At my hospital (I'm a med student), every pregnant woman goes through routine screening for a number of diseases: rubella, hepatitis B, gonorrhea, chlamydia, syphilis, group B strep, and yes... HIV.

These are fairly important pieces of medical information. Not testing would be a disservice both to the mother and the child.

If a mother turns out to be HIV+, there are steps we can do to reduce the likelihood of vertical transmission. A c-section, for instance, reduces the risk considerably over vaginal delivery. For this decision to be made, we have to know the mother's HIV status.

Then there is the mother's health as well. Like any chronic condition, HIV is better treated sooner rather than later.

As far as privacy goes, HIPAA has that covered. Believe me... HIPAA is stressed so heavily that it is damn near a religion around here. Any provider who carelessly discloses the HIV status of a patient likely gets fired.

I understand patients should have ultimate control over their health decisions, and they can certainly opt out of any screening. But some tests are routine at any hospital: glucose and A1C checks for diabetics... plasma electrophoerisis for sickle cell patients.. and screens for important infectious diseases for mothers. All of these screens have demonstratable health benefits, backed up by research.

NOT screening every mother for HIV and other diseases is a lot less respectful to her or her baby, than making the screenings only at the patient's request.

Forbidden:

1. HIPAA is damn near useless and we both know it. Many people's medical info is stolen and sold by health care providers themselves and any law enforcement joe can request it for any reason. The best way to protect info is not to have it.

2.Why do you test? Is treatment free once you do? If not, what good does it do?

3. When you say the info is important, what you mean is that you have been trained to want that info. You do not necessarily mean that you personally as a health care provider will use it to get long term care and treatment. You just want to know.

4. Would you suggest doing HIV tests on every man who enters your hospital and might be sexually active as a routine? If not, you're buying into misogynist over-medicalization of women's bodies, pure and simple.

I think that its really important to remember that HIV is treated differently as an infectious disease primarily because of the vocal and committed activism of the AIDS/HIV advocacy communities and that this comes out of a history of HIV hysteria and prejudice. Yes, in the 1980's there was talk of "rounding up" HIV positive persons and putting them into camps--even as late as the 90's one of the current front-runners, Mike Huckabee, reiterated this heinous idea!!!

But, HIV is an infectious disease and other infectious diseases, such as TB and syphillus have very strict medical procedures in terms of testing and notification policies for the benefit of public health--HIV does not because activist early on saw how out of control homophobia and racism could turn HIV notification mandates into marching papers to camps--this dystopic view and concern came from a fear born by real and dangerous political policy makers (not medical professionals)!!!

So, as the med student stated, it is part of standard care to test for a variety of diseases/conditions during pregnancy because that is just that--PART OF STANDARD CARE. HIV has been politicized, primarily by the Right at first, but the activist Left (of which I consider myself a part of) has also played its part in just such politicization. Why is it that in the collective imagination HIV is different from Gestational Diabetes, for example? Because of the horrors, imagined or real, that HIV patients have been subject to over the past three decades. HIV should not be politicized, it should be dealt with (without judgment) as a health-care issue. Is it more or less patriarchal to test pregnant women for anemia than for HIV? Both pose serious threats to women and to infants. Yes, the idea that people do not have complete control over the tests that are administered can seem anti-feminist since so much of the feminist movement has to do with bodily integrity and the human rights of women, yet, before one can have any procedure or undergo treatment there are STANDARDS OF CARE one must proceed with to undergo care--a blood pressure test, getting weighed, medical history taken (and all that to see if one has strep throat). That's the thing about medicine--we don't get to pick and choose STANDARDS OF CARE in our individual cases because doctors and nurses (and nurse practioners) need as much information to proceed honoring their oath to do no harm. Men and women, at many points in our lives are dependent upon the good graces and compassion of other human beings and we have to trust that as we individually gain out areas of expertise we respect that. I teach, if my students said in my world lit class that they didn't want to learn anything about Chinese Literature, as a teacher would I honor that and still consider the class a "world Lit class?" No, I have that area of expertise and I know that to truly care for my students as learners of a liberal education the class must present some Chinese Literature and not just focus on the West--okay, the metaphor is a stretch, but what I mean to say is that we are all dependent upon one another and to confuse bodily integrity with the right to determine individual standards of care is incorrect. Medical practice needs those tests to serve the patient, its up to our political/social policy makers to make sure that that test does not result in the loss of healthcare coverage, job loss, or discrimination of any kind as a result of HIV status--these are different areas. Respect the standards of care as well intentioned, just like the tests for gestational diabetes, as part of medical practice, not a deliberate attempt to harm pregnant women socially. Vote vote vote for comprehensive health policies--speak out for the reproductive rights of women, but don't allow the politicization of science and medicine.

This is the main problem I have with mandatory testing like this. I live in NY and had my son at home with a certified midwife. I could opt out of the HIV testing, but had I transfered into a hospital without having been tested, I would not have been allowed to breastfeed my baby. I had been with the same partner for (at that time) for over 7 years. I am pregnant again, same man, now over 14 years, and will need to be tested again. Neither of us have been with other partners (and yes, I know this for a fact) and I have been routinely tested for STDs at my yearly exams. I find this sort of mandated invasion exactly that - an invasion. We ultimately ought to have control of our own bodies and health care choices. I do not have the routine tests done during pregnancy because I know that I will not abort or love a baby any less if there is anything wrong with him/her. I don't see how this is any different. Even if my baby had HIV, I'm not sure how I would proceed. If I chose not to treat the baby with the (nasty) drugs available, that should be my right - just like I can choose to breastfeed, circumcise, vaccinate, co-sleep, send to daycare, etc. or not. Not everyone may agree with my choices, but they are ultimately mine. It is up to me to choose what I feel is best for my child and myself.

thealogian - we cannot wish away the political reality. And your Standard of care line would imply forthcoming treatment. Again, that is simply not the case. Knowlegde (without treatment) is not power, at least not for the patient. But it IS power OVER the patient.

Remember that standards of care are created by people and usually not by feminists. They have more to do with preventing lawsuit than with health care.

I want one proponent of this imposed test (just one) to tell me that these women and their babies will get treatment for HIV (free and accessible) and I will back off. If they will not, then the tests are merely slut shaming and attempts to take babies away from mothers as the example in the initial post.

This is a really complicated issue. If tests were only given at the mother's request, then there's a good chance a lot of expecting mothers wouldn't know to ask for it. Personally, I think it would be a good idea to expand HIV testing to both men and women (not just those that are pregnant). Like any other medical test, patients should be informed about what they are being tested for.
HIV is widespread and the only way to step up prevention is to do more testing. I am not suggesting that individuals with HIV need to be targetted for any kind of discrimination, however it is possible that more widespread testing would allow individuals know about their condition in earlier stages, thus making it easier to treat the condition and stop the spread.
To just test pregnant women is neglecting a substantial portion of the equation. Accordng to the CDC website, men account for more than twice the HIV cases than women do, and about 1/4 of those with it do not know they have it.

Lilah, thanks for your story. Medical professionals refuse to believe that we can (or should) make our own choices, but you prove beautifully that we can and must.

I would be ok with offering women the choice. Tell her the risks and benefits of testing and let her decide what is best for her and her baby.

I have heard too many horror stories of children being snatched from their parents when the parents decide that mainstream medicine isn't the route for them.

mirm: 1. I'm not sure what hospitals you've been in, but if random people can walk in and steal medical information... maybe that hospital's security department needs an overhaul. At our place, even using EMR using someone else's login is grounds for suspension. And as far as the legalities go... the thought of cops snooping without a warrant is ridiculous. (but then again, in George Bush's America, anything goes, so you may have a point.)

2. Why do we test? As I said, there are things that can be done if we have a positive test. C-sections cut down on the risk of transmission of some diseases, including HIV. Also, reducing the mother's viral load with anti-retrovirals lessens the risk for the fetus. These steps obviously won't be taken if we don't know the mom is HIV+.

3. Um... okay. You're right. We are just snoopers and peeping toms, sticking our nose where it doesn't belong... that's the only reason why we ask about your HIV status. Seriously, is that what you really think? It sounds like you've had some bad experiences with judgmental doctors. If that is the case, my apologies, but don't judge an entire profession based on a couple bad apples.

4. If a man is sexually active, you're damn straight that I'm regularly going to test him for HIV, gonorrhea, and chlamydia.

As thealogian says, it's all about "standard of care." I know HIV+ patients were discriminated against in the 80s and early 90s, and I understand why people are still hypersensitive about HIV tests as opposed to tests for other diseases. But not only is HIV a serious condition -- but there are also things we can do these days to manage it, and reduce the risk of transmission. THAT is why we want to know.

I don't know if this is true or not but it came up during a conversation once and if it is then it would definitely be important in this case...

Someone once told me that your insurance can suddenly decide to kick you off (of course, they wait until you have something huge and expensive that you need covered) if they see that you've had HIV tests or other tests of that sort before. Something about a risky behavior clause (needing an HIV test would imply that you have unprotected sex, etc). Anyway, the point is, does anyone know if this is true?

I'm hesitant to jump into this because I feel that I'm not well informed enough to develop a solid opinion, yet. The issue, as it seems to me, is about the standard of care that has been mentioned. ForbiddenComma seems to be advocating that health professionals need as much information as possible. That seems reasonable to me and surely necessary for doctors being able to offer the very best medical advice and services possible. If that's the case, as a feminist, I like the HIV testing for pregnant women. These women deserve the best care possible and know all of their options. On top of that, is it painful, inconvenient or expensive to have that test? Although Lilah's story about needing to be tested twice does seem inconvenient, should doctors been seen as slut shaming or as honestly wanting all medical information possible? I'm not sure and it's interesting to think about the two sides.

It gets complicated when that medical information is used either against the patient or at all outside of the doctor/patient relationship. In the case hte NJ woman who was deemed an "unfit" mother based on her HIV status, that's clearly wrong and ridiculous.

Is it possible to separate the two issues? The first issue being mandated testing and the second issue being the use of the results of those mandated tests? I don't know if they can be, it's a genuine question.

newslang, i'd hope that's not true. being screened for HIV means i'm NOT risky because i'm proactive about protecting my health. i've never had unprotected sex with someone who i didn't know his HIV status, and i still got tested. careful healthy people are the people insurance companies should want to keep.

i grew up and live in NJ, and i'm conflicted about this too. NJ is home to many pharmaceutical companies, so i'm always suspicious that any healthcare legislation might be made to benefit these giant taxpayers and employers more than our residents. on the other hand, i believe we have a trusted and respected healthcare community in the state.

i guess what i'm saying is, what others have said. i would trust the mandatory-ness if it was a highly recommended medical procedure rather than on-the-books law. especially since doctors and hospitals are already highly compromising their care because of threat of lawsuits and legislation.

Newslang,
That isn't true. If you have been without insurance and test positive it could be a pre-existing condition, but nothing can happen to you for having the test. Often there are many places to get tested for free and there is no report the insurance companies at all.

I have worked for an HIV Clinic, non-profit youth program for HIV/AIDS children and adolescents, and speak nationally with HIV positive people about prevention and compassion...so this issue really hits home.

I think that the majority of the people I work with living with HIV would be in favor of mandatory testing, and yes, there are many options out there for getting funding for meds. It isn't always easy, but that is why most (if not all) HIV patients have case workers that intricately know the ins and outs of federal funding. I am not a case worker, but I am fairly certain that if you are under 18 you are provided the meds for free. After you turn 18 things are a little trickier.

