I actually knew a Ministry of Health Official from China, who started
working on their AIDS prevention campaign back in the early 1990s.  From
the inside information he told me even back then and subsequent news
reports since, I regret to say that HIV is actually far more prevalent than
the government will ever admit.  It is a huge problem and I pains me to say
that I think it would be wise to let adoptive mothers know that this is
something that they should be checking for.

I'm recovering from a post IBCLE exam slump (yes, I passed!!!) compounded
by becoming a class mom which is far more work than I expected.  But I have
starting to recover and returning to LACTNET.

I appreciated some of the recent discussions about HIV and breastfeeding
which helped me greatly when I read, to my disgust, a posting on the other
listserv I frequent that is for nongovernmental organizations that work on
international health and development projects.  A recent message went out
about HIV and breastfeeding that I had to read it three times before I
realized it was not written by a formula company representative, but
actually by a public health nutritionist who hadn't really done her
homework.

The message claimed that providing full information to mothers would help
them make informed decisions about infant feeding choices, yet the message
did not include any information about comparisons of HIV-free survival,
only postnatal transmission rates.  It ONLY presented the option
replacement feeding with formula after 3-6 months of exclusive
breastfeeding. There was no mention of the fact that wet nursing is a far
more culturally acceptable option in developing countries than developed
countries. So, I had to point out that formula is actually the fourth
choice after exclusive breastfeeding.

Then the message listed shortening the duration of breastfeeding (and later
abrupt weaning) with no discussion whatsoever of how to set up a program to
do so and the incredible problems associated with abrupt weaning that may
actually lead to greater transmission of HIV.  Let alone what every self-
respecting nutritionist knows about one of the worst forms of malnutrition,
kwashiorkor, which was named after the Ghanian practice of abrupt weaning.

The mesage also twisted around the research on thrush in an infant's mouth
being related to greater HIV transmission and suggested that oral thrush be
used as an indicator for preventive messures.  One of the most common
mistakes in public health is to look at a risk factor and then try to use
it for prevention when the appearance of the risk factor is far too late
for any form of prevention.  So, I tried to explain about how oral thrush
is a late sign of a candidiasis infection.

I wish I could say that my former colleagues in international public health
were on top of this issue, but I actually did review a proposal a few years
back where the one and only intervention was to discourage HIV postive
women from breastfeeding.  They had none of the treatments for preventing
transmission during pregnancy nor any breastfeeding promotion activities
for the HIV negative population.  The group proposing this intervention
also had no knowledge of the fact that the stigma of being HIV postive in
Uganda (and bottle feeding is a definite clue) could lead to a woman being
stoned to death.

Anyone interested in educating the international public health community
further please feel free to email me privately.

Susan Burger

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

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