Thursday, September 23, 2010

mandated repeat HIV tests for pregnant women and newborn babies

Today at the ob/gyn they took my blood and the doctor ran off the list of tests she wanted to run. Some of them – such as the glucose test, an iron test – made sense to me. Others I wasn’t so sure of the purpose, but didn’t argue. Until she said HIV test.

“We already did one earlier in the pregnancy, but we have to do one more,” she said.

“Can I skip that? I haven’t been exposed to any risks since the last time and it’s a waste of money to test for it again.”

Now that we are paying for a larger chunk of our medical expenses, I am paying more attention to the tests that are ordered and doing my best to refuse the senseless ones. With prices as ridiculous as they are, even 20% of a single blood test is a significant expense.

“Yes, it is a waste,” she said. “But our state is high-risk for HIV. So we have to test twice during the pregnancy. If we don’t, they will test the baby at the hospital.”

“They can force me to have my baby tested?”

“I’m not sure what the rules of refusal are,” she said. But she also indicated that perhaps they wouldn’t notice I didn’t have the second test.

I told her I wanted to skip it. It’s great to keep an eye out for HIV and to be ready to treat infected babies quickly. But I’m not high-risk. And I don’t want to have to pay for unnecessary tests because of some blanket rule. Nor do I want blood drawn from my newborn baby when there is no chance whatsoever that it’s infected with HIV.

“If they do catch it at the hospital, they will probably give you a chance to take the test again instead of testing the baby,” she said.

I just googled it and found out that indeed, my state has a law requiring testing of all pregnant women in the first and third trimesters, “unless they refuse.” It says if the HIV status of the woman is unknown, the baby will be tested, unless the mother has religious objections. Is my HIV status going to be “unknown” because I was only tested in the first and not the third trimester? If so, I am now developing religious objections. And I’m going to advise my pediatrician of those objections.

The ACLU has an interesting article on the topic from 2001. The CDC has some explanation of a screening policy here. And there is an interesting overview here.

It seems a common reason for opposition to mandatory testing is related to privacy. I’m opposed to the policy based on a belief that no one has the right to extract blood from me or my newborn without my permission, especially when there is no compelling medical risk. I’m also opposed to my family and my health insurance paying for something that has no medical value. I resent the state saying it knows more about my risk factors than I do.
Reaching out to women at risk and in need is great, especially in countries where pregnancy may be the only time when women have regular contact with the medical system. But applying blanket testing requirements in cases where women don’t want to be tested or where testing is a waste of resources, rubs me the wrong way.
If you live in a state with one of these rules, how did you handle it? Do you think such policies make sense?

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