Also, in this country, the mother-to-child spread of HIV has been lowered to an extremely low rate because of the precautions you can take once status is shown. Mother to child transmission is anywhere from 25%-50% without precautions and less than 2% with medications/c-sections/etc. It is one of the easiest ways to stop the spread of HIV.

And, the CDC did recommend last year that EVERYONE (male and female) be tested as part of a routine physical. The test takes 20 minutes and is very cost-effective so there is little reason not to. The CDC also estimates that of there are about 250,000-500,000 people out there who don't know their status and are actively spreading the disease and not getting the care they need. This leads me to a point I tell everyone I know...go get tested.

Oh, and HIPAA definitely is not a joke where I come from. I couldn't even get the phone number for a women to drop off Christmas presents that we had sponsored. We had to wait for her case worker to come back because he was the only one with access outside of her doctor who was on vacation. It may not be the case everywhere, but there is no information sharing in our clinic.

I know HIV+ patients were discriminated against in the 80s and early 90s, and I understand why people are still hypersensitive about HIV tests as opposed to tests for other diseases. But not only is HIV a serious condition -- but there are also things we can do these days to manage it, and reduce the risk of transmission. THAT is why we want to know.

I have to say, it is incredibly naive to think that HIV+ patients are not discriminated against anymore. I am guessing you are in a large, metropolitan area. In smaller towns and rural areas, your health isn't so private, HIPPA or no. When your neighbor's kid's friend is the nurse or the med tech or the doctor, your neighbor may very well know your HIV status. Those things aren't kept quiet long in small towns because the fear is still there (I still here a lot of crap like: "I can't get AIDS, I ain't no fag!") So, while you may be surrounded by dedicated, caring, informed, and ethical healthcare professionals, not all of us are as lucky.

Also, just because you can manage HIV doesn't mean you have the RIGHT to test for it (nor should the patient be obligated to tell you if they have it). You job should be to provide the patient with the facts and talk it over with them, but in the patient should ALWAYS make that decision, pregnant or not. Period.

If a man is sexually active, you're damn straight that I'm regularly going to test him for HIV, gonorrhea, and chlamydia.

The key difference is that is not MANDATORY for a man to be tested for any of those things. You can highly recommend he be tested, but ultimately, the decision is his (with no repercussions, i.e. having his child taken away for not testing). That's all we want for women, pregnant and non-pregnant alike.

(when I say "you" and "they," I mean that in a broad sense, not a personal)

Last question, why in world should I be FORCED to pay for a test I do not need (I know I am not HIV+, why isn't my word good enough)?

HIV is widespread and the only way to step up prevention is to do more testing.

I would generally agree with this statement, but AFAIK, it takes patients up to (depending on who you talk to) 3-12 months to seroconvert so that they test positive if they are HIV positive (somewhere on my blog, I blogged about this and Jay, whom you may know from either feministe or pandagon set me straight).

While people are warned about this, I cannot help but think that if you have a bunch of people tested, you'll end up having more than a few people for whom the warning didn't sink in and they'll be going around thinking they're negative when they are really positive and hence will end up spreading the disease.

I'd say that we really do need to still put some money into better testing before we start making it so widespread.

"That's all we want for women, pregnant and non-pregnant alike."

That should say:

That's all I want..

I don't want to speak for any other feminists as we have varied and interesting opinions on this subject.

OT but Re: HIPAA (I think) ... the daycare to which my fiancee sends her daughter once decided that she (my soon-to-be daughter) had pinkeye. My fiancee had to take off work early (I live in another state), etc. (which is a whole 'nother topic of conversation -- supporting single parents: where are the so-called pro-life people on this?) and take her daughter to the doctor.

The doctor said "this kid doesn't have pinkeye: it's just -- and obviously so -- irritation from the cold dry air". The doctor wrote a note, but the next morning the daycare people decided they didn't believe the doctor's note, called the doctor and started asking questions.

Was the doctor really able to divulge things under HIPAA? AFAIC, the doctor said the kid wasn't contagious: anything else, unless it was directly relevent to the ability of the daycare provider to act in loco parentis, was none of their darned beeswax!

I guess whomever answered the phones at the doctor's office handled it discretely and diplomatically. If I were the doctor (or her receptionist) I would be screeming at the daycare people: "what the #@$% is wrong with you? isn't our note enough!?!?"

And, the CDC did recommend last year that EVERYONE (male and female) be tested as part of a routine physical.

I agree with the CDC. However, recommending it as part of a routine physical and requiring for all pregnant mothers is completely different. Recommending it still leaves the decision upto the patient. Not so with madatory testing, even with an opt-out (as someone pointed out, women are often pressured into testing - some at the threat of losing their new baby).

I also think cost HAS to be part of this discussion as well. The cost of having a child, even with insurance, can be astronomical for some. And, until that changes, I have a problem with adding on more mandatory testing.

Forbidden:

http://www.msnbc.msn.com/id/17048911/

“Medical identity theft, on the rise, can threaten lives as well as wallets� Information is not so hard to get.

My medical history is so boring as to be laughable, so nope, not about me. But nice attempt at misdirection.

Your snooping is well-intentioned. You want to provide care, but information about sero-status does not guarantee treatment. For care, you also need time, money, and patient cooperation, none of which come magically with an HIV+ status. While you may laugh at my comments about medical professionals just wanting to know, when you cannot personally assure treatment after the test, what else would you call it?

There are things you can do, when you know a pregnant patient is HIV+, you may not have the wherewithal (insurance coverage, payment, patient permission) to actually do them. Thus, the test itself is not the answer. Those anti-retrovirals don’t come cheap do they? And they are not easy to take either are they? You cannot say that knowledge about serostatus will get them to a patient. These decisions must be made by the patient, not by the system.

You can mock my attitudes and call me paranoid, but I don’t see you actually addressing my points.

as someone who used to work in a doctor's office which dealt with pain management and addiction, i'm befuddled by all the ragging on hipaa that's going around.

i mean, as i understand it (and i'm no doctor, but i did do my share of filing and storage of medical data), medical information cannot be obtained without the patient's consent unless there is a warrant, subpoena, or similar legal document demanding said information.

in other words, your medical info is about as safe as (perhaps more safe than) your house. a police officer cannot just walk into a doctor's office and say "i'm a cop, gimme the files."

further, in a small town, regardless of how neighborly, if a medical professional were to disclose hipaa-protected information, s/he would be liable to face severe consequences, including that the entire facility would be open to censure.

while some people hold backward views, not all of them live in small towns. further, while news tends to get around small towns, that doesn't mean that nurses and doctors have any less grasp of their professional responsibilities and legal obligations.

if you, or anyone you know, has experienced a situation in which medical information has been shared without consent or legal mandate, i implore you to pursue legal action. without proper follow up, the law means nothing.

hipaa was created, in part, to allow for a higher standard of treatment while allowing individuals to maintain their privacy. if that privacy is violated, people (just look at these comments) will doubt the security of medical professionals, make unwise decisions (refusing to get tested for fear of stolen or shared information) and, well, we might as well just throw away the idea of getting tested for infectious disease altogether.

ethics are all fine and good, but there is a powerful legal structure to support your privacy so you don't have to rely on individuals "ethics."

really.

oh, and DAS, when i was working at that office, i've got to say i behaved much more like you than like your doctor :). then again, i was instructed to not even disclose what kind of doctor's office we were, so my skills at being vague and opaque were tremendous (though sometimes a bit rude).

Dear Vanessa,

I'm a bit concerned that the original post here is a bit disingenuous. The ACLU page that you link to recounts the story of the New Jersey woman and the newborn as well. You state that the baby ended up being HIV negative, which makes it sound like the child's status was always negative. What you don't state is that in the ACLU story it says that the baby was given AZT and that there's no way to know whether or not the child was HIV positive or not before the course of AZT treatment. It is quite possible that the state stepping in saved a life here. The original post here makes it sound like the AZT treatment was in vain when no one will ever know if it was or not.

further, in a small town, regardless of how neighborly, if a medical professional were to disclose hipaa-protected information, s/he would be liable to face severe consequences, including that the entire facility would be open to censure.

while some people hold backward views, not all of them live in small towns. further, while news tends to get around small towns, that doesn't mean that nurses and doctors have any less grasp of their professional responsibilities and legal obligations.

Wow, you are putting a lot of words in my mouth. I never said that the only people that hold backwards views live in small towns or that healthcare professionals in smaller areas have any less of a grasp of their professional responsibilities. If I believed that, I certainly wouldn't be living in a rural community. I am saying that it occurs fairly regularly in small areas (maybe I just notice it more often because it is a smaller area or because I work in healthcare).

When you talk about everyone being professional at all times or suffering consequences, you are talking about ideals, not reality.
Some healthcare professionals violate HIPPA and a good portion of those are never held accountable for it. That's the reality. It happens whether it's ethical or not or whether there are consequences or not.

I really don't understand the entire problem here. HIV has a different political status because it is an STD and because it was originally identified with homosexuality. It is controversial, much like the HPV vaccine, but feminists are usually all for the HPV vaccine and prevention of cervical cancer. I don't understand the difference here. HIV tests cost next to nothing, which is why you can get them free in almost any town in the US. Also, unlike testing in physicals, finding that a pregnant mother is HIV + would result greatly reducing her baby's chances of having the disease. The chance would only be about 3%. That child would then not have to face discrimination, meds that can make you sick, and incredible challenges when they reach the onset of sexuality. Having worked with HIV+ children and adolescents, many of whom acquired HIV at birth, I am sure that every one of them would have been grateful if their mothers had been tested. It is true that HIV patients in the US are living longer than ever before and quality of life is usually very high, but you still face meds every day, discrimination, difficulty with romantic relationships, and many other problems. Why wouldn't you want to prevent this for your child? It is similar to the HPV vaccine...if you can prevent cervical cancer for your child, why wouldn't you?

the ACLU story it says that the baby was given AZT and that there's no way to know whether or not the child was HIV positive or not before the course of AZT treatment.

There is no cure for HIV. Newborns are treated with AZT to prevent the transmission of the HIV virus from the mother (through the womb, during labor, or through breastmilk). If the baby was negative after treatment, then s/he was negative before treatment. Babies that are already HIV+ before getting AZT, will still be HIV+.

Hope - the problem is that testing doesn't mean treatment.

Any mandates for women only are bad.

Choice is good for women.

mirm: There are things you can do, when you know a pregnant patient is HIV+, you may not have the wherewithal (insurance coverage, payment, patient permission) to actually do them. Thus, the test itself is not the answer. Those anti-retrovirals don’t come cheap do they?

If your issue is the lack of socialized care in this country, or the cost of medications, then that is a valid issue... but it is entirely seperate from the issue of whether or not to test to begin with.

Or are you suggesting that because some people cannot afford the antiretrovirals.. then we should not test anyone? I'm not sure your argument is entirely coherent.

I also think if testing was mandated or common few women would consider asking for HIV testing during pregnancy. I think it is important because HIV is a serious disease and the prenatal care provider would need to know an individuals HIV status to make sure everything went well during the pregnancy.

It actually scares me that people would consider not getting tested due to concerns about the level of care or treatment they would recieve as an HIV positive patient. Fear shouldn't overrule being safe and doing what's best for your child and your own well being. I think even if you have been with the same partner for a number of years, can you really be positive about your partner's sex life? No.

