NEW JERSEY UPS ITS BATTLE AGAINST HIV
Volume 28, Issue 495 July 9, 2007
Matthew Gever
New Jersey is looking to become the first state to pass a law implementing revised guidelines from the Centers for Disease Control and Prevention (CDC) on HIV testing of pregnant women and newborns. The result, bill sponsors say, will likely be a cost-effective reduction in the transmission of HIV.
If signed by the Governor, SB 2704 will “require” health-care providers to inform pregnant patients that HIV testing is part of the routine panel of prenatal tests and that they will be tested unless they opt out in writing. Under the bill, patients would be tested twice—as early as possible during the pregnancy and again in the third trimester.
The bill also would mandate that all birthing facilities test every newborn in their care for HIV—if the HIV status of the mother is unknown. Parents could refuse on religious grounds to have their infant screened. Neither the mother nor the newborn would be denied testing because they couldn’t afford it.
“For newborns, early detection can be a life-saving measure,” said Senate President Richard Codey.
“New Jersey has some of the highest HIV rates among women, and we must act quickly to get mothers tested and informed about this serious health threat,” said Assemblyman John McKeon.
If implemented, SB 2704 would make New Jersey the first state to require its providers to test pregnant women twice, in addition to testing some newborns. Presently, Connecticut, Illinois and New York require testing of newborns when the mother’s status is unknown, while Arkansas, New Mexico, Tennessee and Texas mandate that pregnant women be tested once during pregnancy, generally as part of routine prenatal screening. Indiana allows providers to test newborns if the mother has not been tested and the provider believes it is medically necessary.
A Second Testing
The CDC has been pushing for years to have HIV testing included in the standard panel of prenatal tests for all pregnant women. A Yale study shows that a 1999 Connecticut law that included routine offering of HIV testing to pregnant women increased the percentage of women tested, from 22 percent before enactment of the law to 94 percent in the first year after.
The CDC’s most recent HIV testing guidelines, issued in September 2006, differ from earlier ones in that they recommend that pregnant women who are at high risk for HIV be tested twice: first, as early as possible during the pregnancy, and again during the third trimester. Studies have shown that a second test may detect HIV that was not apparent during the first exam.
The CDC advocates a second HIV test for women who meet one or more of the criteria for high risk. Examples of such criteria include using IV drugs or receiving health care in settings with elevated HIV incidence. In 2004, the jurisdictions that had elevated incidence of HIV or AIDS among women aged 15-45 years included Alabama, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Louisiana, Maryland, Massachusetts, Mississippi, Nevada, New Jersey, New York, North Carolina, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Texas and Virginia.
But the CDC also notes that testing all women twice, regardless of their risk status, may be cost-effective, and the New Jersey bill advocates testing all women twice.
Debate Continues
Maretta Short, president of the New Jersey chapter of the National Organization for Women, said she’s concerned that, by requiring women to opt out of testing, the bill puts “pregnant women in a category separate from all other individuals” who do not have to opt out in writing.
Supporters say that routine testing will break down societal barriers. “The additional benefit of testing every woman is that it reduces the stigma associated with testing only those based on their risk behaviors and should, as the statistics show, make women less inclined to refuse the test,” said Senator Codey.
Critics also have expressed concern over privacy matters, and they question just how voluntary the test is. While the bill states that women will not be denied medical care if refusing the test, there is concern that this information could be used punitively down the road.
“Why include this clause if it’s not going to be interpreted as something else later?” asks Short. “I have read about pregnant women who refused mandatory testing, and they were sought after legally for being negligent and forced to give up custody of their children.”
Supporters still contend that the benefits of testing outweigh the other concerns. “Early detection is the key to helping people living with HIV/AIDS to live longer with a better quality of life,” said Senator Loretta Weinberg.
© Copyright 2007, State Health Notes
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