The case against mandatory newborn screening for HIV antibodies

Abstract

The paper examines the controversy surrounding legislative proposals in New York State that would require amending the public health law's stringent confidentiality provisions; the legislation calls for "unblinding" the results of a 7-year old statewide HIV seroprevalence study that tests newborns for HIV antibodies in order to track the incidence of HIV infection among parturient women. The pivotal point is made that mandatory disclosure of the test results is tantamount to mandatory testing of the mother, since presence (or absence) of HIV antibodies conclusively reveals the mother's HIV status. The author presents the history of the epidemiological study and documents the ongoing discussion of mandatory testing, within the medical, bioethical and public health community. Citing numerous papers, including the report of the Subcommittee on Newborn Screening of the New York State AIDS Advisory Council, the author--a member of both the council and its subcommittee--argues against the principle of mandatory testing in general and "unblinding" of the seroprevalence survey in particular. Besides making a strong argument from the ethical viewpoint, the paper provides ample medical data to support the argument that mandatory testing of newborns is poor public health policy that would be essentially ineffectual in the effort to stem the spread of HIV.