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Frerichs, R.R. Prenatal versus Postnatal HIV Screening

SEA-AIDS Network, May 9, 1996

R.R. Frerichs Posting

Ever since Connor and colleagues published their landmark study in the New England Journal of Medicine that documented the benefits that come from pre- and perinatal treatment of HIV infected women with AZT (New England Journal of Medicine 331(18)1173-1180, 1994), the question of whether to test or not test pregnant women has been widely debated.

While many have resisted mandatory prenatal testing to preserve the rights of the women to avoid potential harm from discrimination, similar concerns have not always been expressed for the welfare of their living offsprings. Some public health officials have tried to avoid the controversy surrounding forced prenatal screening but have advocated instead, mandatory screening of all newborn infants. Even though the percentage of lives saved with such post-birth screening is far less than what comes from testing pregnant women, there are fewer ethical battles to be waged or angry groups to contend with.

With pregnant women, some ethicists feel that the balance should favor the right of the infected mother to avoid potential psychological or physical harm, over the right of the infant to avoid infection and near-certain early death. Since women can express their opinions and infants cannot, this position is widely cited in the international literature. When the living infant emerges, the balance for many starts to tilt more actively towards the right of the newborn to avoid infection from contaminated breastmilk, or to avoid dying early from various secondary infections, with less concern shown for the right of the mother to avoid detection. In both situations, the cost, quality and access to HIV antibody testing play an important role for both wealthy and poor countries, as does the need for HIV normalization.

For those in the sea-group interested in this public health issue I am submitting a story from the Wednesday, May 1, 1996 New York Times on legislative actions being considered in the USA, and two recent background articles from the scientific literature on the efficacy of AZT (1994) and the approach being taken in Thailand (1995) [the published material not included here]