Mandatory prenatal HIV testing

Elvish, BSN, DNP, RN, NP · May 15, 2009

at least you are on sound footing....but why are these women given less legal protection than men?

If I could read the legislators' minds, I could retire in style :smokin: ....like I said, I don't like the law myself. My guess, however, is that if men could transmit HIV to their babies while they were pregnant, they'd have to get tested too.

eden · May 15, 2009

Nope it's not mandatory and I really don't see how one could make it mandatory. I have the right to refuse any and all care for myself or my child and would be livid if anyone did something to my child without my consent or against my wishes. I can't see how a law like that could be constitutional, thoiugh I don't live in the US so I'm not sure how it works there.

Here it is offered at the first prenatal and it is perfectly within the woman's right to accept or decline it.

fmoore723 · May 15, 2009

When I lived in Virginia--in the office, we had to take consents on all HIV testings for the prenatal panel. Otherwise, it was illegal to run the test. Im not sure the procedure for the hospital, but I supposed it would be the same as far as consenting. I agree that many women are diagnosed during pregnancy, that otherwise would have not been tested. BUT, I also agree with a patient's right to refuse ANY treatment. Although sometimes I think its not the smartest thing in the world--its one of the few rights left in this country that laws should intrude on. I too, would like to see in text a LAW stating you have to get HIV testing if youre pregnant. Cant we make decisions for ourselves anymore?

Felicia

ragingmomster, BSN, MSN, RN · May 15, 2009

NC legislation mandated beginning in November of 2007 that all pregnant women must have proof of HIV testing in the antenatal period or be tested upon admission to the hospital for labor. In the presence of a refusal on the mother's part to allow HIV testing, the neonate is to be tested.

NC also forces pts to submit to Syphillis testing during the antenatal period and a repeat test at hospital admission for labor if the pt is under the age of 25.

IMHO - Just a leapfrog back into paternalism.

MichelleB34 · May 16, 2009

I work in New York state. I'm not sure if there is a law but this is what happens. An HIV test is done with the initial prenatal blood work. I have noticed that one of the doctors has the HIV test repeated later in the pregnancy but I don't believe the other group does. (I have been on vacation and haven't looked at a patient history in 2 weeks) If the mother refuses to have an HIV test during the pregnancy then the baby has to be tested. I know if an HIV test is drawn on the floor counseling is provided, usually by the infection control nurse. I can't remember how the counseling is done when the HIV test is ordered as part of the routine prenatal blood work. (It's been 4 1/2 years since I have had that prenatal blood work myself.)

nursejohio, ASN, RN · May 17, 2009

NC legislation mandated beginning in November of 2007 that all pregnant women must have proof of HIV testing in the antenatal period or be tested upon admission to the hospital for labor. In the presence of a refusal on the mother's part to allow HIV testing, the neonate is to be tested.
NC also forces pts to submit to Syphillis testing during the antenatal period and a repeat test at hospital admission for labor if the pt is under the age of 25.
IMHO - Just a leapfrog back into paternalism.

Maybe I'm a paternalistic type of girl, but I just can't see the problem with mandatory STD testing in pregnancy. Aside from the obvious benefit of getting mom treated and cleared of the sterility inducing gc/chlamydia, the systemic effects of syphyllis... these are things that can cause serious damage to baby. Add in the HSV and HIV with transmission rates that can be reduced to nearly zero with proper treatment, and we would be not be doing our job (as patient advocates, and as a L&D nurse, I'm responsible for 2. Mom AND baby) if we did any less.

Yeah, I know. Every mom is in a monogamous relationship and such tests are unnecessary for them. I call horse dookie. I've seen too many girls come in (with negative tests at their first prenatal visit) c/o abd pain or discharge and get positive results. Most of them are lucky enough that whatever their husband/boyfriend/baby daddy brought home can be treated with abx, but sometimes they'll pass on a gift that keeps on giving :angryfire

cnm in progress · May 20, 2009

here are the cdc guidelines for hiv screening in pregnancy:

for pregnant women

hiv screening should be included in the routine panel of prenatal screening tests for all pregnant women.
hiv screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
separate written consent for hiv testing should not be required; general consent for medical care should be considered sufficient to encompass consent for hiv testing.
repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of hiv infection among pregnant women.

currently, some states (such as ny) have requirements that are more stringent. (but mom can refuse anything she wants). new york and connecticut both require newborn screening if the mom refuses testing during pregnancy (maybe some other states too...). the problem with newborn testing is the following:

if mom is hiv + and the baby is hiv -, the baby will still have hiv antibodies until around 18 months.
pcr screening can be done to test for viral dna to eliminate the above problem, but that test isn't accurate until about 6 weeks of age.
azt can be toxic for the newborn, so giving it to all babies who have a + antibody screen can expose uninfected infants to unnecessary risk.