I also think couples should have to be tested for HIV and other STD before a woman goes on hormonal birth control (I mean assuming they are not going to be using condoms and the woman is not single) or that it should at least be suggested.

The key difference is that is not MANDATORY for a man to be tested for any of those things. You can highly recommend he be tested, but ultimately, the decision is his (with no repercussions, i.e. having his child taken away for not testing). That's all we want for women, pregnant and non-pregnant alike.

Shelby: If you are correct and the tests are MANDATORY, then indeed that is reprehensible. A patient should always have the option of opting out, assuming they are legally competent to make their own medical decisions. After all, it is their own body and their own health.

While HIV screening should be routine, everyone at my place who gets the test has it explained to them and they have a form to sign explaining the test and clearly stating they have the right to refuse. That seems about right to me.

Again -not my issue of socialized medicine or otherwise.

Of course, it's coherent. Why do the test, if there is no useful end result?

If the medical industry was serious about treating HIV and preventing natal transmission, they would devise a treatment plan BEFORE a testing plan.

Explain to me why we should FORCE tests on people who can do nothing about the test results? That seems incoherent at best, and insidious at worst.

You're also ignoring the patient permission part. I know you cannot understand it (med student), but it is their bodies we're talking about. No-one should be able to force any kind of medical treatment, testing or otherwise.

oh, and "not test anyone" is disingenuous, when we're talking about mandating tests for all pregnant women.

redhead - keep your draconian rules to yourself. my goodness!

As hopeisawakingdream said above, it matters that the number of MTCTs has diminished massively over the last many years in the US and Canada, for all the reasons s/he identifies - it is no longer possible in the US, for example, to do large- (or even small-) studies of children who have received HIV in this way, since there simply aren't enough of them.

If the education and treatment programmes have been so effective without requiring mandatory testing, what's the legislative requirement for the testing doing other than making advocates of women's rights angry and frustrated?

I haven't read all these responses, but this is rebuttal for Forbidden. HIPAA is laughable. Anyone who wants any medical information just has to show up in a white coat with a clipboard. Most of the time someone (MD, nurse, records keeper) will let one look at a chart, even without any kind of identification. The bigger the hospital, the more likely this is. And if it's a teaching hospital (where you are more likely to find vulnerable populations)? Piece of cake. Doesn't matter where you are in the US, either.

This is my first time posting but I had to jump in because my mother is a physician specializing in HIV/AIDS. She has run a program in Atlanta that has drastically reduced mother-to-infant transmissions of HIV and works almost exclusively with poor, minority patients. Because of her work, HIV policy and politics has always been an interest of mine.

Anyway, the point of testing pregnant women isn't "slut shaming" - please, claims like that only give credence to the ridiculous "hysterical feminist" stereotype and if it were true, the tests would be required for all women, pregnant or not. Instead, the objective is to ensure another person doesn't get HIV. There are numerous proven strategies to prevent transmission, including C-Sections and/or nevirapine before/during labor. These methods WORK and we are so fucking fortunate that they are available. It makes me sick to imagine how women in other countries would do anything to have the resources to prevent their babies from contracting HIV. And yet we have those resources and are complaining about the "medical establishment" invading our privacy. Talk about a "first-world" problem.

Wow Panda - way to troll.

Those prevention strategies are wonderful.

Mandatory testing is something else.

Do you understand the difference?

I'm through here, but you might all read Blake Scott:

J. Blake Scott
THE PUBLIC POLICY DEBATE OVER NEWBORN HIV
TESTING: A CASE STUDY OF THE KNOWLEDGE
ENTHYMEME
Abstract. This essay analyzes the web of persuasion named the "knowledge
enthymeme " in the public policy debate over mandatory newborn HIV
testing in the United States and especially New York. Bringing together
classical rhetorical theory and Foucault's theory of the knowledge-power
loop, the essay explains how the conceptual/argumentative frame of the
knowledge enthymeme helped shape the knowledge-power relations of
mandatory newborn testing in dangerous ways. Ultimately, the knowledge
enthymeme blocked more responsive approaches to testing by exaggerating
the beneficial effects of testing and its knowledge, ignoring the contingenices
of this knowledge, and bypassing the "situated knowledges " of the women
it targets.

The objection is not to strongly recommending the tests or making them readily available. The objection is to requiring HIV tests or making them unreasonably difficult to refuse. HIV tests are a good thing, but they are not an unmitigated good in all circumstances. We can and should encourage people to get tested, but we have to let people make their own decisions.

What I find especially disturbing though is that this _isn't_ just a matter of ideal medical practice vs individual freedom. I'd object as strenuously to mandatory testing for other diseases and conditions, but gestational diabetes or multiple sclerosis testing are not on the legislative calendar.

Mirm, I'm not trolling. I've read this site for months but feel compelled to comment because I have very strong feelings on the subject, as I mentioned in my post.

FORCING people to do something at a hospital is certainly an ethically murky area and a reason to examine the issue more closely. But your suggestion that mandatory testing of pregnant women is slut shaming and not part of a prevention strategy is stupid. You could argue that pregnant women should be offered testing, encouraged to be tested, told about why testing is important, but not required to have a test. That's fine, whatever. I'm not going to argue that mandatory testing is the answer and shut out all other opinions. But I've seen first-hand the success that prenatal testing has in avoiding new HIV cases, and I've also seen women who have refused testing (it's not mandatory where I am from) either because of their own ignorance or because they were in denial about their own status, and then have HIV positive babies. It does no good to test the infant AFTER it's born (unless, as you said, they are providing free treatment) but testing pregnant women and to prevent mother to infant transmission, I think, should be compulsory both as a public health measure, and as sound OB practice.

ShanaLyns - My apologies if you felt my post was disingenuous, it's a complex issue and there's a lot of information in the ACLU piece to cover; but my intention wasn't to imply one thing or the other.

Ok perhaps I shouldn't have called Mirm's suggestion "stupid". I do think it is misinformed and willfully ignorant.

I am trying to be civil as I'm new around here...

mirm

Um...except that in many cases, testing postitive DOES mean treatment. Especially if you are under 18. Like I said before, I work in an HIV clinic and each patient (many of whom can't pay for their meds at about $1800/month) does get meds every month. We employ many people whose sole job is to ensure this happens, mostly through federal grants. In addition, there are also grants that pay for housing costs, ect. for HIV + patients. I know this isn't the case everywhere, but having worked in various states with different HIV programs, once you are referred to a clinic as HIV+, there are resources available.

No one has yet to address how this is different from wanting all girls vaccinated for HPV. If you can prevent cervical cancer, why not? If you can prevent mother-to-child transmission of HIV, why not? This isn't a "slut shaming" tactic or removing the choice from mother (they can opt-out you know). It is an important step for the treatment and prevention of HIV. Because of the low cost of testing I am also quite sure that it will become a part of routine physicals until the spread is curbed (it is on the rise...check the recent CDC reports).

mirm- please point me to any comment where I said that HIV testing should be "mandatory."

In fact, I specifically called such a policy reprehensible.

Please don't get carried away, and please don't put words in the mouths of others. Especially when I had written the exact opposite thing.

Anyway, the point of testing pregnant women isn't "slut shaming" - please, claims like that only give credence to the ridiculous "hysterical feminist" stereotype and if it were true, the tests would be required for all women, pregnant or not. Instead, the objective is to ensure another person doesn't get HIV. There are numerous proven strategies to prevent transmission, including C-Sections and/or nevirapine before/during labor.

EXACTLY - people should read the above three times before hyperventilating.

Forbidden - the original post is ABOUT mandatory testing.

I'm not hyperventilating - I'm providing sources and arguing.

Whenever someone argues from a counter-intuitive position, accusations come out.

Hope - the New Jersey program is not the same as your mother's Atlanta program. There is no evidence that treatment will be provided. Thus, the testing may NOT keep people from acquiring HIV. Are you following? That means there has to be another reason for mandatory (yes, mandatory) testing. Dare I say, slut-shaming?

My mother's Atlanta program? I'm not following...I did, however, work with two 15 yo's from NJ who were positive and both of them were on federally subsidized meds.

Federal grants (ie...for all states) provide the majority of funding. I find it hard to believe, and quite ridiculous, that someone in New Jersey hasn't figured it out yet. Yes, there have been some waiting lists and those waiting lists are horrible (I spent a good amount of time lobbying for money to end the lists), but even these lists have been reduced recently. You are arguing with people on the front lines of fighting this disease. I have seen first hand how difficult it is to fight this disease. But early diagnosis significantly improves quality and length of life. And yes, in the case of testing the mother...testing DOES, in fact, prevent the child from acquiring HIV. There are resources available for treatment.

From the Kaiser report on federal funding for HIV/AIDS patients 2007:

The Domestic HIV/AIDS Budget
Care: The largest component of federal funding for HIV/AIDS
is health care for people living with HIV/AIDS in the U.S.,
which totals $13.2 billion in the FY 2007 budget request (58%
of the total budget request and 70% of the domestic share).
This represents an increase of 7% over FY 2006. Most care
funding is for Medicaid and Medicare; these mandatory
programs also account for almost all of the increase in the
care budget. As part of the President’s new Domestic
HIV/AIDS Initiative, the Ryan White CARE Act, the largest
discretionary HIV/AIDS grant program, is slated to receive an
additional $95 million, $70 million of which will be for
addressing the ongoing issue of state waiting lists for HIV
medications and $25 million for expanding outreach efforts
through new HIV community action grants to faith and
community-based organizations, and for technical assistance.
Cash and Housing Assistance: Cash and housing assistance
represent $2.1 billion, or 9% of the HIV/AIDS budget (11% of
domestic programs). Overall funding for these programs
increases by 2% in the request, which includes a slight
increase for the Housing Opportunities.

Got you confused w/ another commenter.

How does the testing itself prevent transmission exactly?

Read New Jersey's law. It provides for mandatory testing so doctors "can take steps." It does not mandate or fund treatment.

"Front lines" "Fighting disease" - whose rhetoric is hyperventilating. I KNOW how awful this disease is. I also know how much people want to control the bodies of pregnant women.

hope - Mirm must have gotten you confused with me. My mother works in the medical field in Atlanta and is the medical director of a clinic treating HIV-positive kids.

It sounds like her experiences are similar to yours - they get many grants to treat the kids, but for adults, getting treatment is far more difficult. She's had to jump through hoops to secure meds for her patients who are turning 18. If someone wants to talk about slut shaming, perhaps the discussion should be about why there are grants and federal funds for pediatric treatment, but not so much for adults (those sluts, homos and druggies are too easy to ignore, I suppose. but who doesn't feel sorry for the innocent kids?)

Wow, "hysterical feminists" "hyperventilating"?

This post very clearly says MANDATORY HIV testing. The discussion is about whether or not New Jersey should require HIV testing for pregnant women. No one is being "hysterical" or "hyperventilating." We are stating our concerns with mandatory testing. Here are some quotes from the article in the post:

Riki E. Jacobs, executive director of the Hyacinth AIDS Foundation in New Brunswick, the state's largest AIDS service agency, said the law won't help the women who don't get prenatal care.
"We need to focus on getting people into care and keeping them in care," Jacobs said. "That is our most potent prevention weapon."

