FREE ESSAY ON AIDS AND SOCIETY

AIDS AND SOCIETY

Aids and Society
The number of newborns infected by vertical transmission of the human immunodeficiency
virus is increasing as the prevalence of HIV-positive women increase within the United
States. It is estimated that while seven thousand HIV-positive women become pregnant each
year, between one thousand and two thousand of their newborns will be HIV-positive. This
research paper will concentrate on the transmission of the human immunodeficiency virus
from mother to child, the benefits of drugs intervention, and whether or not the
HIV-screening process of pregnant women should remain voluntary or become mandatory.
The HIV-virus has proven that it is not a disease to be taken lightly or ignored. I chose
this topic because I want to be informed about the virus and its rate of vertical
transmission so that I will be able to inform others about such ethical topics: Does the
baby have rights and should a pregnant women be denied her right to privacy with respect
to HIV?
Data shows that AIDS is now increasing faster among females than males, with women
accounting for seven percent of cases in 1985 and nineteen percent in 1995. The
incidences of HIV-positive heterosexual women have risen dramatically over the past
decade, and AIDS is now the third leading cause of death among women ages twenty-five to
forty-four. The one thing that all of these women have in common is that they all are of
child bearing age. Consequently, the incidences of HIV-positive newborns have also 
increased. As mentioned previously, about seven thousand HIV-infected women give birth
each year, and about twenty-five percent of their babies are HIV-positive. "Maternal
transmission accounted for ninety-two percent of all new AIDS cases reported in children
in 1994"(Davis15). 
A major breakthrough in drug intervention began in February 1993. The AIDS Clinical
Trials Group administered a double-blinded, randomized, placebo-controlled study of
zidovudine, also known as AST. Four hundred seventy-five women were enrolled in the
study. These women were randomly assigned to one of two groups. One group received
zidovudine while the other, the control group, received a placebo. The administration of
either zidovudine or placebo began in the second trimester of pregnancy and continued
through labor. For six weeks after birth, the babies received the same treatment as the
mothers in a syrup form. Because it was a double-blinded study, neither the researchers
nor the patients knew who was actually receiving the zidovudine. Only three hundred
sixty-four babies of the four hundred twenty-one born were available for testing. Results
showed that, "of the three hundred sixty-four available for testing, fifty-three were
infected with HIV; thirteen were born to mothers receiving zidovudine and forty to
mothers on placebo" (FDA Consumer 3). According to this data, when both mothers and
babies received zidovudine, there was a transmission rate of 8.3 percent. This was a
dramatic decrease in the rate of transmission when compared to the control group who had
a transmission rate of 25.5 percent.
With results such as these, drug intervention with respect to both pregnant women and
newborns should become more commonplace with each day. For example, if the decrease in
maternal transmission rate is duplicated from the AIDS Clinical Trials Group study, and
the estimated seven thousand HIV-infected women deliver infants while accepting treatment
with zidovudine, one will conclude that "under these hypothetical conditions, as many as
two-thirds, or twelve hundred, of all vertically acquired HIV-infections could be
prevented annually"(Davis 15). This decrease in maternal transmission would be ideal if
all conditions were met, but there seems to be one major flaw. Many pregnant women do not
know they are infected with HIV.
The problem now is how to identify HIV-infected pregnant women at an early enough stage,
so that the use of AZT could drastically reduce the chances of the baby being born with
HIV. It is critical that the physician know of a women's HIV-infection prior to or early
in her pregnancy. Because many women who are at risk are completely unaware of it, a
growing national debate has centered on mandatory HIV testing of all pregnant women. This
notion of mandatory screening has raised many ethical issues. It is certain that those
who test positive and accept treatment with AZT would have a decreased transmission rate,
but according to some, this notion takes into account only the child and not the mother.
Opponents on the other hand want to consider the woman's right to privacy. A Center for
Disease Control spokesman says, "mandatory testing destroys the relation ship of trust
between the women and her health care provider"(Kent 18). Many feel that because of the
stigmatization associated with the HIV-virus/AIDS, pregnant women should not be singled
out.
