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Breastfeeding and HIV + » Women's Courage

Breastfeeding and HIV +

January 31st, 2013 by cbax2014 Leave a reply »

Since we learned about HIV and AIDs and it’s effect on millions of women this past week, I thought that it would be appropriate to focus on how this disease is a major obstacle to encouraging women in developing countries to breast feed. I will then mention one possible intervention tool that may make it possible for HIV positive mothers to easily breastfeed their infant without worrying about transmitting the disease.

World-renown journals in the United States, such as Pediatrics and the Journal of Nutrition, have touted the benefits of solely feeding infants breast milk for six months (1).  Yet, breastfeeding in developed countries and developing countries is important for different reasons. For instance, many argue that breastfeeding is especially important in developing countries where malnutrition and infant deaths due to diarrhea and other preventable diseases are common. As a result, several health organizations, including UNICEF, Save the Children, and the World Health Organization (WHO) have focused on the unique needs of infants and mothers in developing countries. In 2003, WHO and Unicef published the Global Strategy for Infant and Young Child Feeding (2). This strategy says that “infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.” The strategy aims to publicize the importance of breastfeeding and to “increase the commitment of governments, international organizations and other concerned parties for optimal feeding practices for infants and young children” (3).

However, the Global Strategy also notes that the prevalence of HIV/AIDs in many areas, especially in Sub-Saharan Africa where over 60% of HIV-infected people are women, is an obstacle to safe breastfeeding. There are three ways that the disease can be transmitted from an HIV positive mother to a baby:

  1. During pregnancy/in utero
  2. During vaginal child birth
  3. Through breastfeeding (4)

In the United States and other wealthier countries, HIV positive women can take antiviral drugs, have a C section instead of a vaginal birth, and feed their baby using formula to drastically reduce any risk of transmitting the disease to their babies (5). Yet, in most developing countries, due to the low value placed on women’s lives, few women have access to any of these luxuries. Many women may not know that they are HIV positive until they are already pregnant or have given birth since they may rarely be tested or even visit a doctor. Moreover, antiviral drugs are expensive (in our reading they were quoted at about 400 dollars a month) and as we also read this past week, more money is usually spent on a man’s healthcare and antiviral medicine than on a women’s. Moreover, WHO states that mothers in developing countries are better off feeding their infant solely breast milk than feeding their infant formula as besides the natural strengths of breast milk, dirty water and contaminated baby bottles when using formula in developing countries can cause many life threatening illnesses. The situation of a mother in a developing country is thus very different from one in the United States.

For mothers in developing countries, there is a delicate balance between the risk of HIV transmission to an infant via breast milk and the risk that an infant dies of malnutrition or a disease that easily could have been prevented through the natural antibiotics in breast milk. So what should an HIV positive mother in Sub-Saharan Africa do? Should she breast feed or solely feed her baby using formula? The answer to this question is confusing and misinformation and lack of education is a major challenge.

 

Even the World Health Organization has drastically changed its recommendations within a very short period of time. In 2010, WHO recommended in its paper Breast is always best, even for HIV-positive mothers  “that all mothers, regardless of their HIV status, practise exclusive breastfeeding – which means no other liquids or food are given – in the first six months” (6). Yet, only two years later, WHO revised its recommendation and said, “WHO recommends either to not breastfeed at all or to breastfeed while taking antiviroal medicine/feeding antiviroals to infant” (7).  Thus, the World Health Organization’s contrasting recommendations suggest that the best procedure for HIV positive mothers who do not have access to antivioral drugs is still unclear. Moreover, a recent study on mice suggests that the ingredients in breast milk may actually kill the HIV virus and prevent oral transmission. As the lead researcher explains, “”No child should ever be infected with HIV because it is breastfed. Breastfeeding provides critical nutrition and protection from other infections, especially where clean water for infant formula is scarce. Understanding how HIV is transmitted to infants and children despite the protective effects of milk will help us close this important door to the spread of AIDS” (8). Such experiments highlight the fact that we still don’t know enough about the relationship between HIV transmission and breast milk.

