Perspectives on Mandatory HIV Testing of Pregnant Women in New Jersey

January 2, 2008

On Dec. 26, New Jersey Gov. Richard Cody signed into law a provision requiring that pregnant women be tested for HIV, and that newborns be tested if the mother’s status is not known.

The purpose of the legislation is to prevent transmission of HIV from mother to fetus. It allows women to opt out of testing, and requires healthcare providers to provide information about “the benefits of being tested, the medical treatment available to treat HIV infection, and the reduced rate of transmission to a fetus if an HIV-infected pregnant woman receives treatment.”

The law has generated mixed reactions. An RH Reality Check blogger noted issues such as the forced nature of the intervention on the woman for the sake of the fetus, and the possibility that women will feel that they are not able to refuse the test. While the N.J. law does not include any criminal penalties for refusing the test, the refusal will be noted in the woman’s medical record.

On privacy and choice, Women’s Bioethics Blog asks, “Does a woman cede certain personal rights when she decides to carry a pregnancy to term?”

Others have pointed out that a better strategy may be expanding access to prenatal care in general, rather than focusing specifically on mandatory HIV testing. Another blogger believes the test is not an invasion of privacy, but notes that a stigma of blame still exists with regards to HIV/AIDS that must be addressed.

Some have asked how New Jersey plans to care for those women who find that they are HIV positive. It appears that the N.J. Department of Health and Senior Services does provide drugs to those with HIV and AIDS who meet certain income caps and lack other means of covering the expensive prescriptions.

What do you think? Was it necessary or useful to move from an opt-in to an opt-out strategy for HIV testing? What does it mean when an intervention is forced for the sake of the fetus? Does the benefit to the woman of knowing her status and being able to seek care outweigh the lack of choice? These are complicated questions, and I’d love to hear your thoughts.

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