A finding that AIDS can be prevented in infants whose mothers take the drug AZT has sparked debate over mandatory testing – and how Christians should confront the aids crisis.
The new study, conducted in health centers in the United States and France, found that infants born to women infected with HIV, the virus that causes AIDS, were only one-third as likely to contract the virus if they and their mothers received AZT during and after pregnancy. The results of the study were published last month in the New England Journal of Medicine.
The finding that early treatment can prevent transmission of the AIDS virus from mother to child has pitted those who argue for mandatory testing of pregnant women against those who say testing should be voluntary. “This isn’t such a complicated moral call,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. “If you can prevent a young child from being infected, it would seem to me that you are under an obligation to take the steps necessary to prevent that harm.”
Ruth Macklin, an ethicist at Albert Einstein College of Medicine, says mandatory testing or attempts at mandatory treatment “reinforces concern for the fetus or child-to-be to the possible detriment of the pregnant woman.”
Meanwhile, Christians are embroiled in a different argument over mandatory testing – one that strikes at the heart of the scope and future goals of the pro-life movement.
THE ROLE OF CPCS
Some prominent Christian public policy analysts say crisis pregnancy centers (CPC), which offer pregnancy counseling and alternatives to abortion, should be on the frontlines of the fight against the spread of aids to infants.
Shepherd Smith, Jr., president of Americans for a Sound AIDS/HIV Policy, argues that these centers should require clients to be tested for HIV – either on site or via referral. “There are such clear medical benefits to [a pregnant woman] being tested,” he says. “And if her health is improved, the health of the child is improved.”
Pro-life leaders say asking CPCS to require testing is out of the question. Robin MacDonald, executive director of the Capitol Hill Crisis Pregnancy Center, says she is “surprised someone would say this is something we’d be required to do unless they are also talking about supporting centers … financially or professionally.”
Harold O. J. Brown, professor of ethics at Trinity Evangelical Divinity School, says that requiring clients to be tested could damage the reputation of CPCS. He says it also would raise pressing legal questions. “CPCS are not in a position legally to demand HIV testing,” says Brown, who is also cofounder of the Christian Action Council, the parent organization of Care Net, an association of 467 CPCS. “They can’t even demand pregnancy testing.”
However, Brown agrees that CPCS should “definitely strongly encourage” HIV testing. For some, testing positive could be seen as an argument for abortion, he explains. “But that is not an argument that testing should not be encouraged.”
EXPANDED SERVICES?
Richard Cizik, policy analyst for the National Association of Evangelicals, says CPCS should widen the scope of their current services to include AIDS counseling and routinely encouraging clients to be tested for HIV.
“If there is a drug which significantly prevents passage of the HIV virus from mother to child, doesn’t it seem that there is now a compelling reason to consider HIV testing/counseling in your ministry efforts?” Cizik recently wrote to Cheryl Jakubowski, director of Care Center Services for Care Net. “If not, it would seem that you are willing to counsel for pregnancy as opposed to abortion, but not for the only means that can save the life of the child, given that the mother is HIV positive.”
Jakubowski says HIV counseling also is beyond the scope of Care Net’s ministry. “Our mission is to reach women and men in crisis pregnancies and give them alternatives to abortion,” she says. “Sometimes we only get 15 minutes with a client. … It’s difficult to talk about adoption, abortion, parenting, sexual issues, their relationship to Christ in 15 minutes.”
She adds that while HIV testing referrals are not standard procedure and probably never will be, some pregnancy care centers already informally refer clients for HIV testing. “Any center that is seeing HIV-positive clients would have a referral system just as all of our centers have referral systems for psychiatric help if it’s needed, or for other social services.”
Federal health officials estimate that 1,000 to 2,000 HIV-infected babies are born in the United States each year.
Harold W. Jaffe, who directs AIDS research at the federal Centers for Disease Control and Prevention, says the Public Health Service and the American Academy of Pediatrics are developing guidelines for testing. He hopes that when they are published they will make offering an AIDS test to pregnant women “a standard of care.”
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