Politics and Policy of HIV/AIDS

AllAfrica.com reports an interesting breastfeeding study, suggesting another nutritional factor that can increase risk of HIV acquisition. Several weeks ago in Nairobi, I met a U of Washington researcher who is investigating the potential links between intestinal de-worming and ARV treatment success. It appears that HIV is found in the gastointestinal (GI) tract in high concentration and there is evidence to suggest that an immunologically compromised GI tract may be a good environment for HIV to replicate.

PanAfrica: Breast is Best – Even for Babies With HIV+ Mums

Anso Thom
Toronto

A South African study has conclusively shown that babies with HIV positive mothers who are exclusively breastfed are significantly less likely to get the virus than if they get breastmilk and other food mixed.

Babies born HIV negative were 11 times more likely to become infected by their HIV positive mothers if given both breastmilk and solids in their first six months than those who were only fed breastmilk.

In addition, babies who are exclusively breastfed have a much lower risk of death from other infectious diseases such as diarrhoea in the first three months than those that are formula fed.

Professor Nigel Rollins, lead investigator from the University of KwaZulu-Natal, said the problem with current government policy was that simply giving free formula milk in many cases results in mixed feeding.
“But mixed feeding is the worst outcome being associated with increased transmission and increased mortality. Replacement feeding, even when exclusive is associated with increased non-infectious diseases and death especially in the first six months,” said Rollins.

The question of how HIV positive mothers should feed their babies has been hotly contested by AIDS researchers, as HIV can be transmitted in breastmilk.

Many of those from wealthier countries believe that HIV positive mothers should only give their babies formula milk, but this is not practical in places where mothers don’t have clean water.

Rollins said there should be a review of government’s infant feeding policy following his study.

“As a study group we feel that women are driven or unduly drawn to replacement feeding by the offer of free formula and that they should be offered an equivalent ‘incentive’ to exclusively breastfeed such as nutrition support to the mother herself.

“This would enable her to gain benefit herself and the child would be protected from diarrhoea with relatively minimal risk for HIV transmission” he said.

Rollins added that they would endorse a transition to replacement feeding at six months if the mother has adequate support available to feed the child safely at that time, as the risk diarrhoea was less and the babies needed food in addition to breastmilk to grow and develop.

Meanwhile, another South African study found that mothers’ decisions to use formula milk were not based on whether she had easy access to clean water; adequate fuel to boil water or whether she was employed or had disclosed her HIV status.

“This means that [infant feeding] counsellors are not taking these socio-economic factors into consideration as required in the World Health Organistion criteria,” said Tanya Doherty of the Medical Research Council/Health Systems Trust.

The study concluded that infant HIV free survival could be improved if women choosing to formula feed had access to piped water, fuel and had disclosed their HIV status.

“Without these, a choice to exclusively breastfeed would result in a better outcome,” said Doherty.