[ Parent ]

It's not picking on men (3.00 / 1)

to test mothers and children only.  See Huntsu's comments above.  The point of the test is to do everything possible to protect the child from transmition during birth and to be proactive in its health care immediately after birth if transmition does occur.  And hey, if the woman finds out she's HIV positive, all the better for her health care in the future too.

It's true that I only earned a C minus in biology but I did learn this:  female humans give birth.  I even have the stretch marks to prove it- my husband does not.  Testing for something that happens during the birthing process is not gender discrimination, it's a reaction to the biological fact. 

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by: Lacey Davenport @ Fri Mar 23, 2007 at 15:54:24 PM UTC

[ Parent ]

Still not buying it (0.00 / 0)

The logical basis for an invasion of medical privacy like this is to protect public health.  I don't buy that it is only for the sake of infants.  Men get the disease as well but the proposed legislation does nothing to inform men who might not know they are HIV positive.  The business about protecting infants strikes me as a smokescreen to increase acceptability of the proposal.  The effect of the test is that women who might not otherwise know that they are HIV positive will know.  That's an unfair advantage conferred by the state.

I was being a facetious when I said that the legislation is discriminatory against men, but the more I think about it, the more I realize that I accidentally made some sense.

Sorry.  I'll try not to let that happen again.

DBK

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by: DBK @ Fri Mar 23, 2007 at 16:03:12 PM UTC

[ Parent ]

I don't agree with this, either (0.00 / 0)

"The business about protecting infants strikes me as a smokescreen to increase acceptability of the proposal."

No, the entire point is about protecting the newborn.  That is 100% the reason for doing this, and there is no other reason.

Conspiracies exist, but this ain't one of them.

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by: huntsu @ Fri Mar 23, 2007 at 16:20:06 PM UTC

[ Parent ]

Not what I meant (0.00 / 0)

First of all, you are way out of line with the BS about "conspiracies".  Am I supposed to be a conspiracy theorist now because I think there is an element of "selling the legislation" by saying that it protects babies?  You are way out of line.  There's something in the community rules about respect and you are being disrespectful suggesting that I am now some sort of conspiracy theorist.  There is nothing in what I wrote to suggest that.  Shame on you.

Second, have you never seen a piece of legislation "sold" on the basis of, say, protecting babies or something when there were maybe other reasons for the legislation and the stuff about infants was put out there as a way of gaining support?

Third, the effect of the legislation is discriminatory, not necessarily the intent, and the effect of a law is as relevant to discussion of discrimination as the intent.

DBK

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by: DBK @ Fri Mar 23, 2007 at 16:44:44 PM UTC

[ Parent ]

Sorry ... (0.00 / 0)

But suggesting that saying the bill is to protect newborns from getting HIV is just a smokescreen for the real purpose of the bill is suggesting that there is a conspiracy to enact the real purpose of the bill under the cover of newborns.

You may not read it that way, but I do.

However, if you were insulted I apologize.  It was not the intent.

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by: huntsu @ Fri Mar 23, 2007 at 19:26:10 PM UTC

[ Parent ]

Did you really need to do that? (0.00 / 0)

smoke screen or smoke·screen  (sm?k'skr?n')
n. 

  1. A mass of dense artificial smoke used to conceal military areas or operations from an enemy.
  2. An action or statement used to conceal actual plans or intentions.
--------------------------------------
con·spir·a·cy  /k?n?sp?r?si/ Pronunciation Key - Show Spelled Pronunciation[kuhn-spir-uh-see] Pronunciation Key - Show IPA Pronunciation
-noun, plural -cies.
1.  the act of conspiring.
2.  an evil, unlawful, treacherous, or surreptitious plan formulated in secret by two or more persons; plot.
3.  a combination of persons for a secret, unlawful, or evil purpose: He joined the conspiracy to overthrow the government.
4.  Law. an agreement by two or more persons to commit a crime, fraud, or other wrongful act.
5.  any concurrence in action; combination in bringing about a given result.
--------------------------------------------

Now, I didn't ask for an apology and that was certainly a crummy one you offered.  It seems pretty obvious that I didn't state any sort of conspiracy theory.  Reading the second definition for "smokescreen" will show that I picked my language fairly well.

