>I think it wd be entirely possible for a mom with HIV to
breastfeed "in the closet", regardless of how we as health workers, or they
as parents, interpret the available research. Or how we counsel or advise
them.<

The mother here in the UK who was taken to court by the authorities in
Camden chose to breastfeed.  She had also had a privat midwife to avoid the
hospital system.  However, her records caught up with her, which is when the
court action began.  I think a woman diagnosed as HIV+ will be at risk of
action every time she meets a new health professional.

I also think that women who want to breastfeed can do so, but may be in
situations where they are forced to give some bottles in front of health
workers -- essentially, they will be forced to mixed feed.  Aside from all
the reasons any mother might wish to exclusively breastfeed her baby, the
Coutsoudis findings indicate that mixed breast and any other feeding could
result in the highest risk of hiv transmission.

In a story in a UK magazine from Positively Women last year I read a story
of a woman from Africa who had her third baby here in the UK.  She bottlefed
and told almost no one.  Her realtives, including her children (who might
inadvertently tell others), thought she breastfed.  She fed EVERY TIME in
private.  She had a photo taken of her with her baby at her naked breast, to
help with this deception.  This is the level of secrecy keeping infant
feeding decisions to yourself might involve.  Is the level of stigma an
African woman might experience if she bottlefeeds (implying HIV) similar to
that a white English mother might experience if she is hiv+ and berastfeeds?
I don't know.

Some interesting qualitative work of breastfeeding by Elizabeth Murphy
suggests that women are highly accountable for their infant feeding
decisions -- this resonated with me when I read her work.  How much more
accountable are HIV+ women?

Magda Sachs
Breastfeeding Supporter, BfN, UK

Murphy,E  (1999)  'Breast is best': Infant feeding decisions and maternal
deviance  Sociology of Health and Illness 21:2 187-208

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