As of August 1994, voluntary testing of pregnant women seems to be the most viable way to
get the cooperation for both testing and treatment. Medical groups such as the American
Academy of Pediatrics and the American College of Obstetricians and Gynecologists say,
"mandatory testing simply does not work for the populations most at risk (for the
HIV-virus), and could undermine physicians' effort to build collaborative, trusting
relationships with patients" (Shelton 15). Mandatory testing could also be viewed as a
deterrent to obtaining prenatal care. Those who would find it as a disincentive would
most likely be those individuals most in need of education, counseling and treatment. The
result would be the loss of opportunity to provide both counseling and treatment. Because
of these findings, voluntary testing seems to be the most effective. On July 1, 1995, the
Center for Disease Control released guidelines specific for HIV-screening. The
guidelines, "recommend that physicians counsel all pregnant women about HIV and that they
are to offer them the chance to be voluntarily tested" (Kent 17). According to the Center
for Disease Control guidelines, those found to be HIV-positive are then offered
zidovudine which has been found to reduce prenatal HIV transmission by as much as
two-thirds. These guidelines were established because it is believed that pregnant women
who are given information about HIV are more eager to comply than those who feel as
though they are being coerced. Aggressive voluntary strategies have been shown to work.
One study showed ninety-six percent of almost thirty-six hundred women at Grady Hospital
in Atlanta, Georgia, chose to be tested after being counseled.
Along with the voluntary testing offered to pregnant women, there is a mandate testing of
all babies born to women who do not receive a prenatal test for the HIV-virus. The
combination of the two testing procedures works well by accounting for the rights of the
newborn child. Even if the mother refuses testing and is HIV-positive, there is about a
seventy-five percent chance the baby would not acquire the virus during pregnancy and
labor. However, the HIV-infection can be transmitted to the infant from the mother even
after birth. Breast-feeding has been shown as a way of contracting the human
immunodeficiency virus. Therefore, breast-feeding should not be an option for those
infants whose mother is HIV-positive. Because of the mandatory testing of the newborn,
one who tests positive for the HIV-virus can be given treatment for AIDS related
diseases. The infant may test false positive due to the fact that maternal antibodies can
cross the placenta and enter the baby's bloodstream. The ELISA test may record a positive
test because of the presence of maternal antibodies to the HIV-virus. Testing of the baby
periodically will determine whether or not the HIV antibodies present are actually
produced by the baby's own immune system, or whether they were passed across the placenta
from the mother's antibodies. This combination of the two tests, "encourages women to
have the test, but for women who do not, who fall through the cracks, this protects their
babies" (Kent 17). 
One question remains about the Center for Disease Control's guidelines, "Who will pay to
screen the women who give birth each year in the United States?" (Kent 18). While many
are concerned about the costs associated with HIV testing and treatment of HIV-positive
pregnant women, they fail to look at the entire picture. One would have to ask them in
return, "Who is paying for the extensive treatment required by those HIV-infected
children." It seems as though there would be economic benefits to the screening process.
The expected total drug costs for zidovudine per case under the AIDS Control Trials Group
076 regimen including all phases of treatment was estimated at eight hundred 
ninety-five dollars. On the contrary, "estimated lifetime cost of pediatric HIV-infection
has previously been reported to be one hundred thousand dollars" (Mauskopf et al 133).
Voluntary screening programs can enhance cost savings and health benefits for pregnant
women. Cost savings will occur for a wide range of zidovudine efficacy rates and lifetime
treatment costs for pediatric HIV-infection. It should also be noted that reducing the
number of HIV-positive infants has more effects than simply the potential savings in
cost. There are also important issues related to avoiding grief as well as the increased
life expectancy for the infant.
This paper demonstrates both the health and the economic benefits associated with
treating HIV-positive pregnant women and their newborns with the drug, zidovudine. I feel
that voluntary screening programs offered to all pregnant women would help to avoid the
problems associated with discriminations, whether it is a demographic location or an
individual's background. The high-risk pregnant women may be more likely to participate
in the human immunodeficiency virus screening because every pregnant woman would be
offered the same regimen. Therefore, there would be fewer stigmas associated with the
screening process. One would not be as likely to shy away from prenatal care because it
would be understood that all pregnant women receive the same opportunity for testing and
treatment. Although there are still ethical question about whether the mother's right to
privacy or the baby's rights are more important, there has been some agreement. As the
incidence of HIV infection among women of childbearing age continues to increase,
programs of voluntary screening and AZT treatment, along with continued educational
efforts, should be considered integral components of HIV prevention programs. 
Bibliography
Bibliography
Davis, Susan F. "Study: Fewer HIV-infected babies being born." American Medical 
News 2 Oct 1995:15.
FDA Consumer "HIV transmission to babies reduced in early study results. "May 1994: 3-
4.
Kent, Cristina. "HIV testing of pregnant women, newborns debated." American Medical
News 24 July. 1995: 17-18.
Mauskopf, Josephine A. et al. "Economic impact of treatment of HIV-positive pregnant 
women and their newborns with zidovudine." The Journal of the American Medical
Association 10 July. 1996: 132-138.
Shelton Deborah L. "Is it the time...for mandatory testing of pregnant women?" American
Medical News 2 Sep. 1996: 13-16.