Mandatory Testing

“An H.I.V. test is about to become as routine as an ultrasound for pregnant women in New Jersey. Under a bill signed into law on Wednesday, all pregnant women in the state will be tested for the virus as part of their prenatal care unless they object. The law also requires testing for newborns if the H.I.V. status of the mother is unknown. The new traesting procedures are some of the most aggressive H.I.V.-prevention measures in the country for pregnant women and newborns, making New Jersey one of just a handful of states with laws requiring some form of prenatal testing.”

“India’s Andhra Pradesh state, which has the country’s largest number of HIV cases, is set to become the first to make it mandatory for couples to take a HIV test before marrying”

“If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable”

“According to a number of physicians at Princess Marina Hospital [in Botswana], the main public hospital in the capital of Gabarone, even with mass education most women refuse to be tested…50% of adult Tanzanian women know where they could be HIV tested, yet only 6% have been tested. In Zimbabwe, only 11% of adult women have been tested for HIV…Mandatory HIV testing, and when necessary, mandatory treatment of all pregnant women in Botswana is both a necessary and a vital part of a broader comprehensive strategy for preventing the spread of AIDS in sub-Saharan Africa.”

“Infants born to women of unknown HIV status undergo rapid newborn HIV testing in New York State.”

“Medical record data suggest that the "opt-in" voluntary testing approach is associated with lower testing rates than either the "opt-out" voluntary testing approach or the mandatory newborn HIV testing approach.”

“Left unresolved, however, is the debate over whether the rights of children should take precedence over the rights of parents…should the privacy rights of pregnant women take precedence over public safety? [no consideration is given in this paper regarding scientific information on the inaccuracy of HIV tests, lack of gold standard, or the danger of the interventions that usually follow, such as AIDS drug therapy]…Mandatory testing was…strongly supported by local newspapers, politicians, and physicians, who agreed it could save or prolong young lives…The increase [in the number of women tested] in 1998 may be due to more aggressive HIV testing…the decline in children born with antibodies to the virus started prior to the enactment of the new policy, which became effective on February 1, 1997…the decline in children born with antibodies to the virus started prior to the enactment of the new policy [the fraction of children of HIV+ mothers who are deemed HIV+ has decreased every year from 522 per 100,000 in 1994 to 397 in 1998]…Women will be advised [i.e. ordered] not to breastfeed. HIV infected women who breastfeed have a 14% greater chance of spreading the disease to their newborns]…The Maternal-Pediatric HIV prevention policy does not give parents [a religious exemption]…pregnant HIV positive women are often treated with scorn rather than compassion…Some caregivers may see HIV pregnant women as causing intentional harm to their babies, even though most infants are born without HIV…A primary benefit [of mandatory testing] will be the early identification of infants born HIV positive so they can be placed on anti-viral medications such as AZT…AZT administered during the infant's first six weeks of life can greatly reduce the chance of transmission…universal precautions are…advised when knowingly handling body fluids of an infected baby g”

“We believe that [universal ‘opt-out’ testing] prevents the problem in the mandatory approach to testing in which some women may decline prenatal care in order to avoid mandatory testing. If this is enacted we believe this type of approach will reduce further the risk of HIV transmission”

“Further legislative measures to support HIV prevention, identified in this review, address requirements for, or offers of, prenatal testing of pregnant women, (9 of 121 [7%], 6% of the world’s population)…The observation that 25% of the world’s population still lives with laws requiring quarantine, isolation, or coercive hospitalization, measures that heavily infringe on human rights without any documented public health justification, compared with a very much lower percentage that require screening for pregnant women and encouraging the use of condoms, measures the preventive capability of which has been well documented, is a further dismal confirmation of the scarce impact of the international institutions on the legislative activity of member states…Public health is recognized as a societal good that may at times call for measures that restrict human rights to some extent (16). Nonetheless, any such restrictions are considered acceptable only if they are: 1. “Provided for and carried out in accordance with the law; 2. Based on a legitimate interest, as defined in the provisions guaranteeing the rights; 3. Proportional to that interest and constituting the least intrusive and least restrictive measure available and actually achieving that interest in a democratic society. Public health is most often cited by states as a basis for restricting human rights in the context of HIV/AIDS. Many such restrictions, however, infringe on the principle of non-discrimination”. Moreover, “coercive [public health] interventions can be justified in only 3 cases: to avert a risk of serious harm to other persons, to protect the welfare of incompetent persons, and, most controversially, to prevent a risk to the person himself/herself” .”

“In Connecticut in the United States, legislators, noting that treatements are available to prevent disease transmission passed laws requiring all children to be tested for HIV status at birth - if the status of the mother is not known. In effect, since 1 October 1999, the statute demands that women be told that unless they are tested at least twice during pregnancy, their babies will be tested for the disease at birth…New York State also mandates HIV testing for all newborns…Dr. Magriples said that she feels that the law is coercive…her study at Yale found that before the law was passed less than 40% of women underwent testing, and after the law more than 95% of women allowed themselves to be tested”

“This march of death is made possible by the surrender of public health authorities to the pressures of political groups opposed to what once had been the standard procedure for fighting epidemic diseases like AIDS: testing. Without testing of at-risk individuals and groups, there is no way to insure that individuals will know their lives are in danger, or that they are endangering the lives of others. Yet irresponsible zealots have successfully removed mandatory testing from the government's arsenal of weapons available in the battle against AIDS. …The majority of the new infections among men, nearly 60 percent, continue to be among men who have sex with men…[In mid-2001], the Centers for Disease Control and Prevention held a gathering in Atlanta nobly titled the "Second National HIV Prevention Conference." But 97 pages of conference agenda, listing more than 200 conference panels, failed to turn up a single one devoted to the question of whether there should be mandatory testing of any at-risk group whatsoever, whether drug-addicted pregnant women, visitors to clinics, or residents of neighborhoods with a high incidence of the disease…Individuals who are recognized to be a medical threat, e.g., tuberculosis carriers, can still be legally forced to take a full course of drugs in order to prevent contagion…Of course testing is just the tip of the AIDS iceberg. Real prevention of new AIDS infections would also involve [mandatory?] reporting and contact tracing, and the closing of infection sites (like public sex clubs) [and mandatory therapy?]…The idea that heterosexual couples can be forced to take tests for syphilis, which is curable, but gay couples and IV drug users can't be tested for AIDS, which is not, is absurd. And yet belief in this absurdity is killing nearly 1,000 young people in this country every week of every year.”