For those looking for hope in the fight against AIDS, there is dramatic news: Infant HIV infection in America has been all but eliminated.
That was the conclusion of a recent New York Times article, which noted that the reduction in the number of HIV-infected newborns nationally dropped to about 200 in 2002, from about 2,000 in 1990. In New York City, cases of infants infected with HIV–the virus that causes AIDS–plummeted from 321 in 1990 to just five in 2003. Illinois reflected that wonderful trend.
Why? More pregnant HIV-infected women are discovering (1) that they are infected and therefore (2) that they are likely to transmit the virus to their newborns, and (3) that they can do something about it. Proving again that information is enabling, the women consented to the application of effective medical treatments. Or, as in New York, the newborn is tested at birth for HIV transmission during the birthing process (i.e. perinatal) in time to administer HIV-fighting drugs.
This comes after the National Institutes of Health’s discovery a decade ago that administering HIV-fighting drugs to infected pregnant women can reduce prenatal transmission (i.e. prior to birth) to the fetus by about two-thirds. And the perinatal administration to the newborn of the antiviral drug Nevirapine can produce an even more dramatic reduction–by 89 percent from 1992 to 2001, according to a later study.
By any measure, this is a spectacular medical victory, for children and all of us. It reflects a comprehensive approach to medicine, which includes counseling, follow-up and testing for the presence of HIV antibodies. In New York, that meant, under the 1996 Baby AIDS law, that newborns must be tested (as part of routine tests for other diseases), with or without their mothers’ consent, so that life-saving treatment can begin in 12 hours.
The results were dramatic. In February 2002, New York Health Commissioner Antonia Novello announced that the rate of HIV perinatal transmission had dropped to 3.5 percent from 25 percent. She credited the Baby AIDS law. Few noticed.
In May 2004, New York George Pataki announced a 78 percent decline in infected newborns between 1997 and 2002. Few noticed.
In December 2002, a Centers for Disease Control and Prevention study found that such mandatory testing of newborns was more effective than an “opt-in” approach, in which pregnant women were counseled about the importance of testing, but that was followed by a test only if they consented. Nor was such voluntary testing as effective as an “opt-out” procedure in which the mother is informed that the HIV antibody test would be a part of her routine prenatal tests, unless she decided otherwise. Few noticed.
So why, with such clear knowledge about how to prevent HIV transmission from mother to child, don’t we save hundreds more lives by following the science and making prenatal and perinatal testing a routine requirement, as are other tests for diseases? Because some people insist that, in the case of HIV, it is an unconstitutional violation of the woman’s and the child’s privacy. In other words, a woman’s privacy rights trump the child’s health or life. Even an Illinois Department of Public Health proposal that only urged Illinois doctors to test high-risk infants was attacked by the American Civil Liberties Union as “an unreasonable, unjustified violation” of the child’s and the mother’s privacy. So even a newborn’s right to privacy is more important than his or her right to a healthy life, or even life itself.
Speaking for this viewpoint was former New York Times columnist Anna Quindlen, who somehow knew that mothers, “with all their many problems,” were unsympathetic to the idea. She said routine testing would “drive” women away from appropriate prenatal treatment. ” . . . [W]inning their trust and cooperation, not coercing and blindsiding them, is how real change will occur.”
Attempts in several states and Congress to make testing a routine fell before what became a well-organized campaign. Editorialists joined in, warning about the impracticality of widespread testing and its lack of “cost-effectiveness.” Physicians should only counsel and recommend testing, they said. In Illinois, “opt-out” legislation didn’t even get out of committee, based on the argument that there’s no “single solution” to pediatric AIDS. As if anyone was arguing there was.
Because HIV transmissions also dropped in “voluntary” testing states, such as Illinois, routine testing clearly is only part of the answer. But how many more newborns could be saved from uncertainty, misery or even death, if HIV testing were routine. Hundreds? Maybe only scores? Probably not worth it, right?
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Dennis Byrne is a Chicago-area writer. E-mail: [email protected]