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Subject:
From:
Magda Sachs <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 1 Dec 2000 15:46:51 -0000
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From The Guardian -- seious UK daily paper

Breastfeeding may guard against HIV
Sarah Boseley, health editor
Guardian

Friday December 1, 2000


Breastfeeding may be the best way for mothers who are HIV positive to
safeguard their babies from the infection, especially in the developing
world, according to scientists whose work suggests that the conventional
wisdom is badly flawed.

Virtually all women in the west who are HIV positive give their babies
bottled formula milk, which experts have maintained is the best way to
protect them from becoming infected with the virus.

But this advice, backed by the World Health Organisation, has been hard to
follow for women in developing countries, who may not be able to afford
formula milk and who risk revealing their HIV status to the entire community
if they do not breastfeed. Most worryingly, the shortage of clean water in
many areas means that bottles can give babies other serious infections.

Pilot studies by a well-respected South African paediatrician, Jerry
Coovadia, and his colleague, Anna Coutsoudis, show that women who
exclusively breastfeed their babies run little or no risk of transmitting
HIV to them. Their work, in a rural area of KwaZulu Natal, two hours from
Durban, where only 5% have clean water and where cholera outbreaks are
common, shows that exclusive breastfeeding is as safe as exclusive bottle
feeding in terms of HIV transmission, and that considered in the context of
the general health of the babies, it is better for them.

A three-year project involving 2,000 women is likely to be launched next
year, funded by the Wellcome Trust, to settle a fraught issue that is vital
for the future of HIV/Aids management in the developing world.

"If more extensive research proves that exclusive breastfeeding is no more
risky than formula feeding, this has profound implications for preventing
the spread of HIV in Africa and the developing world," said Prof Coovadia.

"As well as the many advantages of exclusive breastfeeding - its cultural
appropriateness, simplicity and well-documented health benefits - another
major plus is that breast milk is free."

His work has shown that the least safe method of feeding is the one most
often practised in Africa - mixed breast and formula feeding. The scientists
believe that contaminated water in the bottles may damage the baby's gut,
allowing any HIV virus in the milk, which might pass through harmlessly, to
enter the infant's system.

The scientists published an early report of their findings in the Lancet
last year. Their as yet unpublished follow-up of the children at 15 months
old shows that the exclusively breastfed babies continue to thrive and are
HIV free.

"It is a unique observation by Coovadia and Coutsoudis that if you
exclusively breastfeed, with no additional feeds including water, you have
minimal or no risk of transmitting HIV," said Michael Bennish, director of
the Wellcome Trust's Africa centre, where the study is based. "Not everyone
accepts that."

If breastfeeding is found to be the safest option for the developing world,
one of the last objections to the use of drugs like nevirapine to prevent
mothers transmitting the HIV virus to their babies during childbirth will
have been removed. It has been argued that there is no point giving women
and their infants the tablets, which are cheap and in some places have been
donated free, because the babies will inevitably be infected through their
mothers' milk unless an expensive programme to provide formula and clean
water can be put in place as well.

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