The federal Centers for Disease Control and Prevention has recommended all pregnant women be tested for HIV, though it has said testing should be voluntary. (emphasis mine)

Pardon me for siding with the experts!

Shelby - the post says there would be an "opt out". I'm not sure that "opt out" really qualifies as "mandatory", since you don't have to do it. I'd be happy if testing were the norm for all pregnant women in order to prevent transmission to the baby and the opt out were available (but discouraged and hopefully rarely used))

Mirm, testing allows HIV+ mothers to prevent transmission to their babies by

1) notifying them of their status

2) allowing doctors to take steps to prevent transmission--csection, etc.

If the mother was positive and refused testing, doctors would not know to carry out those precautions.

Testing a child at birth is inconclusive at best. No other health testing should be forced in anyone. It is really easy to treat a woman who is pregnant as being less than human, but she has the same right to refuse screening as anyone else.

"How does the testing itself prevent transmission exactly?"

Testing mothers prevents their children from getting HIV by allowing the mother to be put on drugs that lower MTCT rates to about 3%. Without these drugs and the precautions such as c-sections and not breastfeeding, the transmission rate is anywhere from 25% to 50% of children born to HIV+ mothers will also contract the disease Because a baby is covered under federal funding the mother would receive AZT treatments.

Because there is an opt-out clause, it is not completely mandatory. I do support the opt-out clause and think that should be part of every medical procedure. The testing would prevent children from being infected and that is great. Being on meds and using precautions drastically reduces mother to child transmission. Just like the HPV vaccine which prevents cervical cancer, I don't know why you wouldn't want these easy precautions modern medicine affords.

Like Panda said, if we are concerned with slut-shaming, maybe we should be attacking the fact that it is much harder for adults to secure HIV funding than children. The resources are there, but they require a lot more information than just an HIV test. That is a much worse invasion of privacy if you ask me.

In this case I don't see the test as all that invasive compared with the potential benefit. Prevention and care are the motivation for the test, and you can refuse it so I guess I don't see the big deal. If you can prevent something, why not?

OK, I have read a lot more of the comments. Forbidden coma, the original post is about mandatory testing. Panda, no one is arguing that HIV testing for pregnant women isn't a good idea, in fact, a great idea. Forced testing or refusing care to someone who refuses testing is the issue.

I am also a medical student. I may not agree with many treatments or refusals of treatment, but I sure as hell don't want state legislatures to decide which ones are allowed and which ones aren't, especially when it comes to women, and doubly especially when it comes to pregnant women.

While I am no fan of "slut shaming", I would assume the most common way a pregnant woman would get HIV would be from a cheating partner. That is what we heard in our Department of Health mandatory HIV training. What is important is to offer and encourage testing to all women during pregnancy and allow her to practice informed consent, which is more sacred to me than HIPAA any day.

Monkey - people die all the time by refusing screenings and treatment. Is it what I would want for my family member or for a future patient? No. Will I fight for their right to do so? Absolutely.

I'd be happy if testing were the norm for all pregnant women in order to prevent transmission to the baby and the opt out were available (but discouraged and hopefully rarely used))

And there is the problem: discouraged and hopefully rarely used Why do you think it’s ok to coerce someone into a medical test they don’t want? I am not HIV+, I know this. Why should I have to listen to a doctor lecture me on why I should get test I KNOW I don’t need? What happened to patient rights?

I’m sorry, but I’ll take the CDC’s recommendation over yours. The test should be readily available and recommended to the patient. The patient should be given all the information needed to make the decision, but it should ultimately be voluntary (without badgering), not an opt-out clause. Let’s not forget that some patients will never even be informed that they have the opt-0ut alternative.

Pregnant patients should be afforded the same rights as not pregnant patients.

And, with that, I am “opting-out� (probably more like "passing out") as my cold medicine has worn off and the aches and pains are kicking in.

Since it came up earlier, I am not for mandatory vaccines for anyone. My son was damaged by vaccines, so there is now way that I would want every girl to have to be vaccinated. Yes, there are ways to opt out, but most parents are not aware of that option, or it is difficult to claim exemptions in some states.

I am not for any mandatory medical care. I don't think that anyone should have any say with what happnes with my body.

There have been cases of children being taken away from their parents because the parents choose an alternative model of medical care.

Tell the women the risks involved without knowing your HIV status. Tell them what can be done to reduce their babies risks of contracting HIV. Tell them about what would happen if they tested positive and refused treatment. Tell them they have a choice and allow them to make it.

"Last question, why in world should I be FORCED to pay for a test I do not need (I know I am not HIV+, why isn't my word good enough)?"

I do not consider you or any other poster, a liar. But there are patients who are not forthcoming with their medical histories. Some actually lie, and the health care provider is simply unaware. It's a simple fact. There are also others who do not know their own health status, which is why tests such as these routine tests are required (and why health care providers practice "standard precautions" with all patients such as the wearing of gloves whenever there is possible exposure to bodily fluids and secretions - I remember when doctors, nurses and dentists did not wear gloves or eye protection). And the source of funding for HIV testing would be the same as for any other routine tests which patients may or may not agree to have. Insurance, out of pocket, public funds, or the hospital eats it.

Some posters consider medical testing to be for liability, not health promoting purposes. Very well. What do you think would happen if an HIV positive woman, as is her right, opted out of being tested for HIV, gave birth to an HIV negative child, then passed HIV to the infant through breast milk? Why should the hospital be open to liability for the mother's decision if someone gets the bright idea to sue the hospital for "allowing" the baby to get HIV? What would be the public reaction to a hospital "allowing" a baby to get HIV? It would be safest for the hospital not to allow the mother of unknown HIV status to breastfeed while in the hospital. If the mother is indeed HIV positive, it would also be safest for the baby.

Once out of the hospital, if an HIV positive mother decides not to seek treatment, or does not practice better judgment with her own child or partners, that is indeed, and unfortunately, her affair. It is for the hospital to provide professional, nonjudgmental care for all who come through its doors, if mother or child ever return.

As for men or male partners, I am all for routine, but optional testing, as it is for pregnant women.

While indeed unfair that the mother is considered the "only" means of HIV transmission to her baby, how do posters forsee an HIV positive male with an HIV negative female partner passing HIV to that woman's child? Is he sharing needles or directly exchanging bodily fluids with the child? Is that what fathers or HIV positive males are being suspected or accused of? No one is accusing or suspecting HIV positive mothers of this. It is a simple fact that an HIV positive mother, through NO fault of her own (the reason for her own HIV infection, of which there are a number of possibilities - needle sticks in health care providers - is quite irrelevant, thus it is not "slut shaming"), through the natural processes of childbirth, and breastfeeding, can unknowingly transmit HIV to her child.

That said, it is still outrageous and inappropriate for CPS or any other authority to remove a child from a parent simply for refusing HIV screening, or simply for being HIV positive. HIV infection, while currently incurable, can be managed.

Eric: "these routine tests are required"

Sorry, I meant routine tests are offered or performed. They, as the prenatal screenings I have mentioned elsewhere, are not mandatory. I agree that health care providers need to better express the option to refuse.

"1. HIPAA is damn near useless and we both know it."

Indeed. Now that health care providers don't do email anymore, many expect you to call during office hours instead. Do the people who passed HIPAA really think a hacker's more likely to read your email than a boss or coworker is likely to hear you on the phone (now that phone booths are so rare so you can't step out and use one)?

"2.Why do you test? Is treatment free once you do? If not, what good does it do?"

If you knew that you were HIV+ and that you couldn't get treatment, would you still make an effort to not infect other people? Or would you not bother?

"No one has yet to address how this is different from wanting all girls vaccinated for HPV."

One difference I've seen mentioned in another thread is that even if the mother isn't tested, testing the newborn would reveal her HIV status (a HIV+ result means the mother's HIV+ too) and thus violate her privacy. That argument reminds me of this case:

http://news.bbc.co.uk/2/hi/africa/7117184.stm

"...Tumaini Mbogela said her husband beat her when she returned from a voluntary counselling centre in the town of Makete where she took the HIV test..."

If Ms. Mbogela tested HIV+ and there's nobody she could have got HIV from but her husband, then by testing her the centre would have revealed her husband's HIV status without his permission...

"Mirm, testing allows HIV+ mothers to prevent transmission to their babies by

"1) notifying them of their status

"2) allowing doctors to take steps to prevent transmission--csection, etc."

It also allows HIV- mothers to know they're at less risk, instead of leaving mothers and doctors wondering whether to do all the steps for every birth, just in case.

"What do you think would happen if an HIV positive woman, as is her right, opted out of being tested for HIV, gave birth to an HIV negative child, then passed HIV to the infant through breast milk? Why should the hospital be open to liability for the mother's decision if someone gets the bright idea to sue the hospital for 'allowing' the baby to get HIV?"

In that sort of situation wouldn't she and her family be more likely to argue that HIV doesn't cause AIDS, and/or argue that whatever infected her and her baby are parts of their culture, than to sue the hospital?

To posters such as mirm, Shelby Woo, DAS and others:

You are certainly entitled to your views, and I hope people like you continue to speak out. Your concerns have merit. You are not paranoid. I hope your rights and choices are respected if and when you receive medical care. However, I hope no one, male or female, will be prevented from screenings offered to guide patient care (or to the cynical, to avoid liability) or improve public health. I also agree information without action (eg, affordable treatment for the HIV positive) is useless for *that* patient. However, HIV screening of mothers, with measures taken at childbirth, is an attempt to prevent HIV transmission to the *infant*. It is not necessarily meant to directly benefit the mother at all.

"Why do the test, if there is no useful end result?"

Precisely because the costs and complexity of HIV treatment are so great, reducing the number of people with HIV in the future, which is to say with current technology, saving their lives and protecting the health of their future partners and children, by identifying babies in need of HIV transmission *prevention* so they can be treated, sounds very useful. We can have one or two patients (mother/partner) now, or a handful more in the future. You are correct that HIV testing on a baby already born is of limited usefulness, and no guarantee that they will receive further treatment.

Mina,

at your #2, you bring up some interesting points. But again, those results are because of public prejudice against HIV and the HIV positive. The same "violation of privacy" occurs with nearly any disease that can be transmitted through intimate or sexual contact. My wife being found with chlamydia or genital warts would mean she most likely got it from me. Why should this be used in any argument to prevent testing? So my wife and I would both need treatment. I would thank her and the hospital staff for finding it rather than reacting in anger or shame.

Eric: "What do you think would happen if an HIV positive woman, as is her right, opted out of being tested for HIV, gave birth to an HIV negative child, then passed HIV to the infant through breast milk? Why should the hospital be open to liability for the mother's decision if someone gets the bright idea to sue the hospital for 'allowing' the baby to get HIV?"

Mina: "In that sort of situation wouldn't she and her family be more likely to argue that HIV doesn't cause AIDS, and/or argue that whatever infected her and her baby are parts of their culture, than to sue the hospital?"

I hope you are being facetious. Lawsuits are filed for so much less than "killing babies" by "allowing" them to get HIV from their mothers. It is no wonder so many OB/GYNs are getting out of the business, *limiting choices* for women and mothers.

