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"Breastfeeding in HIV"
The
Star (www.thestar.com.my)
(04/12/05)
AS we mark World AIDS Day, it is sobering to contemplate that the greatest
burden of the Human Immunodeficiency Virus (HIV) is borne by the developing
world, where more than 600,000 children are infected annually and where
breastfeeding is the norm.
Two decades have passed since the discovery that HIV could be passed through
breast milk. The fear of postnatal transmission through breastfeeding,
previously estimated to infect 14 – 16% of HIV-exposed babies, to cause
one-third of all vertical transmission, has undermined confidence in
breastfeeding in areas of the world where babies most need its continuing
protection and where cessation of breastfeeding substantially increases
infant mortality from other diseases and malnutrition.
Current global infant feeding guidelines recommend that babies should be
exclusively breastfed for the first six months of life, and should continue
to be partially breastfed with the addition of appropriate complementary
foods for up to two years or beyond.
Worldwide, over 10 million babies die every year, 60% of them from
malnutrition and infections such as pneumonia and diarrhoea, against which
breastfeeding is protective. This toll could be prevented if more mothers
were assisted to optimally breastfeed their babies.
2005 saw publication of research results which modify our understanding of
postnatal HIV transmission. In Zimbabwe untreated mothers and babies were
followed up for 18 months, giving careful attention to how babies were fed
at various periods of time after birth.
Importantly, this research distinguished babies who received other foods and
liquids besides breast milk from those being fed for three months on breast
milk alone.
Only 1% of babies breast fed exclusively for three months were found to have
been infected between six weeks and six months of age.
At eighteen months, the death rate for exclusively breastfed infants,
whether or not HIV-infected, was less than half that of the partially
breastfed infants.
Exclusive breastfeeding rates increased dramatically, related to how often
mothers were exposed to information about its benefits.
Growing recognition of the importance of breastfeeding has led to new
studies designed to reduce the risk of postnatal HIV transmission by
providing antiretroviral therapy to mothers and/or their babies while
breastfeeding is maintained.
Underscoring the importance of this line of enquiry, research in 2005 also
showed that uninfected and orphaned babies of infected mothers have a far
greater risk of morbidity and mortality than the babies of healthy mothers.
This provides additional endorsement, if any were needed, that the
well-being of both mother and baby are inseparably connected, and that
programmes designed only to reduce paediatric HIV while ignoring the health
needs of the mother are indefensible.
2005 marks a turning point in our ability to reduce the risk of HIV during
breastfeeding even as the consequences of inadequate or no breastfeeding
continue to be documented.
Babies need their mothers; treatment designed to prolong the lives of
HIV-infected women should be provided in developing as well as in developed
countries.
Approximately 90% of HIV-exposed babies are born into settings where, for
the most part, breast milk substitutes are neither acceptable, feasible,
affordable, sustainable nor safe and where mortality from their use is
likely to increase infant mortality four-fold.
About 90% of HIV+ mothers do not know that they carry the virus. Of the
remaining 10%, over 98% would not infect their babies postnatally if they
were assisted to exclusively breastfeed, and the life expectancy of babies
born already infected would be doubled.
The child survival imperative is clear; exclusive breastfeeding is one of
the most powerful and feasible antidotes to infant mortality available; the
time is right to renew support for optimal breastfeeding for all women and
their young children, in order to reduce postnatal HIV transmission and to
keep the majority of babies born in HIV endemic countries alive and healthy.
Note: This is a press release issued by the World Alliance for Breastfeeding
Action.
Notes: STF -: World AIDS Day fell on Dec 1, 2005. We look at new studies
that point to the reduced risk of postnatal HIV transmission during
breastfeeding.
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