Doctors urge mandatory HIV testing

for all expectant mothers

Recent Tyson ruling means forced fetal-infant AZT

administration and breastmilk ban for few who would test positive

by Paul Philpott

Three major groups of doctors have proposed legislation requiring medical personnel to subject all pregnant, American women to HIV testing. A joint statement from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, published in the July Pediatrics (104:1), endorsed the recommendations of a recent Institute of Medicine (IM) study, "Reducing the Odds." The IM study called for "a national policy of universal HIV testing, with patient notification, as a routine component of prenatal care." The proposed legislation would require medical staff to include HIV testing in standard blood work for pregnant women. That would mean mentioning HIV testing along with current standard procedures and then administering all procedures except those to which patients specifically object.

Current standard practice differs by state. Some states already have a universal testing law like the one proposed by the three groups of doctors. Other states subscribe to the current national standard, which calls for medical staff members to recommend HIV testing only to women they suspect of belonging to an official HIV risk group (drug injectors and sex partners of drug injectors or bisexual men). This standard, called "informed consent," includes "pretest counseling" to convince such women to submit to the testing. Some states require patients to sign forms documenting that the patient completed the pretest counseling.

The Pediatrics statement disparages informed consent as "a barrier to testing." Apparently, self-confessed or suspected risk group members often respond adversely to HIV sloganeering from their medical providers. The statement also faults the current national policy generally for "stereotyping and stigmatizing social and ethnic groups."

Nothing in the statement suggests that the doctors understand that mass screening outside the risk groups will identify only a few HIV-positive women. According to the latest and best data (the CDC's 1993 HIV Serosurveillance report figures for first time blood donors and drug injectors), among American women who deny drug-injecting and other official HIV risks (and blood donors must deny these risks), only one in 10,000 tests "HIV-positive" (compared to one in 5,000 risk-denying men); and of women who admit to drug-injecting, 38% test positive.

This means the proposal would require the testing of 10,000 women just to identify a single positive woman who denies official risk exposure. With four million annual American births, this plan would identify a maximum of 400 positive, presumably risk-free women, at a cost of identifying 3,999,600 negative women.
The doctors hope that all women identified as "HIV-positive" will "institute effective antiretroviral therapy for their own health and to reduce the risk of HIV transmission to their infants." The statement takes no position on how physicians should respond to patients who reject the standard prescription for pregnant, HIV-positive women: "antiretroviral" treatment for the expectant mom and newborn, and no breastfeeding. But as the Tyson family of Oregon learned in April (March and June RA), physicians have the power -- and some exercise that power -- to legally force positive-testing mothers to comply with the standard prescription.

This very costly proposal reflects all the popular conceptions about HIV and AIDS: that HIV tests indicate HIV infections, that HIV causes AIDS, that HIV and AIDS affect large and growing segments of the general American population, that "anti-HIV" treatments confer benefits, and that breastfeeding transmits HIV.

But careful and readily available analyses in the form of published scientific articles and books by several medical researchers and physicians overturn all these popular ideas. These "Reappraising AIDS" scientists include UC-Berkeley retrovirologist Peter Duesberg (Inventing the AIDS Virus and Infectious AIDS: Have We Been Misled? ), Michigan State physiology professor Robert Root-Bernstein (Rethinking AIDS ), and University of Western Australia biophysicist Eleni Papadopulos-Eleopulos. According to their evaluations of the primary data: most people who test "HIV-positive" have no HIV infections at all (rendering dubious the terms "HIV test" and "HIV-positive"); the "anti-HIV" drugs rather than specifically targeting HIV actually cause various diseases, including many AIDS conditions; none of these drugs has demonstrated any benefit over taking no drugs at all; HIV lacks any pathological capacity and thus cannot explain AIDS; several non-infectious factors explain AIDS; HIV and AIDS exist only at tiny levels in the officially risk-free population; and breastfeeding transmits HIV either rarely or not at all.

Even outside the context of the RA perspective, the doctors' proposal seems wrong-headed.

According to the most often cited study, one out of four children (25%) born to untreated "HIV-positive" mothers themselves test "HIV-positive" and the standard treatment (drugs for the pregnant mom and infant, plus no breastfeeding) drops this figure by two-thirds, to 8%, or one-in-12 (Conner, New England J Med 331:18, Nov. 3, 1994). So if physicians tested the entire maximum possible risk-free population of 4 million pregnant women each year, and forced the standard treatment onto the 400 who would test positive, 33 new children born to risk-denying moms would test "HIV-positive" instead of 100. But at what cost to have 67 fewer children test HIV-positive each year?

Financially, the price of administering the $50 battery of HIV antibody tests to 4 million women comes to $200 million. It would take the testing of 60,000 risk-denying pregnant women, at a total cost of $3 million, to spare just one child the HIV-positive designation [(1 pos mom/10,000 women) x (1 pos baby/4 pos moms) x (2 spared babies/3 pos babiess) x (1 woman/$50)].

A still higher cost attends this plan for tagging all 400 positives among the maximum 4 million annual pregnant, risk-denying women: all 400 identified children would consume the highly toxic drug, AZT, and be denied their mothers' breastmilk, including the 300 who would have tested "HIV-negative" anyway. Never mind that no studies have asked the following obvious and fundamental question: which is healthier, a breastfed "HIV-positive" child who never consumes "anti-HIV" drugs, or an "HIV-negative" child who has consumed AZT but no breastmilk?

With HIV-positive prevalence among self-confessed risk group members being very high (over 30% for drug injectors) and among risk-denying Americans very low (far below 1%), it would seem that level-headed people who think that HIV explains AIDS would confine HIV screening to the risk groups. For those who reject the HIV explanation for AIDS, the universal screening plan represents not just a scandalous waste of money, but a tragedy as well, since up to 400 kids annually will be unnecessarily poisoned by AZT and denied their mothers' milk. But both perspectives do predict a windfall of benefits for two parties involved in any universal HIV screening program: test manufacturers and testing labs. -- Paul Philpott.