"Cars haven't always been labor-and-delivery units in Virginia's Northern Neck, an 85-mile strip of land on the Chesapeake Bay. Approximately 300 babies were born each year at Rappahannock General, and its two dedicated ob-gyns had been there for more than 20 years. But with the escalating costs of medical-malpractice insurance, obstetrics became such a financial drain that the ward was forced to close in 2004. Scenarios like this are playing out across the country as more and more ob-gyns and hospitals bail out of the birthing business. A survey by the American College of Obstetricians and Gynecologists (ACOG) found that one in seven ob-gyns has stopped delivering babies, and more than 20 percent have cut back on high-risk obstetrics."

http://www.parents.com/parents/story.jsp?storyid=/templatedata/parents/story/data/1166567779265.xml

Hawaii is composed of islands. There was a time recently when the island of Molokai, which previously had five OB/GYNs, lost them ALL to the skyrocketing costs of malpractice insurance (GREATER than ANY possible income). How would any woman like to get on a plane or take a 90 min. interisland ferry ride just to have a checkup? How would you like to plan trips just to have a baby, and pray that everything occurs without incident and on schedule? Would you complain about the medical establishment and doctors if anything went wrong? Would you call it anti-woman? (I would) But it is not THEIR fault they can't afford to be in practice.

Health care providers are extremely liability averse, for good reason. When I was a nursing student, I was extremely sorry to see how facilities had to cover their asses because they were so afraid of being sued. For example, unless you were a direct witness or personally responsible, you cannot write "Patient fell to the floor" in a medical chart. That would be SUICIDAL, implying to any lawyer or jury that the hospital/professional did not have complete control over every aspect of the patient's life and safety, not monitoring and protecting them 100% of the time while on the premises*. No, we were taught, if the time ever came, that we must write "Patient discovered on the floor."

[Lest anyone call this professional negligence, I invite anyone to explain how one nurse at a care home is supposed to monitor up to 20 to 36 patients (I have heard of 60:1 patient:nurse ratio in Honolulu) while also providing them all their medications or treatments on schedule? How about "just" six or seven demanding patients on an acute care ward? How about "just" two in ICU? Better yet, go to school, get your license, and show me how it is done. I want to learn.]

* Note that it is precisely this control or lack of privacy in order to protect them, is what posters are objecting to.

"Mina: 'In that sort of situation wouldn't she and her family be more likely to argue that HIV doesn't cause AIDS, and/or argue that whatever infected her and her baby are parts of their culture, than to sue the hospital?'

"I hope you are being facetious. Lawsuits are filed for so much less than "killing babies" by "allowing" them to get HIV from their mothers. It is no wonder so many OB/GYNs are getting out of the business, *limiting choices* for women and mothers."

True, that does happen a lot. It's just that I heard people caring more about preserving customs than about preventing AIDS happens a lot too.

According to the RH Reality Check report, opt-out-mandatory is only tantamount to actual mandatory testing when the consent isn't written. The specifics of the law should include a requirement for written consent.

Also, the test should be conducted as close as possible to the delivery date, since not all women carry their babies to birth.

With those clauses, saying mandatory testing is flawed would be tantamount to saying that a mother has the right to increase the odds that her child will contract HIV during delivery.

This is what the article says:

In Arkansas, which also has an opt-out testing program that doesn't require written consent, a study found that "16% of women tested did not even know that they had been tested for HIV." Without written consent, "...what they're calling ‘routine testing' will, in practice, be 'mandatory testing," Rose Saxe says.

"It's just that I heard people caring more about preserving customs than about preventing AIDS happens a lot too."

I would welcome any client/patients with views like those of posters to this site. I would treat them as I would any other person who comes through the door. I would, however, also like them to sign releases from liability whenever exercising their right to make their own health decisions, so I or my employer will not go bankrupt for client/patient choices. I would also be grateful if client/patients did not badmouth or sue professionals and their employers when things go wrong, if the unfavorable outcome results from client/patient choices, such as breastfeeding with HIV against medical advice, or against hospital policy. HIV transmission to infants can only be effectively prevented if we know ahead of time that the mother is HIV positive, and the proper measures taken. The client/patient's word is not enough to gamble another life on. We would need to test the mother at some point to know how to proceed. That is, if it is the mother's intent to have a baby without HIV.

"Also, the test should be conducted as close as possible to the delivery date, since not all women carry their babies to birth."

"Without written consent, '...what they're calling ‘routine testing' will, in practice, be 'mandatory testing,' Rose Saxe says."

Good points, SNM. That is one more way to reduce unnecessary testing and costs. Request for consent for each proposed test should also be written and initialed or signed, to inform client/patients, and for legal purposes. Authorization for routine newborn immunization and testing is that way at facilities in my community.

Informed consent is respectful of client/patient rights, and people should not be "surprised" by unauthorized tests, procedures or fees.

just to throw my own $.02 in about how easy it is to obtain medical infomation about other people.

when i was 16 i volunteered at a womens clinic that provided sti testing, pap smears, HBC, pregnancy tests, and counceling about one's options if one turns out to be pregnant.

anyways. i was 16. on my first day, i signed a piece of paper saying i wasnt allowed to talk about anyone medical informations, then i was told i was allowed (almost encouraged) to read any random files when i wanted, in order to learn. nothing was held back from me. and let me tell you, i learned a lot. i can read a medical file like nobodys buiness.

one day i was sifting through files and i stumbled upon a file belonging to a girl in my school, who happened to have a rep as a huge slut and drug addict. i felt guilty reading it, but i couldnt resist. i mean, i wasnt breaking any clinic rules...

Yeah, and if you had told anyone about it, you would have been prosecuted.

Anyone who gets HIV testing could have their records looked at by a clinic employee.

That's not a good reason not to get tested, imho.

There is a lot of justifiable concern about privacy, and mistrust in enforcement of HIPAA.

I would like to add my observation that it is indeed simple to obtain (non-electronic) information on the sly, by appearing to be someone who belongs in a hospital. I will not elaborate.

This concern for privacy is just one more reason the largest local facility is switching to a paperless system. People who do not know employee logins and passwords will not have access to client/patient information. It will probably be as safe as personal e-mail or information in a large company database. Not perfect, but better than reams of paper and files lying around behind the counter with hardly anyone to watch them because they are too busy working.

As a student, I too was allowed access to patient information to study. Luckily for those patients HIPAA is enforced in my community. I was not allowed access to any patient information unless I was responsible for that very patient. If I wanted to retrieve information later (after transfer or discharge), I needed to go through the department of patient records where authorization was required to request specific information. We were not allowed to simply go through charts or computer terminals at random.

That poster may not have been breaking "clinic rules" but that clinic is not following HIPAA, if just anyone including omg - volunteers, can go looking through confidential information at will.

Agreed, not a compelling reason not to get tested.

Not a hijack but an aside about alternative health practices:

As nurses, we were taught to respect client/patients' health care wishes, which may be to do whatever the doctor says, or to reject treatment altogether (unless of course, one has tuberculosis). If it is in the patient's best interest (mental health is also important), they should be allowed to practice their cultural or alternative health practices. This may include prayer, laying on of hands, Hawaiian chanting, belly wraps to aid in postpartum recovery, etc. Many "alternative" health practices such as massage are empirically beneficial and effective.

Quite frankly, some of what I see and hear is pretty out there, and would not pass the test for a licensed health facility to perform themselves. For example, one young instructor told us (without any identifying information) about some parents who approached her with concern that their sickly child's condition was not improving. The nurse went into the room to check on the child, and observed a number of jars scattered around the room. [I already knew what was coming.]

Yes, it turns out that the family practiced urine therapy, and those jars of liquid were urine being saved for the child to drink each day. The nurses were able to convince the family that the child should have the usual treatment in addition to periodic urine therapy.

I do not know how that one made it by the doctors or CPS.

It perplexes me reading some of the posts here and realizing that people are more concerned for themselves than they are for their unborn child. If a test was available to me during any one of my 4 pregnancies that would tell me that I had some disease that would be passed onto my child unless special procedures may help to prevent that.. why would I not want to take it? I would do anything to ensure I can produce a healthy child even at the risk of exposing myself at any time. I would never put myself before my children. As feminists are we taking this too far? Having the right to pass on sexually transmitted diseases to our children which could potentially kill them? In regards to another post up top, many woman have obtained sexually transmitted diseases from their partners where they thought they were 100% faithful. I think its naive. If I were a medical professional, I would not feel I would be doing my job if I didnt administer the test to provide the best healthcare available and preventing the disease to continue unessessarily.

Life in America

I admit, I slipped and posted "That is, if it is the mother's intent to have a baby without HIV" at the end of one of my posts, myself. I also got snarky about preventing lawsuits. That was unprofessional and I apologize.

I like babies. I want people to have healthy babies. But as you may have read, the alternative to not respecting patient choice, is possibly having them not come in at all because they do not feel respected as women, adults, or human beings. This would have terrible repercussions for public health. Making recommendations in the interest of client/patient well-being, and allowing them to make their own informed choices is the best compromise we have without becoming a fascist state.

I am horrified by the notion that someone can take babies away from mothers and families, just because of HIV status. I have never seen it in practice, but do not know how not allowing a baby to be breastfed by a mother of positive or unknown HIV status would be enforced. Does the staff take the baby away for safekeeping between feedings? Do nurses stand guard while the mother bottle feeds the baby? My guess would be the nurse would bring mother and baby formula at regular intervals, and the mother would be free to dump it in the trash and breastfeed the baby if she wants. In privacy.

I think that the vast majority of mothers would take precautions to ensure that their children are born as healthy as possible. However, I am concerned that mandatory testing for HIV could only be the beginning of stomping on patients' rights, women's in particular. Yes, we would like to prevent children being born with HIV. I'm sure that many people would also like to prevent children being born with other diseases and birth defects. Where would that lead?

FSB: "Where would that lead?"

I believe that insurers and elected officials wanting to reduce health care expenditures, will promote or enact an ever increasing number of involuntary means to "improve public health" at the expense of individual freedoms. For examples, funding only "Abstinence Only" education to "prevent" spread of HIV, and prohibiting smoking, even in public outdoor areas and private places of business. Who knows where government regulation will end? It may lead to a form of health fascism, a society where people such as smokers or the obese will be discriminated against for their "unhealthy" lifestyles and "choices," while the healthy and "beautiful" such as thin women with cosmetic surgery and makeup, will be idolized and emulated to an unhealthy degree.

. . . Oh, you mean it's happening already?

An increasing desire to have only "healthy" babies, or to select babies for desirable qualities such as male gender, increased height or intelligence, etc., will lead to "shopping for babies" - trading in desirable eggs and sperm, using IVF and discarding unnecessary or undesirable fertilized eggs, embryos and fetuses; and aborting or giving up for adoption babies with "undesirable" qualities such as female gender or genetic factors for Down Syndrome. [Just examples. Of course there is nothing wrong with a baby girl or someone with Down Syndrome.]

To some degree, it already happens today in the US. Increased understanding of DNA will allow selection for other genetically influenced conditions such as obesity and forms of cancer. I have never watched the movie, but have been told the future could be like "Gattaca." Unrestricted expression of reproductive freedoms could lead to outright eugenics, and determining who would be considered worthy or desirable to be born or to breed. We have seen this numerous times before in the last two centuries, haven't we? It could be starting again, driven this time not by fascist dictators, but the common people themselves.

I forget which support group it was, and whether it was in Japan or the US. Let us pretend for the sake of argument it was the Down Syndrome support group. They were in the news recently to protest against routine prenatal screening (which may lead to abortion for genetic selection) because they argued babies with their condition had a right to be born.

