Wednesday, April 1, 2009

Should African Mothers With HIV Breastfeed?

Amid all the talk about the Pope and condoms the last few weeks, many people overlooked another intriguing development about AIDS in Africa. Health authorities in Mozambique are urging women with HIV to breastfeed their babies. Like many issues in the AIDS world, the logic is totally counter-intuitive. But given the other threats babies face in the poorest parts of Africa, the risk of getting HIV from breast milk is small compared to the risk that babies will die of other maladies that breastfeeding helps prevent.

The most obvious is the danger posed by infant formula itself in places that lack reliable sources of clean water or sterile feeding equipment. A couple of years ago, I wrote a story for The Washington Post about floods in Botswana that caused widespread water contamination, which led to the deaths of more than 500 babies and young children. In some places, two or three died in a single village. What an American team of investigators found was that well-intentioned efforts to provide infant formula to women with HIV had led to widespread abandonment of breastfeeding, even among women who didn't have HIV. A huge percentage of the children and babies who died during the floods were not breastfed. The push for the formula feeding came largely from Western medical authorities working at UNICEF, though the agency later reconsidered as evidence about the dangers of formula mounted.

Breast milk is not only inherently free of the kinds of contaminants that get into drinking water, it also has nearly perfect nutrition for a baby and antibodies that protect a child against all manner of disease. So while women with HIV who have access to reliably clean water, as in the case of some modern cities such as Johannesburg, should use formula, others mothers should abandon breastfeeding only with great caution.

In places where clean water is not available every single day, the best solution for mothers with HIV probably is breastfeeding ONLY for the first six months. Then breastfeeding should stop entirely and be replaced by other foods. Mixing breast milk that contains HIV with other food sources dramatically raises the risk of the HIV infection taking hold in the baby. The reason is that digesting the other food causes tiny intestinal ulcers that HIV can penetrate fairly easily. So let's hear it for the Mozambicans for applying the best available science to a difficult situation.

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