We had a seemingly endless HIV seminar at school today. The last speaker was an ob/gyn professor at our school that I do not see eye to eye with on a lot of issues. He horrified me the first time I met him, when he was speaking to our interest group about malpractice, and he was grotesquely imitating a child with cerebral palsy.
He is known for pushing elective cesarean on his patients. He bragged about it to us, saying he can be “in and out in twenty minutes” and not have to wait for twenty hours of labor. He called that “labor sitting” and said “I’m not a glorified midwife.” What’s worse is that he teaches the public health classes on maternal health.
So, back to today. He lectured on HIV in pregnancy. He said that HIV is on the rise in heterosexual women in our community due to anonymous internet sex parties. You know why? Because one man at his wife’s job as a doctor at the local department of health STD clinic said he had sex with 100 partners in one month. When she asked him how he managed to have so many partners, he told her he went to these anonymous orgies he found out about on the internet. He is HIV+ and has syphilis. He said everybody at the party assumes you are positive.
I really doubt most of the HIV+ women in our county got exposed at anonymous sex parties. He joked around about it for about five minutes. He mocked HIV+ women and painted them as aberrant perverts. I would never want to get HIV tested in his office. The previous lecturer said most HIV positive women are exposed through intravenous drug using sexual partners.
He went on to talk about testing women during pregnancy for HIV. He mocked the reasons that women might not want to get tested. He said he would tell them that he wouldn’t deliver them. “Isn’t that unethical?” he said in a squeaky voice. “Maybe,” he said, and shrugged his shoulders. “That’s what makes medicine fun.” Then he added, “No one is going to push me around.”
Now, let me reiterate that I support HIV testing and think everyone should get tested, pregnant or not. But I also support the right of someone to refuse testing, and I don’t think women lose rights just because they happen to be pregnant. Every sexually active person has the possibility of passing on HIV if they are positive, not just pregnant women. Vertical transmission is a shame, and pregnancy is a great opportunity to prevent HIV transmission. I believe in opt out policies in which every pregnant woman is offered HIV testing equally, and it is refusable.
Private practitioners should be allowed to decide the scopes of their practice. If he does not want to deliver women who won’t get an HIV test, that is his choice. I think it can be ethical as long as he refers her to someone who will deliver her. He seemed to indicate that he would deliver a woman who was HIV+. So, why can’t he treat an untested woman as if she were positive?
The issue I see with this is the slippery slope. If he treats her as if she was positive, (or if she does test positive) can she refuse AZT? Can she refuse a cesarean? Can she refuse giving her child AZT? I am not advocating refusing AZT, but if mothers can refuse to give chemotherapy and blood transfusions to their children, they should be able to refuse AZT. I think a sensitive practitioner would offer her more than once, ask her what her hesitations are, and try to work with her on the issue.