Conditions like Down Syndrome are not like smallpox. To reduce or eliminate cases of genetic conditions currently means to not allow people with these conditions to be born at all.

I am concerned by recent trends seen and debated in the medical community, particularly "shopping for babies," but still support reproductive freedoms.

Sorry, "shopping for babies" for genetic traits is properly called "genetic selection (or manipulation)"

Also, I meant to say in short, that an increasing number of *parents* (plural - I am not blaming women or feminists) are behaving like consumers, and behaving as if (because they are not) babies are commodities. That is the future.

Recent trends and debates on ethics can be seen online with a google search for terms such as "genetic selection."

"An increasing desire to have only 'healthy' babies, or to select babies for desirable qualities such as male gender, increased height or intelligence, etc., "

Add this to the list:

http://www.slate.com/id/2149854/

"Several U.S. fertility clinics admit they've helped couples deliberately select defective embryos. According to a new survey report, 'Some prospective parents have sought [preimplantation genetic diagnosis] to select an embryo for the presence of a particular disease or disability, such as deafness, in order that the child would share that characteristic with the parents. Three percent of IVF-PGD clinics report having provided PGD to couples who seek to use PGD in this manner.' Since 1) the United States has more than 400 fertility clinics, 2) more than two-thirds that answered the survey offer PGD, and 3) some clinics that have done it may not have admitted it, the best guess is that at least eight U.S. clinics have done it. Old fear: designer babies. New fear: deformer babies."

Of course, I bet that these couples consider the embryos they didn't implant the "defective" ones.

"Unrestricted expression of reproductive freedoms could lead to outright eugenics, and determining who would be considered worthy or desirable to be born or to breed."

That already happens every time someone thinks "do I want to have a child with this person?" before deciding whether or not to have unprotected sex with someone else.

"We have seen this numerous times before in the last two centuries, haven't we? It could be starting again, driven this time not by fascist dictators, but the common people themselves."

Hold on a second. The problem with eugenics is oppression of existing people including suppression of their reproductive freedoms.

You're not lumping together murders, forced sterilizations, and forced breeding with my father choosing to only have babies with his wife (which did end up reducing the racial diversity of his contribution to the population) and my choosing to not get pregnant (which does end up slowing the population growth of my demographic groups), are you?

"Conditions like Down Syndrome are not like smallpox. To reduce or eliminate cases of genetic conditions currently means to not allow people with these conditions to be born at all."

It also means allowing people who already have those conditions, or at least carry those genes, to use birth control.

For example, think of all the babies who were never born because of girls with Down Syndrome staying virgins for some time after menarche instead of being raped and impregnated ASAP...

Mina: "You're not lumping together murders, forced sterilizations, and forced breeding with my father choosing to only have babies with his wife (which did end up reducing the racial diversity of his contribution to the population) and my choosing to not get pregnant (which does end up slowing the population growth of my demographic groups), are you?"

I know what you mean by murder, and abortion is not murder, but mothers/parents selecting babies which do not have known defects or for those with conditions similar to that of the parents, is what it is - selecting for what one believes will be a more desirable (usually "healthy") baby *. Yes, the popular term is "designer babies." My wife's choice was to make a natural roll of the dice. After my own diagnoses just this year, we now realize that meant my children had a very good chance, I mean 50% or greater, of inheriting my psychiatric condition(s) such as (allegedly) ADHD. I see the signs and symptoms in them already. In addition, my son, at least, has my body type (very underdeveloped by US standards for age) and cosmetic defects. Raising them and caring for myself will probably be a lifelong challenge.

Forced contraception or sterilization is usually reserved for sex offenders (eg male chemical castration in an effort to control behavior) or those deemed "unfit" mothers (implants or Depo Provera shots).

I do not foresee forced breeding, but genetic selection or manipulation does or will allow parents to behave like consumers when trying to have a child with desirable traits. It is not a random selection, as when a man chooses an attractive partner or vice versa. We can look for specific genes and select embryos today. In the future, we may manipulate genes directly. Fortunately, we still do not know the genetic source of intelligence. People are also free to shop for eggs or sperm from donors with desirable qualities such as looks.

"Yet positive eugenics persists, reborn again in a less goofy and probably more important form than ever. For Graham and for eugenicists in the '20s, the goal was public health and national survival. The goal of today's eugenics is consumer choice. We are entering an age of private positive eugenics. Soon scientists will be able to manipulate embryonic genes—perhaps eliminating diseases, increasing resistance to illness, even augmenting intelligence. It will be done by apolitical doctors, not conservative millionaires, and it will be done for the good of individual patients, not the for the good of society."

http://www.slate.com/id/102374/

Voluntary use of birth control or choosing not to have children is more random. I will dare to say that parents tend to have children like themselves, however. For example, affluent, well educated families have an improved chance of producing same, mostly through economic factors. I choose not to elaborate any further. but will say I do not believe in any class of "undesirable" humans.

* All up to individual choice, of course.

Mina: From "The Rise of the Smart Sperm Shopper"

http://www.slate.com/id/104633/

"Cryobanks became ever more sensitive to consumer anxiety about health and donor achievement. Today the California Cryobank—probably the world's premier sperm bank—tests for a dozen genetic disorders and for almost as many infectious diseases. Donors must complete a 38-page, three-generation medical history, and submit to months of blood testing. The cryobank accepts only college graduates or students enrolled in a four-year program. (The cryobank's offices are in Westwood, Palo Alto, and Cambridge, Mass., meaning that most of its donors hail from USC, UCLA, Stanford, Harvard, and MIT.) And donors must stand at least 5 feet 9 inches tall. By the time it weeds out the sickly, the short, and the dim, the California Cryobank accepts only 3 percent to 5 percent of applicants."

- Goodness, the "world's premier sperm bank" is rather selective, are they not? Positive eugenics, indeed. All subject to "consumer choice" of course.

"The cryobank barrages customers with choices. A recent catalog listed more than 170 men of every race, national origin, and appearance. A client can buy the entire long medical history (written in the donor's own hand, so the client can judge handwriting). Some donors make audiotapes that clients listen to."

- Judging donor father fitness by *handwriting* and voice? I never imagined it went that far. News flash: improve your child's handwriting through study and practice of good penmanship, a fairly lost art today.

A lot of this is moot, I have four children born in three states, all ob's took several vials of blood, to test for various things, including iron levels, chlamidia, blood type, and so on. These are the same vials used to test for HIV, not an extra vial, and the same blood is used to test for protein levels to determine possible birth defects, the tests are pretty much run as a matter of course to plan a course of action for the rest of your pregnancy. Once the tests are back, the OB can than decide what sort of treatment to provide. Most OB's will require it as policy, they don't want to go blind into a pregnancy without knowing they could have prevented HIV transmission.

I suspect that the policy has been tracked to a decrease in HIV transmission from mother to child, so it would make sense that a proven method would be handed up to state legislatures.

I think it is draconian to require by law any test, however it makes good sense on the part of the ob to test everyone.

It isn't about not caring about your baby, it is about wanting to protect your rights and the rights of your baby.

http://www.mothering.com/articles/new_baby/breastfeeding/azt-roulette.html

http://www.mothering.com/articles/new_baby/breastfeeding/hiv-underground.html

Sassy Girl

AZT is not the only way to lower the odds of HIV transmission. C-sections are also an option.

Also, what the NEW JERSEY law is talking about is routine testing, it's not strictly mandatory since there is an opt-out clause. The only thing that needs to be clarified is that the opt-out clause should include written permission/denial.

When did all these cases take place? I don't see a lot of dates.

Again, we are talking about ROUTINE testing which the CDC advocates, the label of mandatory is not accurate in NJ.

Spaceninjamonkey,

C-sections, while becoming fairly routine, are still surgery and still have risks. What would happen to the woman who tested positive (even though the incidence of false positives are fairly common) and she refuses surgery?

BUT, the opt out option will probably not be disclosed. Just like mandatory vaccination laws, many parents think that their children have to be vaccinated or they won't be able to go to school, they don't know that they can file an exemption. This will probably be the case with the HIV testing. The doctor will probably tell the woman that it is mandatory that she is tested and she will not know that she can say no.

OR, if she refuses, will she be deemed an unfit parent? What will happen if she is tested and decides that she is not going to do AZT and refuses a c-section? What if she wants to breastfeed? Studies have shown that babies with HIV positive mothers who are breastfed have the same rates of HIV as those who aren't. There are others who feel that it is risky, will these women lose their babies?

I still think that it should be offered to every woman, and man for that matter, but should be "offered" nonetheless.

Women are not stupid. We are able to make our own decisions. We should be given the facts from BOTH sides and be allowed to make an informed decision, and if a woman decides to not be tested, that decision should be respected.

Spaceninjamonkey,

C-sections, while becoming fairly routine, are still surgery and still have risks. What would happen to the woman who tested positive (even though the incidence of false positives are fairly common) and she refuses surgery?

BUT, the opt out option will probably not be disclosed. Just like mandatory vaccination laws, many parents think that their children have to be vaccinated or they won't be able to go to school, they don't know that they can file an exemption. This will probably be the case with the HIV testing. The doctor will probably tell the woman that it is mandatory that she is tested and she will not know that she can say no.

OR, if she refuses, will she be deemed an unfit parent? What will happen if she is tested and decides that she is not going to do AZT and refuses a c-section? What if she wants to breastfeed? Studies have shown that babies with HIV positive mothers who are breastfed have the same rates of HIV as those who aren't. There are others who feel that it is risky, will these women lose their babies?

I still think that it should be offered to every woman, and man for that matter, but should be "offered" nonetheless.

Women are not stupid. We are able to make our own decisions. We should be given the facts from BOTH sides and be allowed to make an informed decision, and if a woman decides to not be tested, that decision should be respected.

"it's not strictly mandatory since there is an opt-out clause"

Until this is clear to all individual women, and publicly known, the effects will be the same. I have seen tests and procedures verbally "recommended" and "highly recommended" by medical staff, without explicitly adding that refusal is an option or informing them of possible complications. Also, verbal recommendation instead of actually encouraging and doctors *waiting* for women to sign the more detailed forms, is an unfortunate reality. Actual informed consent needs to be practiced, according to policy and law.

As a nursing student, I encouraged women in OB to ask questions, going so far as to elaborate or expand on questions to the doctor, if I felt the women were apprehensive or vague. One role of the nurse is patient advocate. We are not there to "help" doctors. We are there to help *patients* and see their rights are respected. [Which is why nursing abuses are so tragic and inexcusable.]

Correction: Also, verbal recommendation instead of actually encouraging women to read and comprehend the required forms before signing, while the doctor waits, is an unfortunate reality.

Doctors can be an impatient and intimidating bunch. Even I don't like them watching over or waiting for me. Some individuals are actually well-known for being dicks to nurses and patients.

"I know what you mean by murder, "

Yeah, I was thinking of how fascist dictators implemented eugenics. Likewise when I mentioned forced sterilization.

"I do not foresee forced breeding"

I wasn't forseeing that either, I was remembering reading about it:

http://www.crimesofwar.org/thebook/sexual-violence.html

"...Mirsada was released only when she became visibly pregnant, and her jailer-rapists said, 'Go bear our Serbian children.' By the time she crossed the front and found medical care in Croatia, the fetus was too developed to be safely aborted..."

"It is not a random selection, as when a man chooses an attractive partner or vice versa."

