Academic journal article The Hastings Center Report

HIV and Pregnancy

Academic journal article The Hastings Center Report

HIV and Pregnancy

Article excerpt

Recently in a hospital in an English provincial town where drugs, HIV infection, and prostitution are problems associated with a distant world of fast city life, a young woman encountered special difficulties with her first pregnancy. Clearly there were problems, but no diagnosis that seemed at all plausible had been offered. Only as she went into labor did a young woman physician make her first diagnosis of AIDS. For the young mother, this was a totally unforeseen disaster-once the diagnosis was made, she was able to identify the source of the infection as a brief sexual encounter preceding die committed relationship in which she had embarked on pregnancy and childbirth. But at this stage, it was too late for the tragedy to be anything other than a double one, for the child was later found to have been born with HIV infection. At the beginning of pregnancy, normal medical care includes testing a sample of blood for a variety of conditions it might be important for a woman embarking on pregnancy or for those caring for her to know about. These include tests for syphilis, rubella, hepatitis, and other possibilities. Few pregnant women are aware of the list of diseases being ruled out at this stage. There is no need for them to be, since for the vast majority the tests are negative. In addition, most of these conditions can be treated effectively and no stigma is attached to positive findings. HIV infection, however, is seen as a special case, posing a special need for informed consent. At the same time, the notion of informed consent is being given an especially strong interpretation, in which extensive counseling is regarded as a necessary condition if consent is to be considered truly informed."

The burden of this counseling is, however, likely to be less medical than social and economic. Medically, HIV infection is a condition that cannot be cured, although there is evidence that some approaches to the problem may help maintain health longer. Undoubtedly, however, the social and financial implications of a positive diagnosis are serious. Health and life insurance, mortgages, and house purchase may all be affected. There may be problems for some types of employment and there are clearly likely to be difficulties on the personal level where the question of what to tell sexual partners or close relatives must loom large. A special practical fear on the part of a pregnant woman may be the loss of a sexual partner who is providing home and support for her. These are far from negligible considerations, and it is understandable, therefore, that some people might prefer to avoid knowledge of seropositivity.

Nevertheless, there may be good reasons to establish a woman's HIV status early in pregnancy; and women who might become pregnant may have stronger reasons than others to be sure that they are not seropositive. Our argument is not that testing should be forced on women who genuinely do not want it, but that it is useful and should be recommended to them-indeed, more strongly, that it should be regarded as routine except where special objections are expressed. Respect for objections need not suggest, however, that "consent" should be given a stronger interpretation for HIV than for other tests administered during pregnancy, or that women should be counseled against giving consent.

Because AIDS in the USA and in Western Europe has been particularly associated both in the public mind and in medical reality with certain clearly defined groups-gay and bisexual males, IV drug users, and hemophiliacs-it would be easy to underestimate the problem it poses for young women contemplating or embarked on pregnancy. In New York City, however, the fact is that AIDS is already the leading cause of death for women aged between twenty and twenty-nine and is soon expected to become the leading cause of death for all women of childbearing age in that city. In the UK, there was a 26 percent rise in the discovery of new HIV infection in pregnant women in 1987. …

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