Important note: Information in this article was accurate in 1987. The state of the art may have changed since the publication date.
MDs Urge More Testing for AIDS, Suggest Screening Pregnant Women
Miami Herald - Saturday, February 21, 1987
Rosemary Goudreau, Herald Staff Writer
ATLANTA - Pregnant women in cities with a high rate of AIDS -- including Miami -- should be tested for exposure to the disease, several researchers said Friday. If infected, they should consider terminating their pregnancies. Otherwise, more and more children will be born with AIDS, further squeezing urban hospitals and frustrating pediatricians who can offer little hope for a long or pain-free life. Jackson Memorial Hospital in Miami is treating about 90 children with AIDS, according to Dr. Gwendolyn Scott, associate professor of pediatrics at the University of Miami School of Medicine. Some of the children, who range in age from newborn to 7 years old, have been hospitalized 10 to 12 times, she said. Mandatory testing for pregnant women was debated by doctors at an international conference on AIDS in children and heterosexuals. Most support the idea, but they reached no consensus on when or how such a program should be implemented. "I strongly support screening pregnant women and finding out who's at risk for this," said Dr. Leon Epstein of the New Jersey College of Medicine. "Anyone who has the ability to infect another person doesn't have the right not to know it," he said. Epstein works in Newark, which runs neck-and-neck with Miami for the second highest number of children with AIDS. New York City is first. San Francisco and Los Angeles are fourth and fifth. "Pregnant women probably should be screened routinely, but certainly if they live in an area where the disease is endemic, such as New York, New Jersey, Florida and California. There's a lot more virus there, and those women are obviously at greater risk just by where they live," Epstein said. Three-fourths of children with AIDS were born to infected mothers, 15 percent caught the disease from blood transfusions, 4 percent were children with hemophilia who received infected blood-clotting products, and in 4 percent the cause is unknown, said Dr. James Oleske, a pediatrician at the New Jersey College of Medicine. AIDS-infected children suffer fever, failure to thrive, diarrhea, infected lymph glands, thrush and an enlarged spleen and liver. At present, most of them come from poor urban families, he said. Don't want scare Women who become pregnant in Miami are not now given the test that detects antibodies to the human immunodeficiency virus that causes AIDS. But the idea is under consideration, said Scott, who runs the Jackson program for children with AIDS. "We don't want to issue a huge scare to the women who are pregnant . . . but if you're a woman who does have concerns about a prior history of abusing drugs or are the sexual partner of someone who abused drugs, it would be reasonable to request testing," she said. What if you don't know whether you've been exposed, in light of the fact that the virus is making its way into the heterosexual community? "That's why it will come to everyone being screened," Scott said. "I think it will come, but when it comes is another question." First, the issue of counseling must be addressed, she said. "It's very difficult to tell someone they're HIV-positive. It has implications for their sexual partners and their previous children," she said. It also is difficult because for many women, self-esteem is tied to the ability to bear children. By the time a woman gives birth at Jackson, doctors know if her blood is infected with the AIDS virus, Scott said. Those who test positive are advised not to breast-feed their babies. There has been one reported case of a baby catching AIDS from breast milk, Scott said. The costs of Jackson's program for children with AIDS haven't been computed, but the average pediatric AIDS case in San Francisco costs $41,000, in Boston $50,000 and in New York $86,000, according to Ann Hardy of the Centers for Disease Control in Atlanta. By 1991, when as many as 20,000 children are expected to be infected, the cost of caring for them may exceed $9 billion, Hardy said. 'Overwhelmed' "It seems the cost of testing would be much cheaper," said Dr. Andre Nahmias of Atlanta, president of the International Interdisciplinary AIDS Foundation, which organized the conference. Hospitals already are having trouble handling the number of children with AIDS, Oleske said. "By 1991, we're supposed to have 600 children with AIDS in Newark. . . . We're not going to have the hospital space, the outpatient space, the community services to deal with the problem. "Until we can convince childbearing-age women in risk groups for AIDS to avoid pregnancy . . . not only are hospitals in Newark, San Francisco and Miami going to be overwhelmed, but elsewhere in the country," he said. The cost of pediatric AIDS is more than financial. The disease causes a slow and painful death. Ways must be found to control the pain, he said. By the time they die, many children with AIDS end up with permanent muscle contractions, "bed-bound and mute," Epstein said.
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