Mandatory testing of pregnant women and newborns: a necessary evil?

The potential capability of the drug zidovudine (ZDV) to reduce the maternal-fetal HIV transmission rate from 25% to about 8% has raised complex questions about mandatory HIV testing of pregnant women and newborns. Advocates of this strategy equate mandatory HIV testing with interventions such as vaccination and quarantine, where expected health benefits are assumed to compensate for the associated loss of autonomy. At present, however, data on the effects of ZDV administration on vertical HIV transmission are incomplete and inconclusive. Moreover, concerns have been raised that ZDV treatment during pregnancy may compromise a woman's future treatment and have an adverse effect on infants likely to be born HIV-negative even in the absence of treatment. HIV testing of newborns indicates only maternal HIV status, since maternal antibodies are present for up to 18 months of age. If compelling evidence were available of a treatment likely to reduce significantly the risk of vertical transmission without adverse long-term effects for mother or infant, then the case for mandatory HIV screening would be stronger. At the present time, however, the infringements of civil liberties inherent in such a strategy outweigh its potential benefits.