Your response compounded the uncalled for insult.  Your response also was just another assertion and not responsive to the arguments.  Which is fine.  I'm just defending myself here.  I don't care if you apologize or if you offer a rational argument.  I didn't think I'd have to defend myself (rather than my arguments) and I certainly didn't expect a personal attack because of a bit of theory regarding the discriminatory nature of the proposed legislation.  And before you complain about it, no, it is not a personal attack to say that the claimed motive for the bill was at least in part salesmanship to garner support for something that might be unpalatable.

If you want to address my arguments, feel free.  If you want to get personal, please don't.  I think better of you than that and am kind of stunned at what you said about me.

Let's stick to the issues in the future, 'kay?

DBK

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by: DBK @ Fri Mar 23, 2007 at 20:08:54 PM UTC

[ Parent ]

agreed DBK, on different grounds (0.00 / 0)

You seem to be arguing that it's unfair men will not be tested also and that they should be? (maybe I'm misunderstanding).

It is considered discriminatory (and thus illegal) to fire a woman from her job because she is pregnant.  This is because since only women can get pregnant, such a policy can only have an adverse effect on women and thus is discrimination against one gender. 

The current proposal is very similiar.  Only women can get pregnant, thus only women are affected by it.  There are equally strong arguments to argue for testing men who have the intention of getting a woman pregnant. However, such testing burdens a fundamental right: the right to have children.  It may have a chilling effect: women who do not wish to be forced to take part in this mandatory testing and treatment that follows may choose to simply not seek medical help in birthing at all.  How well off is the fetus then?  Granted, the bill allows women to opt out in writing only, but the vast majority of the population will most likely be unaware of this. 

Also, I think the point made above about how if women are found to be HIV positive and, if the point of the legislation is to protect a baby during childbirth, then what if a woman refuses to take part in the extra precautions?  Will that be forced on her?

This problem is much better solved through education of women once they are in the doctor's office. 

Finally, who is going to bear the cost of this mandatory testing?  Is the state going to subsidize it?  Was that in the bill?  Are we going to further financially burden mothers who are seeking care?

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by: morrisdem @ Fri Mar 23, 2007 at 16:30:43 PM UTC

[ Parent ]

You got it. (0.00 / 0)

DBK

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by: DBK @ Fri Mar 23, 2007 at 16:46:19 PM UTC

[ Parent ]

Re (0.00 / 0)

Sorry, but requiring someone to get tested is in no way similar to losing your job.  I also find it a stretch to say that a woman would forgo all medical care because they don't want an HIV test.  I'm not saying that there isn't a single person that wouldn't think that way, but I think it's a pretty stupid action to take, when it comes down to it.  That, of course, is beside the point.

You still haven't explained how having someone take a test, the results of which are as protected as any other health information, would be either an imposition on women or a violation of their privacy.

The issue of the cost is, from what I can tell, the only really valid point of contention.  I'd make an educated guess that insurance will cover it, just as they do for all the other testing that goes along with being pregnant.

As for the case of a woman who knows she has HIV and refuses to provide any protection for her child - I think that would be covered under medical child abuse.  Can you think of a legitimate reason why a woman would willingly expose her child to a deadly illness that wouldn't be either abusive or neglectful?  Of course, standard exclusions (such as known religious objections, health of the mother, etc.) would apply.

XT

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by: Thurman Hart @ Fri Mar 23, 2007 at 20:37:51 PM UTC

[ Parent ]

Re (0.00 / 0)

I don't think that the argument for testing men who may impregnant a woman is an equally strong one.  Not if the purpose is to prevent transmition of HIV from mother to child during birth.

Unfortunately, an actual copy of the bill is not available online yet.  But according to the article, women who test positive will be given information about further medical treatment, not forced into it.

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by: Lacey Davenport @ Fri Mar 23, 2007 at 20:40:16 PM UTC

[ Parent ]

Unnnn, no. (0.00 / 0)

"As for the experience being different, what difference does that make?  Both the mother and father can spread the Human Immuno-virus, and what are we really talking about here? "

No, fathers cannot spread HIV to a newborn during birth, and is highly unlikely to spread it to their child at any other time unless they are a child molester or giving them a blood transfusion.

The woman delivering the newborn, on the other hand, has a 25% chance of doing so during birth.

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by: huntsu @ Fri Mar 23, 2007 at 16:18:19 PM UTC

[ Parent ]

Re (0.00 / 0)

Come on, get serious.  I hate men because...I am one.

Ok, seriously.

