HIV testing, opting out, public health and civil liberties

Here’s an interesting question: should pregnant US mothers have more access to civil liberties than me? My wife mentioned this story:

New Jersey will require all pregnant women to be tested for HIV unless they opt out under legislation signed into law today by Richard Codey, the Senate president serving as acting governor while Jon Corzine is on vacation.

Codey, who sponsored the legislation in the Senate, said it is modeled after recommendations from the Centers for Disease Control and Prevention. In a 2006 report, the CDC estimated that the rate of transmission during childbirth might be reduced to less than 2 percent from about 25 percent with a combination of universal screening, preventative drugs, Cesarean delivery and avoidance of breast feeding.

The number of children in the U.S. reported with AIDS attributed to HIV transmission during childbirth declined to 48 in 2004 from a peak of 945 in 1992, primarily because of the identification of infected pregnant women and the effectiveness of preventative drugs in reducing mother-to-child transmission, according to the CDC report.

Although she probably read it elsewhere (my wife is not a Bloomberg reader, as far as I’m aware).

My first reaction was to ponder the legislation-ness of it all – as opposed to something more English, which would be offering financial incentives to GPs/hospitals who perform X% of tests on their pregnant mothers. Trust me – it’s a sure thing. Although I haven’t (and, in all likelihood, won’t) read the legislation itself, this just seemed like non-funded command and control. The news articles I’ve seen have yet to mention how the initiative is to be funded, beyond saying things like “health care providers will …”. I’ve seen the shunting back-and-forth of bills between providers and my insurance company, from my medical tests for my spouse’s visa: nobody wants to pay for this stuff.

Which leads to the question. Pregnant mothers have the right to opt-out. This is better than opting-in, because it means more women “submit” to the test, hence more tests, more cases identified and, critically, more cases prevented. This is a public health issue, after all: HIV is a communicable disease. It’s used to keep immigrants out, and I have to get tested as a matter of course, when applying for my residency. Only I didn’t get to opt out.

Now, I’m not American: I don’t get the Bill of Rights automatically (necessarily) – that’s fine. The AIDS Healthcare Foundation (AHF), for example though, specifically identified the opt-out clause as a criticial civil liberties issue, without which they would not have supported New Jersey’s initiative. My question is, why? Given that this is a public health issue, do ‘we’ not have as much right to prevent HIV-positive children being born into the US (and, remember, this is not a Eugenic issue: if the mother is identified, she can still have a child, it’s just that we have the opportunity to prevent transmission of the disease to the newborn) as we reserve to prevent HIV-positive people immigrating into the US?

And that’s the question. I’m not suggesting that pregnant women be forced to have HIV tests; nor am I arguing that immigrants be allowed to opt-out. I’m just suggesting that a double-standard exists here, where I don’t believe it should (or, at least, stand un-addressed by the debate).

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