Choosing *one* partner is still considerably less random than some of the other possibilities...

"Mina: From 'The Rise of the Smart Sperm Shopper'

"http://www.slate.com/id/104633/

"'Cryobanks became ever more sensitive to consumer anxiety about health and donor achievement. Today the California Cryobank—probably the world's premier sperm bank—tests for a dozen genetic disorders and for almost as many infectious diseases. Donors must complete a 38-page, three-generation medical history, and submit to months of blood testing. The cryobank accepts only college graduates or students enrolled in a four-year program. (The cryobank's offices are in Westwood, Palo Alto, and Cambridge, Mass., meaning that most of its donors hail from USC, UCLA, Stanford, Harvard, and MIT.) And donors must stand at least 5 feet 9 inches tall. By the time it weeds out the sickly, the short, and the dim, the California Cryobank accepts only 3 percent to 5 percent of applicants.'

"- Goodness, the 'world's premier sperm bank' is rather selective, are they not? Positive eugenics, indeed. All subject to 'consumer choice' of course."

That still sounds less selective than many women are when choosing which men to have children with via unprotected sex.

For example: Suppose a 5'8" MIT alumna who carries the sickle-cell anemia gene only wants to get pregnant with her 5'10" grad school sweetheart who would find that he meets the sperm bank's standards if he applied?

Must she instead bear the children of a diverse range of men (including at least one man shorter than her, one man less educated than her, one man carrying the sickle cell anemia gene, etc.) in order to not be guilty of eugenics? After all, limiting her pregnancies to her lover's sperm would reduce her children's genetic diversity even more than limiting them to the sperm bank's men's sperm would...

"Doctors can be an impatient and intimidating bunch. Even I don't like them watching over or waiting for me. Some individuals are actually well-known for being dicks to nurses and patients."

WTF? Shame on them.

Maybe I'm just fortunate, but usually the nurse sees me first then I'm waiting for the doctor instead of the doctor seeing me first and lurking over the nurse.

This setup seems to let my appointment begin before the doctor's previous patient's appointment ends (if the doctor's running late). Doctors should be *grateful* for nurses making it possible.

Eric: "I do not foresee forced breeding"

Mina: "I wasn't forseeing that either, I was remembering reading about it:"

http://www.crimesofwar.org/thebook/sexual-violence.html

Ok. But I thought we were talking about a practice of positive eugenics, such as parents freely choosing to raise a future generation of "healthy" children, not war crimes to increase numbers of my own ethnicity. I rather enjoy the government public handwringing over the rapid decline in the Japanese population, BTW.

"Must she instead bear the children of a diverse range of men (including at least one man shorter than her, one man less educated than her, one man carrying the sickle cell anemia gene, etc.) in order to not be guilty of eugenics?"

People are "guilty" of nothing, and I demand nothing. It is practicing reproductive freedom. However, consciously or unconsciously limiting one's choices in desirable qualities in one's mates (or children) based on race, height, looks, athletic ability, intelligence, academic background, or socioeconomic class, while rejecting others, is what it is. It will not go away until people expand their range of choices.

[I, for one, look forward to the day, reportedly mid-21st century, when "minorities" and people of mixed ethnicity outnumber caucasians. Not because I hate caucasians, but because I prefer diversity. I love being in Hawaii, where 67% of people are "minorities," many of them foreign born. I will enjoy seeing the reaction of people like David Duke, however. I see from his website that he's worried enough already.]

"After all, limiting her pregnancies to her lover's sperm would reduce her children's genetic diversity even more than limiting them to the sperm bank's men's sperm would..."

Why would that mean reducing genetic diversity?

"Ok. But I thought we were talking about a practice of positive eugenics, such as parents freely choosing to raise a future generation of 'healthy' children, not war crimes to increase numbers of my own ethnicity."

In my original mention of forced breeding, and my later clarification of it, I was thinking more of the "driven this time not by fascist dictators, but the common people themselves" statement.

"However, consciously or unconsciously limiting one's choices in desirable qualities in one's mates (or children) based on race, height, looks, athletic ability, intelligence, academic background, or socioeconomic class, while rejecting others, is what it is."

Exactly. That is what it is no matter if the two's egg and sperm meet via IVF or via sex.

"'After all, limiting her pregnancies to her lover's sperm would reduce her children's genetic diversity even more than limiting them to the sperm bank's men's sperm would...'"

"Why would that mean reducing genetic diversity?

For example, having two babies with the same lover's sperm would be less genetically diverse than having two babies with the sperm bank donations of two men who aren't identical twins.

Eric: "Some [doctors] are actually well-known for being dicks to nurses and patients."

Mina: "WTF? Shame on them."

Did I read that you are a medical student? You are fortunate not to experience much of this. I see many readers have problems with their OB/GYNs, for example. Ours are reportedly all fine.

Well, some doctors, all male and tending toward middle aged in that limited sample population, believe their skills and experience make them special. My nursing instructors made their sentiments quite plain with sayings such as:

"Nurses run the hospital. Doctors are just guests.*"
"Doctors are not God."

* In acute care, a given doctor may make morning and afternoon rounds on weekdays, a few minutes each day, if they can take themselves away from their practice or surgery. (I considered it a favor if doctors came in after hours or on days off in their street clothes, to check on their patients.) Nurses, naturally, are always there. In long term care, healthy residents see their doctors *once a year*. It is no surprise that locally, directors or managers of facilities are probably nurses. And women.

"Doctors should be *grateful* for nurses making it possible."

I respect doctors. In return, doctors should realize that nurses are their eyes, ears, and hands, and when authorized, act or speak on their behalf.

"Did I read that you are a medical student?"

Not me, I'm just a patient at times. OTOH, I live in Boston. Maybe the competition among health care providers and options weeds out more of the bad doctors here?

"I respect doctors. In return, doctors should realize that nurses are their eyes, ears, and hands, and when authorized, act or speak on their behalf."

And patients should respect nurses for that too!

Eric: "Why would that mean reducing genetic diversity?"

Mina: "For example, having two babies with the same lover's sperm would be less genetically diverse than having two babies with the sperm bank donations of two men who aren't identical twins."

There is also the possibility of using the same sperm donor, or "trading up" for subsequent children. The so-called "Nobel Sperm Bank" was noted for having popular requests. For example, sperm donor code name "White," while unable to have children of his own, fathered at least 13 others with different women, according to Slate. His legacy lives on. Egg and sperm donations expand the lines of people who never would have had that many children to begin with (A handful. Tens? Hundreds?), while substituting their own DNA for that of the legal parents. [One reason Japan does not legalize sperm/egg donations is because they fear a future where anonymous half-siblings or parents and children encounter by chance and have sex or reproduce. Hysteria, but it is interesting that the US does not share such concerns.]

Amale: "I would, however, also like them to sign releases from liability whenever exercising their right to make their own health decisions..."

Woah, Nellie! Patients should always be making their own health choices. Women are adults. Adults get to decide whether they are going to undergo tests, surgery, medical therapy, etc.

In fact, it ought to be the other way around. When patients decide to let physicians make decisions FOR them, both the patient and the physician should have to sign something. imho it should include a garuantee ("If this bladder repair surgery is unsuccessfuly, just come back within 6 months for a free do-over") and the physician's acceptance of any adverse consequences resulting from medical mistakes. How ya like them apples?

Sassygirl, I'm totally on the same page with you about the health choices of pregnant mothers. As a homebirther, I've encountered much of the fascism that passes as "concern for babies" -- as if health care professionals could possibly care more about my babies than I do??

I have a great OB who is supportive, but his office staff is not. They routinely try to pressure me into tests that I do not want or need, which only cost me money. Last pregnancy I was taking off my clothes to give them a GBS test I didn't want or need, knowing that even if it was positive I was not going to be on IV antibiotics during the labor because I would be at home. Why was I going to do it? Because some nurse had nearly convinced me to do it FOR THEM, so THEY wouldn't get 'in trouble' or whatever. LOL Fortunately my husband was there to remind me that I was at the OB's office for my needs, not THEIRS.

Women are routinely bullied into all kinds of medical decisions. My daughter, for example, who pushed into a c-section with the phrase, "We can either do a c-section now, or wait until your baby goes into distress and then do it." Her baby was perfectly fine, all vitals great, and there was no indication that he was about to go into distress. She had simply been occupying the LDR room for too long and they were ready to move on to the next patient. Their words made her feel like she would be a bad mommy if she didn't lay down where they could cut her open.

Millions of women experience this kind of subtle bullying. Other times it's more overt -- like the cancer patient who was put into a medical coma so they could railroad through court a decision to deny her chemotherapy and instead deliver her baby by c-section -- an action they knew would kill her. She and her baby both died, since the baby was too premature to survive (which they also knew.)

In more recent cases, women have been arrested or threatened with arrest for refusing inductions or c-sections. Hospitals can also refuse to release your baby if you don't comply with their bullying.

I am also a homebirther. I had my first son in the hospital and I could not handle the bullying and lack of choices. My second was born at home and it was wonderful.

abra abra

Welcome. I don't believe we've ever met. I haven't been able to change my sign in and make it work yet, but my name is Eric.

Thank you for your response. It pleases me that people think the opinion of a man is worth reading.

abra abra: "When patients decide to let physicians make decisions FOR them, both the patient and the physician should have to sign something. imho it should include a garuantee ("If this bladder repair surgery is unsuccessfuly, just come back within 6 months for a free do-over") and the physician's acceptance of any adverse consequences resulting from medical mistakes. How ya like them apples?"

You and every other poster who are upset about being denied choices at their doctor, or being treated with disrespect are absolutely correct in that regard, and I'll tell you why. Bear with me.

Firstly, that was one of my posts where I got snarky. I have apologized for being unprofessional, if you didn't catch that earlier, and I apologize to you now for touching a nerve.

I am very sorry to read of your experience at the hospital. A number of posters have had serious complaints about their OB/GYN, including actually being sexually violated, through no fault of their own. Their treatment is appalling and inexcusable. I encourage anyone to take their concerns or complaints through the proper channels, as high as necessary, to make yourself heard. Report it to the authorities or file a lawsuit, if necessary. If that is what it takes to wake them up to their problem and take measures to address them, so be it. [Just because I complain about lawsuits does not mean I believe they are without merit.] I am also sorry that this step is people's own responsibility, because the offender probably does not know or does not care about your poor treatment or complaint, to change on their own.

[In the largest facility in my community, there is a new nurse manager position. This woman, a talented nurse supervisor to begin with (Jamaican - awesome), does not practice nursing anymore. Her full time job is to maintain quality control and client/patient satisfaction. She handles all complaints, large or small. As a student, I have watched her respond to complaints personally, apologizing to client/patients, and doing what she could to address their situation. I have seen her then instruct staff (gathered all of them, not just the offender) on how to provide better customer service. That's right. I said, customer service. For example, no matter how hectic things get, there is no excuse for ignoring a bedside call buzzer, or leaving someone "dirty" in bed, or allowing them to go without a daily bath. I hope the facilities you go to have people like this who sincerely want to address people's concerns and respond to complaints.]

Secondly, before I got off topic, this thread was about (not) having the right to refuse a mandatory HIV screening before childbirth, which many consider offensive and a violation of their rights. I agree with their position against mandatory testing.

