It was revealed that besides the most obvious route of mother-to-child transmission of HIV, breastfeeding of babies by a non-biological HIV positive caregiver was the single most important factor associated with HIV infection in children.

Released in Cape Town this week, the Human Sciences Research Council and Nelson Mandela report, ‘€œHIV risk exposure among young children‘€ was commissioned after a previous national study found unusually high rates of infection in the 2-14 age group.

‘€œAfter seeing the results, Nelson Mandela personally said that he wanted an urgent investigation,’€ said Dr Olive Shisana, Executive Director of the HSRC and co-principal investigator of the study.

Shisana said it was worrying that 86% of the mothers breastfed their children beyond six months and 60% longer than one year.

Researchers found that when mothers had died, were sick or when they had to work away from their children, other women sometimes breastfed the babies.

Of the 3 530 mother-child pairs who participated in the study, 29,1% of the mothers were HIV positive and 14,8% of the children.

The overwhelming majority of children who were HIV positive had HIV positive mothers. Only 7 children (1,4%) had HIV negative mothers.

Shisana said this showed that at least 1,4% of the children could possibly have been infected via nonsocomial (healthcare acquired) transmission. She added that the only factors that seemed to set these children apart was the fact that they were from two of the same districts, that they could have been breastfed by a non-biological mother, that they had visited a dentist and that they could have received their milk via the milk room in the hospital.

The study found that 24,6% of dental instruments ready to be used on patient’€™s mouths and gums and 24% of instruments destined to be used for maternity and paediatric patients were contaminated with invisible blood. A startling 17,5% has visible blood.

Researchers also found that babies could be exposed to HIV contaminated milk ‘€“ 29,7% of the sample of breast milk destined for feeding babies tested positive for HIV, and six samples contained high viral load.

Only 13 of the 25 participating hospitals had dedicated milk preparation areas. A major problem was that the bottles were labeled by cot numbers rather than the name of the baby and rarely checked, allowing milk to be fed to the wrong baby if the cot was moved.

Shisana said they had briefed the National Department of Health on their findings and she urged them to formulate policies on infection control and to revisit the policy on breastfeeding.

John Samuel, CEO of the Nelson Mandela Foundation said the challenge lay in translating the findings into policymaking.

‘€œOtherwise it becomes nice information contained within the pages of a report. (The Department of Health know that) children do not have to die. It is high time we acted on this,’€ he added.