USPHS Task Force Reaffirms the Right of Pregnant Women with HIV to Control Medical Decisions Related to their HIV Care, Pregnancy and Prevention of Perinatal Transmission (2008)
On July 8, 2008 the U.S. Public Health Service (USPHS) Task Force Perinatal Guidelines Working Group issued a revised version of its Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States that reaffirms the right of pregnant women with HIV to control medical decision-making for themselves and their offspring.
The November 2007 version of the guidelines had, without explanation, deleted language included in the October, 2006 version about a woman's right to refuse ARV treatment without penalty. In response to this change, CHLP submitted an inquiry to the working group’s Executive Secretary and leader, Dr. Lynne Mofenson of NIH, questioning the group’s rationale for removing this important language. Dr. Mofenson quickly and responsively agreed to take CHLP’s concern back to the working group for consideration of reinstating the language concerning women’s rights.
We are pleased to report that the new version of the recommendations includes an even stronger statement affirming women’s rights in the introduction:
“After counseling and discussion, a pregnant woman’s informed choice on whether to take antiretroviral drugs either for her treatment or for prevention of mother-to-child transmission or to follow other medical recommendations intended to reduce perinatal HIV transmission should be respected. Coercive and punitive policies are potentially counterproductive in that they may undermine provider-patient trust and could discourage women from seeking prenatal care and adopting health care behaviors that optimize fetal and neonatal well-being.”
Click here to see the guidelines and the list of Task Force members.
An HIV-positive woman’s right to decide whether or not to undergo ARV therapy, either for her own health or to prevent transmission to her fetus, is fundamental, and its importance cannot be underestimated. CHLP extends its gratitude to Dr. Mofenson and the working group for considering our comments and clearly confirming the importance of making explicit a woman’s basic right to control medical decision-making related to her HIV care and her pregnancy.
The following sets out the noteworthy changes contained in the July 8, 2008 guidelines in more detail:
1. The introduction elminates any mention of monotherapy to prevent perinatal transmission. It also adds this language: "After counseling and discussion, a pregnant woman's informed choice on whether to take antiretroviral drugs either for her treatment or for prevention of mother-to-child transmission or to follow other medical recommendations intended to reduce perinatal HIV transmission should be respected. Coercive and punitive policies are potentially counterproductive in that they may undermine provider-patient trust and could discourage women from seeking prenatal care and adopting health care behaviors that optimize fetal and neonatal well-being."
2. In the sections on antepartum care and infant prophylaxis, the guidelines provide updated information about Viracept, the use of which had not been recommended because of "a process-related impurity." As of 3/31/08, the drug was deemed safe for use in all populations, including pregnant women and children.
3. The section on postpartum follow-up care now acknowledges not only the physical changes women go through after delivery, but also the psychological changes.
4. Also in the section on postpartum follow-up, the recommendation on continuation of ARV therapy after delivery has been changed. The recommendation now is to make this decision in consultation with the woman's HIV provider, taking into account several factors. The recommendation used to be continuation of therapy without mention of consultation or consideration of other factors.
5. The section on sterilization as a possible method of contraception now includes the following sentence: "Advance counseling and discussion about sterilization is strongly encouraged in order to enable the woman to make a well informed choice."
6. Two new tables have been added: (1) Intrapartum maternal and neonatal Zidovudine dosing for prevention of mother to child HIV transmission, and (2) Intrapartum maternal and neonatal dosing for additional antiretroviral drugs to be considered only in selected circumstances.