How HIV is affecting breastfeeding practices: What should the Pharmacist advise
Net News: May 1999
Candy Day candy@healthlink.org.za
After many years of throwing all efforts behind the drive to promote breastfeeding, the
emergence and explosion of the AIDS epidemic, has caused some controversy in this area.
Although recommending formula instead of breastfeeding is a proven way of reducing the
risk of transmission of the deadly disease from mother to infant, the dangers introduced
by discouraging breastfeeding range from mental, social to risk of death from diarrhoea.
The pharmacist should be abreast of the issues in order to provide the best advice to each
client, bearing in mind that socio-economic factors may influence that advice.
What are the risks?
WHO suggests that the risk of HIV transmission
from-mother-to-child is roughly as follows:
- Two-thirds of babies born to mothers with HIV are not infected at all;
- Of the one-third of babies who are infected, two-thirds are infected in the womb or at
birth; one-third are infected through breastfeeding.
- Some studies indicate higher levels of risk, for instance, where breastfeeding continues
for a long time.
Breastfeeding is more risky when:
- the mother acquires HIV infection herself during pregnancy or lactation;
- the mother's nipples are cracked or she has abscesses and other breast
problems;
- she is already symptomatic for HIV-related diseases;
- the baby has sores in the mouth or an inflamed gut.
Policy dilemmas
The World Health Organization ( http://www.who.int
) and the United Nations Children's Fund (http://www.unicef.org/)
have been slow to support moves towards non-breastfeeding for mothers with HIV in
developing countries. This is because of the real risk that more babies will die of
malnutrition and diarrhoeal infections than would be saved through avoiding HIV infection.
Two considerations are changing this view: the high levels of maternal HIV in some areas
(over 20% of pregnant women in most of southern Africa, for example) and recognition of
the right of women and families to information on which to make their own decisions.
Where maternal HIV infection is high, huge numbers of babies are potentially at risk of
infection. The most important strategy must be trying to reduce maternal infection, trying
to protect young women in particular from becoming infected in the first place. In
addition to this, the number of infected babies can be reduced by:
- increasing reproductive choices for women; - short-course ZDV (AZT) administered to the
mother during late pregnancy;
- certain obstetric procedures at birth (e.g. avoiding early rupture of membranes);
- administration of vitamin A and other micronutrients to the mother during pregnancy and
lactation;
- mothers with HIV avoiding breastfeeding.
The strategy of avoiding breastfeeding, although an important option is problematic
because, if replacement feeding is undertaken only by HIV positive mothers, their
confidentiality over their HIV status is automatically lost. If HIV negative mothers also
stop breastfeeding, many babies in poor families will die from malnutrition and diarrhoea
who were at no risk of HIV.
In 1998 the Southern Africa AIDS Information Dissemination Service (SAfAIDS) - http://www.safaids.org/ or info@safaids.org)
released a fact sheet on this topic which discusses all of these issues.
Infant feeding recommendations
The new WHO, UNAIDS and UNICEF policy guideline on breastfeeding
is that all women should:
- be kept optimally informed about the risks of HIV transmission through breastfeeding;
- have access to VCT to find out their HIV status;
- be supported to undertake safely the option they choose, either breastfeeding or
replacement feeding.
In line with this revised policy, the UN organisations emphasise that breast milk and
breastfeeding remains the desired option for all women who are HIV negative as well as for
all those who do not know their HIV status. The worst outcome of all would be if fears
about HIV transmission undermine breastfeeding in the general population.
If mothers with HIV do breastfeed, the duration of breastfeeding should be reduced to
between 3 and 7 months according to various researchers. The transition to other foods
should then be rapidly undertaken to avoid the extra risks of HIV transmission during
mixed feeding.
More resources
- Publications on feeding practices have been made available by the Support
for Analysis and Research in Africa project (SARA) and are available from http://www.info.usaid.gov/regions/afr/hhraa/docs.htm
. "HIV and Infant Feeding" summarises what is currently known and unknown about
the transmission of HIV through breastfeeding. The "Designing by Dialogue"
manual provides research tools for programs to improve infant feeding.
- The Child Health Unit at UCT runs a very good resource centre available at http://users.iafrica.com/m/mc/mchirc/
or by email at mchirc@iafrica.com . Their
newsletter, MCH News (#9) has also looked at issues of breastfeeding. This newsletter is
also distributed electronically via a free email discussion list - details available from http://www.healthlink.org.za/hlink/hlelists.asp
, or subscribe by sending an email to lyris@healthlink.org.za with only the
following text in the email message: subscribe mchmail Firstname Surname
Linux – a viable alternative to the Windows operating
system
Linux is a free Unix-type operating system originally created by
Linus Torvalds with the assistance of developers around the world. Although Linux has been
relatively inaccessible to the average user, it is becoming much more user friendly, and
many more companies are releasing software for Linux, including the well known Corel
WordPerfect, which can be downloaded for free from http://linux.corel.com
.
A local SA site – http://www.linux.org.za
– is not very flashy, but will point you to some useful resources, including
local support options.
Otherwise, a good place to start is the official Linux site, http://www.linux.org
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