Screening moms for AIDS is test for state lawmakers
New Jersey is moving rapidly toward becoming the first state in the nation to require both pregnant women and some newborn children to be tested for HIV.
While everyone looks forward to the day when AIDS is eradicated, 
the issue is not so simple when it comes to the "mandatory" part of the proposed testing law.
The bill, sponsored by, among others, state Senate President Richard J. Codey, would require that all pregnant women be tested for HIV twice; once early in the pregnancy and again in the third trimester. Newborn children would be tested if the mother tested positive for HIV in either of her pregnancy tests.
Most of what the bill's proponents say makes good sense.
Codey cited a Centers for Disease Control and Prevention study which found that medical treatment during pregnancy cuts the risk of transmission to the newborn child from 25 percent to just 2 percent.
The state health and senior services commissioner, Fred Jacobs, has signed on, endorsing the bill at a Senate Health Committee hearing last week. "The sooner pregnant women can be tested for the HIV infection, the sooner they can be treated," he said.
We already test for genetic birth defects, so why not HIV?
Fortunately, the number of HIV-positive children born in New Jersey is low. Of the 115,000 children born in 2005, seven children were born with HIV. Comforting — unless, of course, you are one of the seven.
Proponents insist that the law, which would allow women to "refuse" in writing to be tested, ensures that the tests are really voluntary. That "refusal" will be noted in their medical records, but proponents say it should not affect medical treatment.
But it makes a lot of difference to have to "refuse" vs. having to "opt in."
The reality is that many women, especially those in poorer areas of the state, are served by healthcare providers who may render inferior care and who may have tremendous workloads, or simply have trouble communicating with their less educated or minority patients. Or they simply may not have or take the time to explain the test to them. Instead, they will simply be testing women without their knowledge and consent.
That, say critics, is not "voluntary."
But if healthcare providers can take the time to go over insurance forms and obtain signatures on them, they can certainly take a few minutes to explain HIV testing and get a patient's consent.
Voluntary testing has another positive benefit. It forces doctors to actually spend that extra little bit of time to educate their patients.
There has always been a strange reluctance when it comes to AIDS testing. Much of it likely goes back to a time when the diagnosis meant a certain death sentence. While treatment requires a lifelong regimen of medication, that is no longer the case.
Still, people get squeamish about these things. A number of years ago, Illinois mandated AIDS testing of all couples as a marriage license requirement. Illinois' marriage rate dropped immediately while those of neighboring states like Indiana rose considerably. The law was a failure.
The opposition is well reasoned. Deborah Jacobs, director of the American Civil Liberties Union of New Jersey, testified that the bill "needlessly sacrifices the rights of women" and "deprives them of their moral authority to make decisions for themselves and for their children."
"HIV testing must be informed, voluntary, and free from coercion," she said.
Another major shortcoming in the proposed law is that it fails to require standards of medical treatment and support services for those women testing positive. What good is one part without the other?
There are four states that require healthcare providers to test a mother for HIV unless she specifically asks not to be tested. Three others, including New York, are the only ones that test all newborns. No state requires both.
There are lessons to be learned from the experiences of these other states. For instance, one out of four women surveyed in California felt they didn't have a choice to decline prenatal HIV testing. As many as 16 percent of Arkansas women said they didn't even know they had been tested. Younger, more vulnerable women, either through social status or education, may feel coerced if it is simply an "opt-out" system.
Relatively few women are ever likely to refuse voluntary HIV testing, or to decline to take anti-HIV medications if the test is positive. But the test must truly be voluntary and not through government-mandated fear and coercion. That is important.
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