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Sat, 5 Feb 2005 08:05:24 EST |
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Beth,
What you are describing in your post is the "spillover" effect in which
breastfeeding is sabatoged because the HIV status of the mother is unknown. Thus
HIV counseling and testing effects the promotion of breastfeeding and increases
the use of infant formula. This has been well described in Africa. UNAID
materials for health care providers, state that breastfeeding is recommended for
women who are HIV negative and of unknown status. And they specifically
mention the need to avoid the spillover effect in counseling. I have never seen a
discussion on the spillover effect in developed nations like the USA.
All mothers should have the right to refuse hiv testing (particularly since
this test generates alot of false positives, pregnancy, by itself, can create a
false positive). The CDC's revised recommendations for testing of HIV in
pregnancy states at the very beginning of the document:
"These guidelines recommend voluntary HIV testing to preserve a woman's right
to participate in decisions regarding testing to ensure a provider-patient
relationship conducive to optimal care for mothers and infants and to support a
woman's right to refuse testing if she does not think it is in her best
interest."
I believe the revised recommendations by the CDC are still considered
current. If you live in New York State or Connecticutt, there is mandatory newborn
HIV testing and thus legislation has circumvented informed consent of mothers.
Newborns of mothers that have refused HIV testing during pregnancy and
delivery have their blood tested for HIV. Newborn HIV testing only tells you the
HIV status of the mother not the infant.
Sorry I can't help you out regarding policy in hospitals, since I am not
employed by a hospital. What you are witnessing should be documented. It shows
us that the "spillover effect" of HIV testing is not limited to developing
nations.
Valerie W. MClain, breastfeeding advocate
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