Breastfeeding is still the best option – even for HIV positive mothers, according to the findings of a recent study by researchers at the University of Natal, Durban which has caught the attention of international AIDS researchers.
Worldwide, women are told that “breast is best” for the first few months of their babies’ lives. In recent years, HIV positive mothers have become an exception to this rule. They have been encouraged to bottle feed their babies to avoid the possible transmission of HIV.
According to Dr Kubendran Pillay, one of the researchers involved in the new study, previous statistics have shown that breastfeeding increases the risk of mother-to-child transmission of HIV by 14%. However, these statistics were flawed because they failed to distinguish exclusive breastfeeding from mixed breast- and bottle-feeding.
The new research, conducted by Anna Coutsadis, Pillay and colleagues, shows that mothers who breastfed exclusively during the first three months of life did not transmit HIV to their babies more often than mothers who bottle-fed. These findings confirm what other researchers have suspected for years that although breastmilk contains the HI virus, it also contains HIV-antibodies which neutralise the virus.
The researchers found that, in a group of 549 infants born to HIV-1 infected women, mothers who combined breast feeding with bottle feeding (mixed feeding) were twice as likely to transmit HIV to their babies. Evidence suggests that the babies’ intestines are damaged by other fluids and foods, and this makes the child especially vulnerable to the HIV transmitted via breast milk.
According to Dr Pillay, “What the evidence suggests is that mixed feeding is a worse option than exclusive breast feeding for HIV positive mothers. HIV infected mothers need to be educated that exclusive breast-feeding has benefits over mixed feeding and is similar in terms of risk to formula-feeding.”
These new findings are important because, in certain communities, the exclusive use of formula to feed newborn infants is seen as a sign that the mother is HIV positive. Many HIV-positive mothers thus choose to breastfeed occasionally rather than subject themselves and their infants to the stigma and prejudice associated with HIV.
Many HIV positive mothers also resort to breastfeeding when they cannot afford formula milk.
The study still needs to be confirmed by further research. However, if the findings are correct and exclusive breastfeeding during the first three months is as good an option for HIV positive mothers as exclusive bottle-feeding, it will be extremely good news.
According to the researchers, who reported their findings in the respected British medical journal, the Lancet, “exclusive breastfeeding may offer HIV-1 infected women in developing countries an affordable, culturally acceptable, and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding.” [Medline abstract]
As Dr Pillay points out, “societal pressure is to breastfeed so it’s an easier choice to make.”
According to Prof Daniel Halperin of the International Centre for HIV/AIDS Research and Training, “the South African study raises the possibility of an entirely new approach to the prevention of post-natal HIV infection.
“Given the rush to include bottle-feeding recommendations as part of various global efforts to control maternal-child HIV transmission, [this study] may have important policy implications, especially if confirmed in future studies.”
Of concern is the fact that most South African women still believe that it is best to give mixed feed to their babies, even within the first month of life. According to a recent survey conducted by the Medical Research Council, only 10% of infants in South Africa are exclusively breastfed in the first three months of life.
Exclusive breastfeeding is indisputably the best source of nutrition for infants. Combining mother’s milk with other feeding during the first few months of life can have a detrimental effect on all babies, regardless of whether the mother is HIV infected or not.
Rachel Jewkes, Division Head of the Women’s Health Division of CERSA, Medical Research Council, sounds a final note of caution, “The Durban study suggests a change in policy but first, it’s important to replicate the findings. Also, given the social and practical pressures on mothers to mixed feed, it may be dangerous to tell HIV infected mothers that it’s okay to breastfeed rather than bottle-feed, as this may result in more mixed feeding rather than less.” -Health-e News.
[published: Sunday Times 3/10/99]