Julie, thanks for sending along details of the 
Huffington Post article on prevention of 
mother-to-child transmission of HIV.  It's good 
to see this topic is being given exposure in this 
mainstream publication.  And great to see that up 
to date guidance is reported and even a pic of a 
baby breastfeeding, as you mention.  Yes, the 
importance of maternal antiretroviral therapy 
from early pregnancy is to to reduce her viral 
load to undetectable so that transmission during 
birth and during breastfeeding can be reduced to 
0-1%.  For this to happen, there has indeed been 
recognition that getting the father on board 
means that the mother can take her meds openly 
and that he can help defend the need for the baby 
to be exclusively breastfed against input from 
the grandmothers, aunties and other family 
members who traditionally control infant feeding 
and believe that little sips of water and little 
mouthfuls of porridge are necessary to the baby's health.

Interestingly, the focus on fathers is nothing 
new.  In the past when avoidance of postnatal 
transmission hinged on avoidance of breastfeeding 
(before it was found that formula killed more 
babies than HIV) the focus on the need for 
"couples counselling" was so that the father 
would be more accepting of "replacement-feeding" 
(formula-feeding)..... likewise the need for 
"community support" was promoted for the same reason.

There was only one small mis-reporting that I 
could see in the article, and that's near the 
end, but I think it's important to identify 
it.  It's implied that an HIV+ mother would stop 
taking her antiretroviral meds when breastfeeding 
ends.  The most up to date WHO recommendation 
(WHO 2013, Consolidated guidelines on the use of 
antiretroviral drugs for treating and preventing 
HIV infection: Recommendations for a public 
health approach, (available 
at 
<http://www.who.int/hiv/pub/guidelines/arv2013/download/en/index.html>http://www.who.int/hiv/pub/guidelines/arv2013/download/en/index.html 
) is that all women diagnosed as HIV+ should 
receive full antiretroviral therapy from 
diagnosis (hopefully before or during early 
pregnancy) and that this should be continued for 
life.  This recommendation makes so much sense - 
to protect not only against mother to child 
transmission, but also to constitute 
treatment-as-prevention against further sexual 
transmission and protect future children.  Not 
least, it improves the mother's health and allows 
her to live a normal lifespan, rather than 
limiting treatment to the time of pregnancy and 
breastfeeding as used to happen - in effect 
effectively treating her as just an incubator of uninfected children.

Pamela Morrison IBCLC
Rustington, England
-----------------------------------------------
Date:    Sun, 15 Jun 2014 17:19:48 -0700
From:    the juliest person you know <[log in to unmask]>
Subject: HIV, pregnancy, breastfeeding

http://www.huffingtonpost.com/2014/06/15/hiv-couple-kids_n_5492198.html?ncid=txtlnkusaolp00000592 
The article discusses the importance of the 
woman's significant other being involved in HIV 
testing and treatment in terms of not passing 
along the virus to their children.  While the 
article does not mention breastfeeding, in the 
first picture, the mother is clearly 
breastfeeding the youngest child.  Julie Tardos 
==== Gold were as good as twenty orators, and 
will, no doubt, tempt him to anything. Richard III, act IV, scene II


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