Tacoma/Pierce County Health Department Proposing Mandatory HIV Testing of all Pregnant Women, Inmates, People Diagnosed With Other STDs

All pregnant women, anyone who exhibits symptoms of a sexually transmitted disease and anyone arrested on drug- or sex-related charges in Pierce County, Wash., would be tested for HIV under a new proposal by the Tacoma/Pierce County Health Department, the Tacoma News Tribune reports. Health Department Director Federico Cruz-Uribe plans to submit the proposal, which would be among the "most sweeping in the nation" if adopted by the county board of health, for discussion and public hearings in January. Under the plan, people would be tested and receive counseling on HIV treatment and ways to prevent transmission. The sexual or needle-sharing partners of those who test positive would also be notified and tested. "If you do that, you're picking up the two most important groups when you look at how the virus spreads across the United States and in our own community," Cruz-Uribe said. Although vertical transmission is low, testing all pregnant women would ensure that it remains that way, he added. Sixty-two people in Pierce County were diagnosed with AIDS and another 147 tested positive for HIV last year. The county was the first in Washington state to make HIV cases reportable by name. The News Tribune reports that it is unclear how many people would be tested annually, but about 10,000 women gave birth last year, nearly 3,000 people were diagnosed with an STD and 28,000 people were arrested last year, 60% of whom faced drug-related charges.

Drawing Fire
The plan has "generat[ed] shock waves" among area AIDS advocates, the News Tribune reports. "AIDS is not like other diseases. It has different social implications and stigma attached to it. To us, mandatory testing follows a slippery slope. What's next? Are you going to mandate treatment and other things?" Joel Hastings, director of government affairs for the Lifelong AIDS Alliance in Seattle, said. Jeannie Darneille of the Pierce County AIDS Foundation called the proposal "radical" and said that the measure -- particularly the part that would require testing of anyone arrested for, but not yet convicted of, a drug- or sex-related crime -- was unlikely to withstand a legal challenge. "That is absolutely preposterous. It's just a fundamental civil rights issue," Darneille, who is also a state representative, said. According to the Tribune News, a "handful" of states require testing for pregnant women and Washington currently administers HIV tests only at a woman's request. The state Board of Health is considering making testing standard, but allowing women to "opt out" if they do not want to take the test. However, the Governor's Advisory Council on HIV/AIDS rejected the notion because of fears that some women may avoid obtaining prenatal care due to the testing. Most states can require testing of inmates; however, no jurisdiction has attempted to require testing of people arrested but not convicted of a crime. Pierce County Prosecuting Attorney Gerald Horne said that law enforcement officials should be able to require someone arrested to take an HIV test, saying that if officials have enough evidence to arrest someone, they also have probable cause for the testing, especially when the public health is at risk. The Pierce County Medical Society board supports the proposal, according to its president, Dr. Patrice Stevenson. "It's hard to argue with what [Cruz-Uribe] is proposing. That's the way they eliminated smallpox: Find cases and identify their contacts," she said (Doughton, Tacoma News Tribune, 11/19).