Elizabeth B. Cooper

HIV Disease in Pregnancy

This essay focuses on the concerns related to HIV that both health care consumers and health care providers bring to the gynecologic or obstetric setting. It begins with a recognition of the shared goals of consumers and providers, focusing on the role of trust that “must lie at the foundation of any successful provider-patient relationship”. It continues by noting the importance of the provider raising HIV-related issues and concerns with all sexually active patients, and not trying to perceive whether a particular patient might be at risk. The piece also provides some guidance to how providers should manage situations when a woman tests positive or negative, as well as when a patient chooses not to be tested for HIV. It explicitly rejects mandatory testing as a vehicle for facilitating access to HIV-related care. The essay concludes with the recommendation that all HIV-related public health policies be adapted as scientific information and medical treatment advances.

HIV DISEASE IN PREGNANCY: Ethics, Law, and Policy

Legal and ethical principles mandate that informed consent be an integral element of HIV-related education, counseling, testing, treatment, and intervention. Minimizing patient counseling and education (for economic reasons or otherwise) is likely to backfire. The presumption that a parent will act in her childs best interest, accepted in analogous contexts, should be foundational in the development of HIV policy in the obstetric and gynecologic setting. Most women, when provided with counseling, care, and confidentiality, consent to prenatal or perinatal testing and, most important, engage their families in HIV-related care and services. Because of the changing terrain of knowledge about and treatments of HIV disease, providers must thoroughly counsel women regarding the risks and benefits of available treatment and intervention.