Proposed Title: The History of the Debate Regarding Prenatal HIV Screening
Abstract:
In 1959 the first known case of HIV was reported. At first specific groups were rounded up as being the only groups susceptible to the disease; soon after it was discovered that HIV/AIDS knew no bounds. As such, a great attempt was made to educate/help the high risk populations, as well as protect the most vulnerable, namely infants. A prolonged debate between proponents and opponents of mandatory HIV screening of newborns occurred, with topics of controversy concerning a pregnant woman’s constitutional right to privacy, the “snowball effect” of increasingly invasive legislature, and the disintegration of the patient-provider relationship, among other things. The 1991 AIDS Clinical Trials Group 076 provided astounding results of the drug zidovudine (AZT, ZDV), which lowered mother-to-infant transmission of HIV from about 25% to about 8%. Other studies attempted to answer questions that ACTG 076 did not answer, such as optimal time for treatment, and optimal dose. But the ethical question of placebo controls served as a proverbial rock in the road for such research. Even so, by 1997 New York had legalized mandatory testing for newborns, as well as other groups such as organ donors, etc.
Annotated Bibliography:
“HIV Testing of Pregnant Women and Newborns.” American Civil Liberties Union. The American Civil Liberties Union and the ACLU Foundation. 1 Jan. 2001. Web. 7 Sep. 2012. Gives a background of the AZT drug for newborns. Explains how vertical transmission of HIV occurs. Gives the statistics of how AZT lowers the risk of HIV transmission from mother to child.
Lagitch, Kellie E. “Mandatory HIV Testing: An Orwellian Proposition.” St. John’s Law Review 72.1 (1998): 103-137. Print. Provides background information regarding newborn HIV/AIDS and introduces the concept of mandatory newborn HIV screening, along with a critical eye against such a proposition. Analyzes and acknowledges the constitutional right to privacy of the seropositive mothers. Provides several Supreme Court and lower court cases in which set the precedent of comparing states’ interest to personal interest regarding medical privacy and overall public health.
Manuel, C, P. Enel, J. Charrel, D. Reviron, M. P. Larher, X. Thirion and L. Sanmarco. “The Ethical Approach to AIDS: A Bibliographical Review.” Journal of Medical Ethics 16.1 (1990): 14-27. Print. Analyzes and provides the different themes in which articles pertaining to AIDS/HIV in the Medline, CNRS, Bioethics, and AIDS databases were based on. Provides tables and graphs that acknowledge a direct correlation between elapsed time in years and quantity of publications pertaining to AIDS/HIV. Raises the question of personal privacy versus public health.
Nicholson, Erin. “Mandatory HIV Testing of Pregnant Women: Public Health Policy Considerations and Alternatives.” Duke Journal of Gender Law and Policy 9.1 (2002): 175-191. Print. Explains the background of how the drug AZT works. Gives alternatives to the AZT, such as Nevirapine. Explains and analyzes the patient-provider relationship, and how mandatory testing ultimately hinders such relationships. Brings up possibility of stereotyping and discrimination of positive results due to mandatory screening of HIV for pregnant women.
Orr, Alistair. “Legal AIDS: Implications of AIDS and HIV for British and American Law.” Journal of Medical Ethics 15.2 (1989): 61-67. Print. Analyzes the influence of the United States’ possession of a Bill of rights over its adamant reluctance for mandatory HIV screening. Analyzes the concept of patient confidentiality. Analyzes the contradiction in state laws regarding when the interest of an individual can be overridden by the interest of the public, especially the right to privacy.
Roleff, Tamara L. AIDS: Opposing Viewpoints. Farmington Hills: Greenhaven Press, 2003. Print. Examines the properties of the disease, treatments, and controversial topics. Analyzes the moral issues regarding testing for HIV, etc. Raises up questions on partner notification of those seropositive and patient confidentiality.
Scott, J. Blake. “The Public Policy Debate over Newborn HIV Testing: A Case Study of the Knowledge Enthymeme.” Rhetoric Society Quarterly 32.2 (2002): 57-83. Print. Lists pro-mandatory testing of newborns arguments and debunks them due to lack of logic. Recognizes that HIV positive women’s knowledge of their serostatus does not seem to affect their reproductive decision-making, because there are other factors that influence those decisions, such as cultural values, family pressure, and religious beliefs.
Yovetich, Tasha. “Making it Mandatory: Should HIV Tests Be Required for Pregnant Women?” Network Magazine. Canadian Women’s Health Network, 5 Dec. 1998. Web. 7 Sep. 2012. Brings up the toxicity of the AZT prenatal drug, and the questions whether the drug is necessary. Brings up the fact that only one in four newborns born from seropositive mothers contract the disease. Acknowledges that informing a woman against her will that she is infected does not equate to her agreeing to treatment with anti-retrovirals. Brings up the question of if the state is allowed to force testing of HIV, is it allowed to force treatment?
Zivi, Karen. “Contesting Motherhood in the Age of AIDS: Maternal Ideology on the Debate Over Mandatory HIV Testing.” Feminist Studies 31.2 (2005): 347- Print. Argues that traditional conceptions of good and bad mothering (maternal ideology), were complicated from both the rights and public health fronts. Argues that motherhood was both challenged and codified in the rights versus public health debates, as were mandatory HIV testing policies. Examines the arguments for both pro-mandatory testing and against mandatory testing.
