Doctors urge mandatory HIV
for all expectant mothers
Recent Tyson ruling means forced fetal-infant AZT
administration and breastmilk ban for few who would
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.