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The challenge of providing choices to women
Guest Editorial
The Challenge of Providing Choices to Women
An estimated 7,000-10,000 infants (CDC, 1994) are born to women with HIV/AIDS each year in the United States. Prior to 1994, approximately 25%-30% of these infants woldd ultimately be infected with the AIDS virus. Since the disease progresses rapidly, AIDS has quickly become the seventh leading cause of death for children ages 1-4. The results of a clinical trial (ACTG 076) provided researchers and clinicians with optimistic information: Perinatal transmission could be reduced by providing A Z T therapy to the mother during pregnancy and delivery and to the infant in a 6-week course of treatment. The reduction of perinatal transmission from 25% to 8% in the A Z T group versus the placebo group (Connor et al., 1994) led the CDC to issue guidelines recommending that A Z T therapy (076) be promulgated as "standard care." Additional CDC guidelines (1995) expanded the initial recommendations to include voluntary offering of HIV testing to all pregnant women and subsequent offering of A Z T therapy to all HIVpositive women for themselves and their newborns. While the findings of 076 were promising as a potential opportunity to prevent maternal transmission, in some if not all cases the results also raised many unanswered questions. While follow-up clinical trials of the mothers and infants who participated in the ACTG 076 are in progress, the long-term effect of the drug on the infants, as well as the mothers taking AZT, is yet unknown. Nevertheless, the guidelines encourage adherence. Implementing the new CDC guidelines of counseling and testing and A Z T therapy "in the real world" will be challenging in the months and JANAC
Vol. 7, No. 1, January-Februar39 1996
years ahead, particularly as the AIDS pandemic spreads and children are seen as the "innocent victims" of this disease. The most critical challenge, however, may be in educating physicians and caregivers of HIV-positive pregnant women in ways to give important information about 076 and provide women with the choice of taking AZT. The genetics model of "nondirective" counseling may be the most appropriate approach for caregivers. As we stand on the verge of proposed legislation for mandatory HIV testing of all pregnant women and~or their newborns, it is imperative that we safeguard women's right to free choice to accept or reject A Z T therapy and set aside our personal opinions and judgments related to these complex issues. When all else fails, practitioners would do well to remember the old familiar Golden Rule, "'Do unto others..."
Stormy Schevis, MSW, is Manager, Community Relations and Public Policy, Children's Diagnostic & Treatment Center Fort Lauderdale, FL. References C e n t e r s for D i s e a s e C o n t r o l & P r e v e n t i o n . (1994). Recomm e n d a t i o n s for the use of z i d o v u d i n e to reduce perinatal transmission of human immunodeficiency virus. Morbidity and
Mortality WeeklyReport, 43,409-416. Centers for Disease Control & Prevention. (1995). U.S. Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women.
Morbidity and Mortality Weekly Report, 44, 1 -16 Connor, E., Sperling, R., Celrer, R., Kiseleu, P., Scott, G., O'Sullivan, M. et al. (1994). Reduction of maternal-infant transmission of h u m a n i m m u n o d e f i c i e n c y virus t y p e 1 w i t h z i d o v u d i n e treatment. New EnglandJournal of Medicine, 331, 1173-1180.
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The Challenge of Providing Choices to Women
An estimated 7,000-10,000 infants (CDC, 1994) are born to women with HIV/AIDS each year in the United States. Prior to 1994, approximately 25%-30% of these infants woldd ultimately be infected with the AIDS virus. Since the disease progresses rapidly, AIDS has quickly become the seventh leading cause of death for children ages 1-4. The results of a clinical trial (ACTG 076) provided researchers and clinicians with optimistic information: Perinatal transmission could be reduced by providing A Z T therapy to the mother during pregnancy and delivery and to the infant in a 6-week course of treatment. The reduction of perinatal transmission from 25% to 8% in the A Z T group versus the placebo group (Connor et al., 1994) led the CDC to issue guidelines recommending that A Z T therapy (076) be promulgated as "standard care." Additional CDC guidelines (1995) expanded the initial recommendations to include voluntary offering of HIV testing to all pregnant women and subsequent offering of A Z T therapy to all HIVpositive women for themselves and their newborns. While the findings of 076 were promising as a potential opportunity to prevent maternal transmission, in some if not all cases the results also raised many unanswered questions. While follow-up clinical trials of the mothers and infants who participated in the ACTG 076 are in progress, the long-term effect of the drug on the infants, as well as the mothers taking AZT, is yet unknown. Nevertheless, the guidelines encourage adherence. Implementing the new CDC guidelines of counseling and testing and A Z T therapy "in the real world" will be challenging in the months and JANAC
Vol. 7, No. 1, January-Februar39 1996
years ahead, particularly as the AIDS pandemic spreads and children are seen as the "innocent victims" of this disease. The most critical challenge, however, may be in educating physicians and caregivers of HIV-positive pregnant women in ways to give important information about 076 and provide women with the choice of taking AZT. The genetics model of "nondirective" counseling may be the most appropriate approach for caregivers. As we stand on the verge of proposed legislation for mandatory HIV testing of all pregnant women and~or their newborns, it is imperative that we safeguard women's right to free choice to accept or reject A Z T therapy and set aside our personal opinions and judgments related to these complex issues. When all else fails, practitioners would do well to remember the old familiar Golden Rule, "'Do unto others..."
Stormy Schevis, MSW, is Manager, Community Relations and Public Policy, Children's Diagnostic & Treatment Center Fort Lauderdale, FL. References C e n t e r s for D i s e a s e C o n t r o l & P r e v e n t i o n . (1994). Recomm e n d a t i o n s for the use of z i d o v u d i n e to reduce perinatal transmission of human immunodeficiency virus. Morbidity and
Mortality WeeklyReport, 43,409-416. Centers for Disease Control & Prevention. (1995). U.S. Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women.
Morbidity and Mortality Weekly Report, 44, 1 -16 Connor, E., Sperling, R., Celrer, R., Kiseleu, P., Scott, G., O'Sullivan, M. et al. (1994). Reduction of maternal-infant transmission of h u m a n i m m u n o d e f i c i e n c y virus t y p e 1 w i t h z i d o v u d i n e treatment. New EnglandJournal of Medicine, 331, 1173-1180.
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