United Press International - Monday, 3 December 2001
Ed Susman, UPI Science News

The move was applauded by most doctors at the semiannual gathering of the AMA's House of Delegates in San Francisco.

The AMA's Council on Scientific Affairs recommended the 290,000-member physician organization change its policy that has stood since 1996 when studies first showed treating mothers infected with human immunodeficiency virus -- which causes AIDS -- with potent antiretroviral medication would protect the vast majority of newborns from contracting the virus during childbirth.

However, numerous other medical groups shied away from making such testing a mandatory recommendation, concerned that if a pregnant woman was faced with undergoing a test she did not care to take, she might avoid all prenatal care.

In a review of its HIV testing policy, the CSA revised its recommendations to say "that there should be universal HIV testing of all pregnant women with notification of the right of refusal as a routine component of prenatal care."

The new wording makes it clear the AMA believes all pregnant women should be tested, but still allows women not be coerced into it.

In presenting the CSA report Sunday to the public health committee of the AMA's House of Delegates, Dr. Mohammed Khan, a member of the CSA from Ann Arbor, Mich., said: "We believe the data show a clear benefit to universal HIV testing. We believe it 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."

The recommendations will be weighed by the public health committee, which then will either recommend adoption of the new AMA policy, reject those changes or send the report back to the committee for further tinkering. The full House of Delegates is to decide on the proposal's fate later this week.

Testimony before the public health committee, however, was universally in favor of the changes. The AMA policy had been in contrast with recommendations of other medical organizations such as the American College of Obstetricians and Gynecologists, which advocated testing but not making it mandatory.

Two states, Connecticut and New York have enacted forms of mandatory HIV testing for either pregnant women or newborns.

Speaking for the ACOG delegation, Dr. Paul Gluck of Miami said, "We commend the CSA for this excellent academic, scholarly report that balances privacy, ethical concerns about autonomy and self-determination, public health concerns and individual health. We think this approach has been working and will continue to work and will provide universal screening for HIV in our pregnant population."

Speakers representing state medical officers, the public health service, the American Academy of Family Physicians and others also supported the change away from a mandatory position. Delegations from New York and Connecticut did not offer testimony on the matter.

The CSA report noted treating pregnant women and their newborns with antiretroviral mediation has lowered the incidence of babies infected with the disease from around 2,000 a year in 1994 to less than 200 a year currently.

Khan said the CSA intends to work with other AMA committees to create an overall revamping of the organization's recommendations regarding aspects of HIV treatment.
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