Mothers and AIDS.

• Author: Hooker, Tracey
• Position: Mandatory AIDS testing for pregnant women

AIDS is the seventh leading cause of death in young children. A new study, however, has shown that AZT will help protect unborn babies from their mothers' HIV infections. Should HIV tests be required of pregnant women and newborns?

It's a political quagmire: individual liberties vs. life and death; a mother's rights vs. her infant's. And it's tied into two short acronyms: HIV and AIDS.

HIV and AIDS have made steady inroads among women in the United States. In 1985, only 7 percent of newly diagnosed AIDS cases involved women; as of June 1994, women accounted for 18 percent of new AIDS cases.

In 1993, approximately 7,000 HIV-infected women gave birth in the United States, according to the Centers for Disease Control and Prevention (CDC). Of those newborns, 1,000 to 2,000 are infected with HIV - now the seventh leading cause of death in children aged 1 to 4.

A year ago, a joint study by American and French scientists showed that the drag AZT could decrease by 67.5 percent the transmission rate of HIV from infected mothers to their newborn babies. That finding reopened the controversy over mandatory testing - since studies estimate 44 percent to 50 percent of HIV-infected women don't know they carry the disease. It has been estimated that 100,000 women are infected with HIV, but no one knows for sure.

ROUTINE HIV TESTING ENDORSED

On one side of the debate are those who believe all pregnant women should be routinely tested for HIV as part of a prenatal checkup.

A majority of states have laws or regulations that require women to be tested at least once during their pregnancy for syphilis. In 45 states, the District of Columbia and the Virgin Islands, all newborns are routinely tested for up to nine genetic diseases such as sickle cell anemia and phenylketonuria. Babies' blood samples also are tested for HIV in those same states, but the results are kept secret and are used only to track the epidemic in women and children. These numbers are then used to estimate needs for HIV services and prevention programs.

Why not a routine HIV test?

Because, from the beginning, HIV/AIDS has been "addressed totally backwards" as a public health hazard, says W. Shepherd Smith, president of Americans for Sound AIDS Policy.

"Early diagnosis and information used confidentially to help patients is what medicine is based on," he contends. "That hasn't been the case with AIDS."

Since the early 1980s when AIDS was considered a disease of homosexuals and when an HIV antibody test first became available in 1985, the test was perceived by gay coalitions as a potential tool for discrimination. Intense lobbying efforts ensured laws that provided a solid cloak of confidentiality, that allowed testing only after counseling and only after written consent.

Despite public education on the disease and how it is transmitted, a stigma still attaches to a diagnosis of HIV or AIDS. And discrimination follows its victims. The result has been reinforcement of confidential and anonymous testing as well as consent laws set in concrete.

Dr. Lou Cooper, director of pediatrics at St. Luke's-Roosevelt Hospital in New York and a member of the board of directors of the American Academy of Pediatrics, gives a good explanation of the laws' metamorphosis in New York where confidentiality is paramount:

"In the 1980s, when the AIDS hysteria was so high, a 20-plus page bill on confidentiality and HIV passed the Legislature. The language was proscriptive, and it became even more proscriptive through...