Therefore, the comment you responded to was meant to express, that I do respect their right to choose not to be tested for HIV. The reason I got snarky was, the hospital and staff should not be held responsible if a mother refusing an HIV screening (losing the opportunity to take proven measures to greatly reduce the chance of HIV transmission), or breastfeeding her baby against medical advice, resulted in the baby contracting HIV, i.e. giving baby a fatal disease. A woman's right to refuse tests and procedures for any reason, should be recognized. In return, I'd appreciate hospitals and doctors not to be sued for "allowing" babies to get HIV from their mothers while in the hospital. Thus the request for releases to be signed.

About your response to me. Again, you are 100% correct. I wish health care professionals could do all those things for patients. Unfortunately, and as you well know, the very nature of imperfect medical science and imperfectly understood human physiology means quite frankly, that nothing can be guaranteed. [Bear with me.] Did you see my comment, "Doctors are not God?" I meant it. This is a world where people have been proven to keel over dead from taking a simple Tylenol, or go into arrest if a gloved hand even touches their skin (allergies, often unknown to the patient).

Please read the warning label on any over the counter medication in your home, and please read the fine print on any consent form from your hospital. Those warnings are there for a reason: there have been proven cases of harm and death (there is NO perfect drug or treatment), even when not due to medical incompetence or error. Women and children in this day and age, can still tragically die from childbirth as part of a natural process, through no fault of anyone's.

A mother who is HIV positive, carrying a fetus which is HIV negative, however, represents a very manageable risk, if only doctors can be given the opportunity to help the baby at birth, i.e. mother allows herself to be tested for HIV, and appropriate measures taken to prevent transmission. Allow me to reiterate that many HIV positive people are completely unaware of their condition, despite being monogamous*, practicing safer sex, and feeling fine, thus a hospital is unlikely to simply take one's word for it.

*Can you also vouch for your partner always being monogamous, practicing safer sex, not engaging in high risk behavior such as sharing intravenous needles, and being HIV negative before ever meeting you to begin with? Mm. We've heard that one before. So why did I say it is not really necessary to test the dads or partners the way they do mothers? Because while unfair on the surface, how is an HIV positive man supposed to pass HIV to a baby?

Now, about actual medical errors, oversights and incompetence, and I agree there is a lot, too much of them. I shouldn't get into what national studies have shown about preventable harm and deaths caused to patients, because it literally scares some people away from hospitals and doctors.

I am not a hospital administrator who has to worry about the bottom line, nor am I a doctor with pride and a reputation to protect. I am a nurse, and a new one, at that, still full of ideals. By definition (current curriculum, anyway), a nurse is a patient advocate who is meant to stand for patient rights. I agree wholeheartedly that hospitals and staff members should be held responsible for errors, oversights, and incompetence. They should indeed be required to do "re-do's" for free, and if the harm is beyond their ability to undo, they should find patients someone who can do it right, out of their own pocket. [If the error is undoable, I believe the "re-do" part is standard, anyway, though they might have a crappy attitude about it.]

I complain about lawsuits and liability, but in cases of actual error, oversight or incompetence (eg - this has actually happened in the US - someone in the birthing room attached the oxygen tube to the carbon dioxide tank, and furthermore, the staff did not notice it. So when the baby was born, it was given CO2, causing irreparable brain damage through oxygen deprivation. The baby survived, but this is a lifelong disability.), you are damned right that the facility and any responsible doctor or staff member should be made to pay. Pay for treatment and lifelong care of that harmed patient, if still living, as well as for pain and suffering, and punitive damages**, as well. Responsible staff should be disciplined, retrained, and if necessary, fired and permanently stripped of their licenses to practice. If I ever cause harm to a patient, even by honest mistake, I'll probably be so shaken, I'll give up the profession myself anyway.

** Here's where lawsuits often get into the millions, on this alone. [In one notorious product liability case, the automaker GM was ordered to pay "six people who were severely burned when their Chevrolet Malibu exploded in flames in a 1993 collision," $4.9 BILLION dollars in punitive damages. For a single accident. In one car. Did I mention that no one died? A later judge reduced the award to only $1.09 BILLION.] The US will need some tort reform, if we do not want innocent hospitals and doctors (like many OB/GYNs) put out of business because of high insurance costs and fear of lawsuit.

Recap: All concerns and complaints I have read on this thread are valid. In this OP, doctors and nurses want to prevent HIV transmission from mother to child. People's right to refuse tests or treatment for any reason should be recognized (unless they have a highly contagious disease such as TB). People should recognize they are also responsible for direct outcome of exercising their rights, e.g. baby gets HIV, please don't sue. And I am sincerely sorry for anyone who has had a negative experience with their health care provider, and hope they can find redress.

God, I hope that covered it.

I am glad to hear of people's experiences with home births, and am saddened to hear there are places in the US where homebirths or midwives are not allowed.

abra abra: " . . . to give them a GBS test I didn't want or need, knowing that even if it was positive I was not going to be on IV antibiotics during the labor because I would be at home. Why was I going to do it? Because some nurse had nearly convinced me to do it FOR THEM, so THEY wouldn't get 'in trouble' or whatever."

Is it possible they were trying to cover their asses in case there was some complication, and you had to come in to give birth at the hospital?

"Because while unfair on the surface, how is an HIV positive man supposed to pass HIV to a baby?"

Good point.

The only such transmission possibility I can think of is that if he thinks it's cultural genocide to drop a custom, and part of his culture says that sex with a virgin will cure him, and by watching the baby since her birth he becomes absolutely certain that she's a virgin...

One thing to keep in mind is that YOU hire your doctor and YOU can fire your doctor. They work for YOU, not the other way around. YOU can always hire one who is more in line with your beliefs and fire the ones who aren't.

I have an awesome doctor who is also a professional midwife. She is in it because she wants to help people, not make the almight buck. When money was tight here and I wanted an IUD, she offered to do it for a reduced rate; $50. She once attended a birth for an Amish family and accepted a puppy from their litter as payment.

While this may not work in an emergency situation, you kind of get what the hospital gives you, although, I have requested different doctors in the hospital before, it is well within your rights to fire your ob/gyn if you are not pleased with your treatment.

"One thing to keep in mind is that YOU hire your doctor and YOU can fire your doctor. They work for YOU, not the other way around. YOU can always hire one who is more in line with your beliefs and fire the ones who aren't."

Of course you are correct again. Seeing things from inside, I am very disappointed to see how many steps are to cover one's ass to avoid lawsuits, like all those forms with small print. I spoke up in class and asked if the charting methods used were not "deceptive" and if families did not have a right to know, for example, that some elderly person who cannot testify for themselves, indeed "fell to the floor" (rolled out of bed, climbed over the rails, lost their footing to/in the bathroom, etc.).

That one unsupervised patient (restraints are not allowed) fell down, particularly in the middle of the night*, is not the fault of an overworked nurse, but of the facility which would allow such unmanageable workloads as 20/29/36/60 patients each. I hope California sets a precedent for other states to legally limit patient/staff ratios.

*On your next visit to a hospital or care home, please notice how many people have little tags on their gowns or clothes, with wires leading behind to their chairs or beds. Those are alarms to notify staff someone is trying to get up without asking for the help they require. Also see how many mattresses are directly on the floor with no bed or frames, so these determined patients do not simply climb over safety rails meant for their safety because they refuse to ask for help, and fall even farther to the ground. A person has a right to be and feel independent, but it is a different story when one has been judged (usually by family) unable to live independently because of disability or self-care deficits.

An HIV + male can pass it on to the mom, who can pass it onto the infant through breastfeeding.

It is typical and insulting to single out birthing moms and target them for mandatory policies. If it is just an opt out policy and it is mandatory for the practitioner to offer it, then I am OK with that.

"An HIV + male can pass it on to the mom, who can pass it onto the infant through breastfeeding."

Yes. Perhaps the father or current male partner is where the mother got the HIV in the first place. But the man will not pass the HIV directly to the baby like an HIV positive mother can through the simple act of childbirth, or at least, not during the three days or fewer in the hospital. And wanting to prevent transmission through breastfeeding while in the hospital, is why some hospitals do not want to allow HIV positive or women who refuse the test, as is their right, to breastfeed, because the hospital does not know if it is safe. If mothers would like to refuse this advice or hospital policy, if any, they can give their babies HIV if they want to. To kill them.

"It is typical and insulting to single out birthing moms and target them for mandatory policies."

Yes, it is against the rights of women and mothers to make testing mandatory. But in this case, testing a father immediately before childbirth, when there is no reason to believe he will pass HIV to the baby directly (sharing needles? sexual intercourse? blood transfusion?) is even more unnecessary than most feel testing a mother who can indeed pass on HIV to be. If you do not trust a man to be HIV free (there is no reason for me to believe anyone is HIV free), test him before the woman even gets pregnant, because that is the only time that matters for the baby. If a mother does not mind giving her baby HIV through bloody childbirth or breast milk, and kill them, that is her business, but release the hospital from liability.

No one has explained how anyone other than the mother is going to give a baby HIV. And kill them.

"test him before the woman even gets pregnant, because that is the only time that matters for the baby"

Alright, technically not true. The baby could receive HIV during months in the womb through the mother, from the partner. So test the man, if he accepts. If the man is HIV positive (or he refuses, like the woman can), then what? Do we cut the mother open, give her drugs, and forbid her from breastfeeding on that basis alone? Don't we need to test the mother (if she accepts) anyway? There is NO way to get around needing to test the mother, IF the mother wants to prevent (approx. just 2% chance with treatment) mother-infant transmission of HIV. At childbirth, the mother is the only source. That is a simple fact.

There I go getting snarky again. I am sorry. Mothers are not "killing" their own babies just by refusing tests*. I should let people read and judge for themselves. But a father/partner's HIV status is not an issue in a pre-birth screening.

* "Many people also don't know that there are ways to greatly reduce the risk of mother-to-child HIV transmission. About 25% of children born to HIV-positive women who receive no treatment or interventions against perinatal HIV transmission become infected with HIV -- that means an average of 25 out of 100 babies, or 1 in 4, can pick up HIV from their mothers during pregnancy, birth, or afterward from breastfeeding. But perinatal HIV infection rates can drop to as low as 1% or 2% for babies whose mothers are able to use combination antiretroviral therapy during pregnancy, AZT or nevirapine prophylaxis during labor and after birth, and choose the birth option that's safest, according to maternal viral load levels, for both mother and baby." ("Perinatal HIV Transmission and Birth Options for HIV-Positive Mothers").

"With good care and support, your risk of transmitting HIV to your fetus or baby is very low. Don't let that worry stop you if you want to be a mother."

http://www.thebody.com/content/treat/art907.html

The Body: The Complete HIV/AIDS Resource ("With 550+ Topic Areas!"
http://www.thebody.com/index.html

Have a Happy New Year.

Again, no one is arguing that screening and intervention are effective and may save lives. What we are arguing is that women still have the right to refuse. Just like anyone else, just like the case I posted about the boy refusing blood transfusions. He died. People die from refusing care all the time. men walking all over the world can infect other people and kill them eventually with the AIDS virus, but we do not pick one point in their lives (like childbirth) and say "Hey! You need an HIV test before you can get this vital care." Men in prison infect other men in prison with HIV.

I am sure testing men when the are initially incarcerated and even coming up with an HIV prison and a non HIV prison would do SO much more in preventing the spread of HIV in America than testing moms in labor. Would it be ethical? Not sure. Do they do it? No.