Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
The Associated Press - Wednesday, July 28, 1999
That's because the expectant mother would be urged to take a quick type of HIV test with a relatively high rate of erroneous results before her child's birth if she hadn't already been tested by her doctor. If the mother refuses, the newborn will be tested and mother and child will remain in the hospital to await results.
The regulation also could interfere with breast-feeding, because a mother who tests positive will be encouraged to delay feeding until -- and unless -- she gets a negative test. That could take a week, said Dr. Frank Gigliotti, chief of pediatric infectious diseases at the Children's Hospital at Strong Memorial Hospital in Rochester.
"I am really outraged about this because I think they are manipulating the public health law," said Marilyn Menegus, chief of the microbiology lab at the University of Rochester Medical Center. The physicians' oath "first, do no harm" should apply to public health measures, she told the Rochester Democrat and Chronicle. "There's the potential here to wreck what should be someone's happiest time."
Dr. David Gandell, a Rochester obstetrician, says while the state's motivation is admirable, the means is "dangerous."
"If somebody is in labor, that is not the time to do a sexual history and tell them how they can reduce risk by using condoms," he said. "Now every woman will have to have HIV counseling and urged to get tests when she comes in for labor, even if she's 8 centimeters dilated."
The law aims to reduce the number of HIV-positive infants by encouraging every expectant mother to get HIV testing during pregnancy - either during prenatal appointments or at the hospital just before child birth.
The state Health Department says the new policy is needed because only 53 percent of pregnant women in the state now get prenatal HIV testing. Using 1997-98 data, the state determined that, each year, up to 200 of those women may be HIV positive and unaware they have the infection.
"I think they want to make hospital testing so unappealing the obstetricians will just test everybody beforehand," he said. "If that happens, it would be a good thing."
Newborns in New York state are already tested for HIV but are allowed to go home before the results are in, said Dr. Maggie Vill, a perinatologist at Rochester General Hospital. If the result is positive, the pediatrician calls the parents and the baby is retested.
The first HIV test on a newborn is not conclusive because it is done on cord blood, which contains antibodies from the mother, Vill said. Rapid HIV tests and cord blood tests have high rates of false positives, she said.
HIV infection can be passed to the baby in the womb, during delivery or through breast milk. About 30 percent of HIV-infected babies experience a rapid decline, dying by age 5 or 6, Strong Memorial's Gigliotti said. The others have a slower disease process similar to AIDS in adults.
Early diagnosis is important because the drug AZT can prevent transmission to the infant.
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