Prevention Of HIV Transmittance To Babies Essay

, Research Paper

Prevention of HIV Transmittance to Babies

Last year, it was cause for celebration. The cause of celebration was for the

results that several clinical trials of zidovudine cut the risk for mother to

child transmission of human immune deficiency virus (HIV) by two thirds.

Although, this year, it is the basis for new federal recommendations that all

pregnant women should receive HIV testing and counseling. But, these findings

have been cause of protests by several activist groups. Activists fear that

conservative legislators and policy makers will use the clinical data to justify

mandatory testing and treatment for pregnant women.

During the latter part of February, the United States Public Health Services

published guidelines for HIV pregnant women in the Federal Register. Which

coincidentally was published on the same day as the National Conference in

Washington, DC for “HIV infection in women: Setting a New Agenda.” The

conference included activists, physicians and HIV positive women who used the

meeting as a forum to voice their concerns about how best to balance women’s own

medical needs with those of their infants. Other concerns of activists that

were voiced were that they don’t want laws, policies or medical care imposed on

women merely as “vectors” who may transmit HIV to their infants.

The new guidelines recommend that all pregnant women should receive HIV

counseling and testing. These guidelines are aimed at helping pregnant women

know their HIV status early so that medical care, including zidovudine (Retrovir,

known as AZT, Burroughs Welcome Co., Research Triangle Park, NC), can be made

available. The new guidelines also reiterate previous federal health advisories

that say counseling should precede HIV testing. Physicians and other health

professionals who counsel women should be well informed about the complex issues

that face HIV infected pregnant women, according to the guidelines. This

information should include about all of their reproductive options. Women

should also be advised that in order to help reduce prenatal HIV transmissions

HIV infected women in the United States should not breast feed their infants.

The guidelines further states that all HIV testing should be voluntary for women

and their infants. Also, all decisions about AZT use should be made by the HIV

infected pregnant woman in a non coercive atmosphere and based on a balance of

the benefits an potential risks of the regimen to herself and her child. The

guidelines also state that women who are infected or refuse testing must not be

denied medical care, reported to child protective agencies, or discriminated

against in any way.

The center for Disease control and Prevention (CDC), Atlanta, GA. reports that

as of December 31, 1994, there were 58,448 women with AIDS in the United States.

Nearly one fourth of the total were reported in 1994 alone. AIDS is now the

fourth leading cause of death in US women ages 25 to 44 and in 15 major United

States cities.

In 1993, the CDC estimated that 7,000 HIV infected women gave birth in this

country, in other words, about one in every 625 women who gave birth that year

was HIV positive. The rate of mother to child transmission rate ranged from 15%

to 30%, which is estimated that there were as many as 2,000 HIV infected infants

born in the United States in 1993. Much of the controversy centers on AIDS

Clinical Trials Group (ACTG) protocol 076. In the 2 year study, 239 of the 477

HIV infected women enrolled received AZT during pregnancy and delivery. Their

infants received the drug for six weeks. At 18 months, 8.3% of the infants in

the treatment group vs. 25.5 % of the controls were infected. “Evidence based

on every analysis that has been done of the outcomes to date shows that this is

a prevention breakthrough,” said Wanda Jones, DrPH, acting associate director of

CDC’s office of Women’s Health.

Activists believe that the data is incomplete and should not be used as the

basis for federal guidelines. They wanted to know the effects AZT might have on

the estimated 75% of infants who are born to HIV positive mothers but don’t

seroconvert, and whether a pregnant woman who takes AZT early in the course of

infection will still benefit from the drug later, when she is sicker. They also

wanted to know what the long term effects may be if women take AZT during

multiple pregnancies, and whether ACTG 076 showed a correlation between high

maternal viral load and the likelihood of transmission. A few small studies,

including one from New York State Health Department, are beginning to point in

that direction. Jones of the CDC conceded that the study leaves many question

unanswered. However, it is the only one ever to have demonstrated any effective

method of preventing maternal fetal HIV transmission. “It would be

irresponsible for us not to be out front on this,” she said. James W. Curran,

MD MPH, associate director for HIV/AIDS at the CDC added that, “The reason we

published these guidelines is that we believe they represent the very best in

public health practice.”

Besides their scientific concerns, activists also believe that the guidelines

come at a politically tenuous time. Two years ago, before the ACTG 076 results

were announced and before Congress took a conservative turn, New York lawmakers

considered legislation to unbind mandatory testing of newborns so that

seropositive infants could be identified. The law failed. But now, since the

clinical results have been widely publicized, a similar bill is pending in

Congress. For example, in Illinois, lawmakers are considering a bill that would

mandate HIV testing and counseling for all pregnant women. And in New York, they

have proposed legislation would mandate testing of pregnant women without

requiring counseling. Experts say that initiative like those in Illinois and New

York are likely to crop up in more states. To counter pro-mandatory testing

movements, activists have urged federal health officials to strengthen language

in the guidelines before they are finalized so that the document won’t be

construed as supportive of mandatory testing.

Mandatory testing has been controversial since the AIDS epidemic began.

Opponents contend that is violates civil rights, results in discrimination and

may drive some people away from receiving the medical care they need. Therefore,

without a stronger message in support of voluntary testing the guidelines may

become a way to discriminate against pregnant women who are HIV positive.

Bibliography

Rogers, Martha, Simonds, R.J.; March 15, 1996; Preventing Prenatal HIV

Infection “How Far Have We Come?”; Journal of the American Medical Association

Volume 19; Page 1514

Voelker, Rebecca; April 5, 1996; US Public Health Service Recommends Counseling

and HIV Testing For All Pregnant Women; Journal of the American Medical

Association; Volume 19; page 977

Wolfe, Maxine Ph.D.; October 1, 1996; Mothers To Infant HIV Transmission 076

Update; Women Alive; page 6