>My opinion is =
that although there is evidence connecting a higher rate of HIV-1 =
transmission to infants through breast milk, it may be more beneficial =
to advise the mother to breast feed if they are in a low-resource =
environment. <

Kristen, just to pick up on one point in your post, I would like to point
out that the WHO training course on HIV and Infant Feeding says that women
should be counselled, and that counselling is different from advising.
[Yes, Pamela, I know something of the pitfalls of counselling in a culture
where this is an alien concept, but the WHO applies to all settings,
including resource poor women in developed countries.]  I have had words
with the UK Royal College of Midwives becasue their official policy is to
advise women [in this case, to avoid breastfeeding].   It seemed that they
could not understand that there is a difference in approach between advising
and counselling.

Also, you ask about safe alternatives.  I think in this context (as in so
many others) we have to be talking about relative safety and maximising or
minimising risks as best we know how.  We come unstuck if we think anything
is free of all risk in regard to hiv transmission, or, as you rightly point
out, overall child health.

In the UK, as I believe in the US, when I have spoken to people who have
been supporting a mother who is making infant feeding choices, I feel
ethically compelled to mention that, while I feel that exclusive
breastfeeding is a rational choice, the social services may disagree and the
hiv+ mother who chooses this may be at risk of court action.  Kathleen Tyson
lost custody of her son, and control over her choices, other women have lost
more.

Magda Sachs
Breastfeeding Supporter, BfN, UK

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html