However, experiments have shown that currently, the use of antiretrovirals (ARVs) is one of the best ways to dramatically reduce the risk of transmission through breastfeeding. Women who took ARVs themselves during breastfeeding or gave ARVs to their nursing infant daily saw a drop in transmission from an estimated 5-20% to just 2% (9). Moreover, not only do ARVs help protect the infant from carrying the disease, but they also help ensure that women receive appropriate care for their own HIV (10).

One Intervention: Antiretrovirals Nipple Shield

Researchers at Cambridge University cleverly designed a nipple shield that women can use to breastfeed their infant and easily feed their infant ARVs. The idea is that ARVs can be put inside the shield which is placed over a mother’s breast and which the infant sucks on. In this way, the milk that the infant is receiving is already being “purged” of the HIV virus (11). A promotional video about this new invention can be found here: http://justmilk.org/media.html. However, it’s important to note that this device is still in its early design stages and has not been tested on subjects yet. Moreover, the intervention doesn’t address the problem of the high cost of ARVs. Instead, the nipple shield simply creates an easier way for mothers to feed their infants breast milk with HIV-fighting drugs. Nevertheless, I think that it’s a very creative idea and am curious to see where it goes from here.

 

Sources:

1  http://www.childinfo.org/breastfeeding_overview.html

2)  http://whqlibdoc.who.int/publications/2007/9789241595193_eng.pdf

3) Ibid.

4) http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pregnancy-and-childbirth/

5) Ibid.

6) http://www.who.int/bulletin/volumes/88/1/10-030110/en/index.html

7) http://www.who.int/maternal_child_adolescent/documents/9241590777/en/index.html

8)  http://www.sciencedaily.com/releases/2012/06/120614182751.htm

9) http://www.who.int/maternal_child_adolescent/documents/9241590777/en/index.html

10) Ibid.

11) http://justmilk.org/

 

 

 

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3 comments

  1. Kira says:

    I was really shocked by the research you mentioned that stated that breastfeeding reduces the risk of HIV transmission. Not only is this research stating that breastfeeding doesn’t cause transmission of HIV from mother to child, but it is also claiming that there is a decreased likelihood that the child will contract the disease. This so blatantly opposes the claims made by Aids.gov and all the other sources most of us have heard about. Furthermore, doesn’t your statistic from WHO blatantly show how breastfeeding can transmit HIV? (”Women who took ARVs themselves during breastfeeding or gave ARVs to their nursing infant daily saw a drop in transmission from an estimated 5-20% to just 2%.”) I certainly want to look into this, because how can we tackle the problem if there is disagreement on what in fact the problem even is?

  2. chierika says:

    Great post. I think that this is an important topic because of the invaluable benefits of breast feeding and the difficulty in finding something to supplement its nutrients. I was actually reading a paper that stated that infants born to HIV infected mothers are more likely to die than infants born to mothers without HIV, I think that in the case of breastfeeding, basic nutrition and immunity concerns factor into this statistic.

    I think the issue is the lack of treatment options for women in the developing world, they are unable to receive medication to reduce viral loads and they are forced to choose between feeding or harming their child.

    Great, thought provoking post!

  3. crennels says:

    This was a really interesting post- breastfeeding has so many benefits, and is clearly the right choice for a mother who is not HIV positive. You did a good job communicating the struggle a mother who is HIV+ faces; should she give her baby the best nutrition possibly by breastfeeding, despite the risk of transmitting a terrible disease?

    I did not know that there is still so much research to be done about the transmission of HIV via breastfeeding. I hope that researchers can more clearly define what the best choice is for HIV+ mothers, so that soon this choice will not be such a difficult one for them to make.

    The intervention you mention is really interesting and seems simple; you mention cost and we have seen in this class that even simple health-promoting medicines and devices can be out of reach for women in low-income countries. Thank you for your post!

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