How can you make it mandatory if the man isn't there?  Personally, I have no problem with making it mandatory for the men you can identify, but that isn't really the same thing.

XT

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by: Thurman Hart @ Fri Mar 23, 2007 at 20:30:51 PM UTC

[ Parent ]

Balderdash ... (0.00 / 0)

This bill is not about determining the HIV status of the woman, but to determine if steps need to be taken to protect the newborn from becoming HIV positive.  You talk about the disease attacking "women and men" but it also attacks newborns who have no ability to defend themselves from it or make decisions on their own to protect themselves. 

Remember, also, that the test is done during delivery and not before.

The reason to test only pregnant women is that men cannot transmit HIV to a newborn during the birth process.  The reason not to test women who are not delivering is because they cannot transmit HIV to a newborn during the birth process.

Testing men and women who are not delivering to make it "equal" doesn't make it equal, since the person being protected here is the newborn. 

If the government's interest was in determining who has HIV and who doesn't, your argument would make sense.  But the government isn't, and your argument doesn't.

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by: huntsu @ Fri Mar 23, 2007 at 16:16:07 PM UTC

[ Parent ]

EVERYONE (3.50 / 2)

should be tested.  and any tool that will bring about more testing, i support 100%.  i think an HIV test should be run on every person who enters the medical system for anything. in short: anyone who's ever had a sexual encounter of any kind should be tested.

i understant the position of those who feel otherwise. just never underestimate the damage that comes out of not knowing.  it's too greusome to contemplate.


activist for hire.

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by: Jay Lassiter @ Fri Mar 23, 2007 at 15:50:01 PM UTC

I disagree ... (0.00 / 0)

I would like to see everyone tested for HIV, but I don't think the government has an interest in testing everyone for HIV and no other diseases. 

By this logic we should all be tested for any infectious disease that has permanence like Hepatitis, etc.  It's too much, in my book, to do that.

I think that requiring tests for this kind of thing is situational, and not universal.

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by: huntsu @ Fri Mar 23, 2007 at 16:22:12 PM UTC

[ Parent ]

Trusting women to do the right thing (0.00 / 0)

NY State has a policy of opt-in testing for pregnant women and mandatory testing of mothers who are not tested.

On the basis of clinical trial data, perinatal HIV-transmission rates among HIV-infected women who begin antiretroviral treatment during pregnancy are as low as <2% (6), compared with 12%--13% early transmission rates among women who do not begin preventive treatment until labor and delivery or after birth (7) and 25% among women who receive no preventive treatment (8).

In New York and Connecticut, mandatory HIV testing of newborns was associated with increases in prenatal testing rates...Data from the Perinatal Guidelines Project indicated that the majority of women will accept HIV testing if it is recommended by their health-care provider (9). Perinatal HIV experts and professional organizations have advocated streamlining prenatal HIV pre-test counseling and consent procedures to reduce barriers to the offer of testing by health-care providers (1,2,10).

Morbidity and Mortality Weekly Report link

In my 10 year midwifery career I have never had a women refuse testing during pregnancy when they are given complete explanation of the rational for screening (i.e. reduced transmission to their fetuses/newborns.)If a woman declined testing initially she would usually come around quickly as the discussions continued throughout future visits. Initial refusals were the result of fear.

One of the differences between NYC public hospitals and NJ I have experienced is a lack of certified health educators or HIV counselors in the maternity care system in NJ. I have taken care of HIV + women and the quality of pre and post-test counseling is critical.

I had a MD colleague when I was working in Chinatown who told our shared patients at 16-20 weeks they had to have a test to see is their fetuses had Downs Syndrome. That was their counseling "sign here." We frequently argued about this because he didn't see what the "big deal" was about "a simple blood test."

The big deal is that the further testing to diagnose Downs Syndrome is an amniocentesis which carries with it a risk of miscarriage. His clients had not been told about false positives or the difference between a screening test and a diagnostic test and the follow-up amniocentesis. With a 5% false positive rate many of our clients were then faced with the decision to proceed with the amnio or worry until after the birth.

It was a quiet night on L&D when one of his patients who had the amnio ruptured membranes and delivered a stillbirth 22 week old fetus with normal chomosomes. I hope he practices differently now, he moved out of state not long after the event (and unrelated to it.)

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by: zora01 @ Fri Mar 23, 2007 at 21:05:02 PM UTC