Important note: Information in this article was accurate in June 2002. The state of the art may have changed since the publication date.
Being Alive Opposes Mandatory Testing for Pregnant Women Being Alive - June-July, 2002 Brad Sears
This year, Assemblyman Roderick Wright introduced legislation, AB 2930, that would have permitted doctors in California to test pregnant women for HIV without pre- and post-test counseling and without their consent. Currently, California law requires that pregnant women be offered an HIV test, but does not force them to be tested. Current law also requires that pregnant women receive HIV counseling, including counseling about how to prevent the transmission of HIV.
On behalf of Being Alive, the Being Alive Advocacy Committee drafted a letter in opposition to AB 2930 because it violates the privacy rights of pregnant women and would not reduce the spread of the HIV virus from mother to child. Being Alive is opposed to mandatory HIV testing for any segment of the population, including women -- who are the least likely to have access to medical care. We believe that individuals should be treated with dignity and should be allowed to make their own informed decisions about when to be tested and when to begin treatment. In fact, under the current law, 96% of pregnant women make their own free choice to be tested for HIV.
Mandatory HIV testing could result in more health problems for pregnant women and their babies as women may avoid pre-natal care because they fear being tested without their knowledge and without their consent.
In response to Being Alive's letter and the work of other advocacy groups, Assemblyman Wright amended AB 2930 so that it no longer mandates HIV testing for pregnant women. The text of the letter sent by the Being Alive Advocacy Committee to Assemblyman Wright and other members of the Assembly Health Committee is shown below.
Dear Assembly Members Wright, Thompson, and Koretz:
On behalf of Being Alive Los Angeles, Inc., an organization of, by, and for people living with HIV and AIDS in Los Angeles County, and its Board of Directors, I write to express our opposition to AB 2930 (Wright). This bill effectively mandates an HIV test for all women receiving prenatal care by repealing Health and Safety Code 125107.
This bill deletes the mandate for providers to offer HIV testing to pregnant women, and instead requires blood drawn for purposes of prenatal testing be tested for HIV. AB 2930 states that a women may refuse such a test only if she is known to be chronically infected with HIV or if a physician has explained to her the reasons for the testing. However, it does not require physicians to explain the reasons for the testing.
As people living with HIV/AIDS, we believe that AB 2930:
violates the critical rights of privacy and autonomy over medical decisions of pregnant women, and
would undermine, rather than advance, the prevention of HIV-transmission from mother to child.
By deleting the current statute there is no requirement that a women be informed she is going to be tested for HIV. This law would exclude pregnant women as a group from California laws that protect people from being tested for HIV without their consent. The law assumes that pregnant women as a group are incapable of making their own decisions about protecting their bodies, their health, and their babies.
1. Current California law is preventing the transmission of HIV from mother to child. Health and Safety Code §125107 represents an historic compromise between health advocates, medical providers, legislators and women affected by HIV. Currently, California state law mandates that all pregnant women be offered an HIV test by their prenatal care provider and be offered important pre and post test counseling. This section was passed not only to protect the rights of pregnant women, but because public health officials believed that protecting such rights was the most effective way to ensure that women who were at risk of becoming infected with HIV sought prenatal care, HIV-testing, and treatments to prevent the transmission of HIV to their babies.
Experience with the application of this law in California and other states has shown that this theory was correct. The current system is working. There is an extraordinarily high level of voluntary participation in HIV testing achieved in the State of California. Under the current law:
California has seen vertical transmission drop by 89% from 1993 to 1999, and
Currently over 96% of all women offered HIV testing in California accept.
Relatively few women refuse the voluntary HIV test offered in prenatal care and most of the women testing positive take anti-HIV medications if recommended. A small number of HIV infections have resulted from vertical transmission in the last several years. In Los Angeles County, four to five vertical transmissions are reported each year, while San Francisco County estimates as few as one per year. While even a small number of cases of vertical transmission are unacceptable and require individual attention, the fact remains that California leads the way in successful voluntary HIV testing.
2. AB 2930 would discourage women, especially poor and minority women, from seeking prenatal care. Informed consent is essential in allowing a pregnant woman to develop a trusting relationship with her provider. Removing informed consent and a woman's right of refusal could drive the most vulnerable women from accessing prenatal care. In a study comparing the effects of voluntary versus mandatory HIV testing on the likelihood of women receiving prenatal care, voluntary testing, which included informed consent, significantly improved the likelihood of women receiving prenatal care. In addition women who are most vulnerable and who already face obstacles to quality prenatal care such as the threat of domestic violence, immigration concerns, language barriers, and homelessness will be less likely to access prenatal care if informed consent and the right of refusal are removed.
3. AB 2930 would prevent women from getting information that they need to protect themselves and their babies from becoming infected with HIV. Moreover, by repealing Section 125017, pregnant women would not be given important information to protect their own health or the health of their babies. AB 2930 takes a very cramped view of the risk of HIV-infection -- it is only concerned about a woman's HIV-status on the day that she is tested. Unlike the law it repeals, it does nothing to prevent the woman from becoming infected after the test has been taken. At best, this approach would only help women who are positive on the day that they are tested to take measures to reduce the risk of infection to their current child.
The current law seeks to protect all pregnant women from becoming infected during the course of their pregnancy and in the future. The current law seeks to protect women as well as their children. It requires that all pregnant women be given information about all modes of transmission and all ways to prevent HIV transmission. This education enables women to make sure that they don't become infected at any time during their current pregnancy as well as in the future. Under AB 2930, pregnant women would be tested without being providing any of this risk reduction information. Those that are negative would not be given the information that they need to remain negative.
We understand that the intent of AB 2930 is to reduce HIV infection. However we remain concerned that by deleting current law that works to engage a woman as an active partner in her health care, this bill could ultimately decrease participation in prenatal healthcare and increase HIV infection and other maternal and infant health problems.
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Important note: Information in this article was accurate in June 2002. The state of the art may have changed since the publication date.
