Legal Issues Concerning Public Health Efforts To Reduce Perinatal HIV Transmission

Abstract

Since its inception in 1981, the Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV / AIDS) epidemic has raised challenging legal and ethical questions for public health officials, physicians, policymakers, patients, lawyers, and ethicists. Although HIV / AIDS mostly affects adults in their prime working years, it has also emerged as a pediatric health problem. Current estimates indicate that in the absence of effective maternal treatment, eight hundred thousand children worldwide born to HIV-infected mothers will be infected each year. Yet, one of the most significant advances of the epidemic has been the discovery that antiretroviral medications taken by the mother during pregnancy and delivery, and by the child after birth, can greatly reduce the risk of HIV transmission. As a result, the United States and the rest of the global community have the opportunity to take proactive steps toward the reduction and virtual elimination of perinatal HIV transmission. This Article explores the legal issues related to the reduction of perinatal HIV transmission in the United States to demonstrate that proper education, along with voluntary testing and treatment during pregnancy, can significantly reduce such transmission. Part I examines the history of this topic from a medical perspective, focusing on studies of efforts to reduce perinatal transmission. Part II looks at the evolution of recommendations, policies, and laws regarding the testing and treatment of HIV-positive pregnant women. Part III examines existing state laws regarding HIV testing and counseling, while Part IV reviews legal challenges to these and related laws. With the current medical, legal, and policy information in mind, Part V makes recommendations concerning state legal interventions to reduce perinatal HIV transmission. Part VI concludes that a carefully crafted policy of routine testing that incorporates informed consent is the key to a viable strategy to reduce HIV transmission.