My name is Darci Emerson and I am a nursing student at the University of
North Dakota College of Nursing. In recent years there has been a great
deal of concern with the possibility of transmission of HIV from mother to
child through breastfeeding. It raises difficult issues in that
breastfeeding is the best source of nutrition for the infant and it's good
for mothers, but poses a huge risk of the infant acquiring HIV from it's
HIV-infected mother. One mother in the state of Oregon found out just how
big an issue this can be. Because she was HIV positive and insisted on
breastfeeding her newborn infant, state officials were called in by the
hospital staff and later before a judge, she was ordered not to breastfeed
her child (McCarthy, 1999).
In Malawi, a study was conducted to understand the risk of HIV
transmission through breastfeeding. A total of 672 infants born to
HIV-infected women who were HIV-negative at birth participated in the
study. Results showed 47 infants became HIV-infected while breastfeeding
but none after breastfeeding had stopped. It also suggested that the risk
of HIV infection is highest in the early months of breastfeeding (Miotti,
Taha, Kumwenda, et.al, 1999). So with research showing that HIV is present
in breast milk, how is best to advise HIV-infected women to feed their
baby? "Despite the protective properties found in human milk, through
research, the World Health Organization (WHO), UNICEF, the Centers for
Disease Control (CDC), and the American Academy of Pediatrics Task Force on
Pediatric AIDS (AAP), have released similar recommendations stating that in
the United States and other countries where safe nutrition other than
breastfeeding is available, HIV-infected mothers should be advised against
breastfeeding their infants to avoid that possible route of HIV infection"
(Miner, 1998).
But what are the choices for mothers who live in areas where alternative
infant feeding is not safe, not acceptable, or not affordable? In some
circumstances, the risk of HIV by breastfeeding may be low compared to the
risk of other infections or diarrhea that a baby is exposed to if it is not
breastfed. In a recent study by the WI-IO Collaborative Study Team, the
risk of dying from infectious diseases in the first two months of life in
developing countries showed to be six times greater in infants who are not
breastfed than in those who are (Latham, Preble, Zwi, & Soderlund, 1999).
Some relatively new research suggests exclusive breastfeeding, the sole
consumption of breast milk, may pose less of a risk in contracting HIV than
the more common practice of mixed feeding, breast milk along with water and
other fluids and foods (Smith & Kuhn, 2000). Some of the biologic
mechanisms proposed to explain the protective effect of exclusive
breastfeeding for gastrointestinal, respiratory, and atopic diseases may be
relevant to the HIV transmission, but should health workers be promoting
exclusive breastfeeding? Further research needs to be done.
So then, we come back to the question on should a mother with HIV
breastfeed her infant and what advise can we give her? In 1997, the Joint
United Nations Programme on HIV/AIDS (UNAIDS) issued an interim statement
for establishing a policy on HIV and infant feeding. Four elements were
covered, including supporting breastfeeding as a general principle,
improving access to HIV counseling and testing, ensuring informed choice,
and preventing commercial pressures for artificial feeding (World Health
Organization, 1997). Only a year later, the UN shifted its position on
breastfeeding and discouraged all HIV positive women from breastfeeding
their babies (Kent, 1999).
Because there is such a serious debate and strong opinions concerning how
to feed children born to HIV-infected mothers, parents are left confused on
what is best. If they decide to breastfeed their infant, there's the risk
of giving the virus to her baby, and if she chooses to use formula, there's
the risk of her baby getting diarrhea and other life-threatening illnesses.
What can be done to decrease vertical transmission of HIV without having to
sacrifice giving newborns the best possible milk, breast milk? Does anyone
have any personal experiences and opinions concerning this topic? Any
response is appreciated. Thank you. Darci Emerson, Student Nurse,
University of North Dakota.
Kent, G. (1999, May). HIV and breastfeeding. Mothering, (1) 64.
Retrieved February 6, 2001 from Electronic Library database (Health
Reference Center) on the World Wide Web:
http://web7.infotrac.galegroup.com/itw
Latham, M., Preble, A., Zwi, K. & Soderlund, N. (2000, June). Appropriate
feeding methods for infants of HIV infected mothers in sub-Saharan Africa/
Commentary. British Medical Journal, 320 (7250), 1656-1660. Retrieved
February 12, 2001 from Electronic Library database (Proquest) on the World
Wide Web: http://proquest.umi.com/pqdweb
McCarthy, M. (1999, May). Judge in USA bars breastfeeding by HIV-infected
mother. The Lancet, 353 (9163), 1506. Retrieved February 12, 2001 from
Electronic Library database (Proquest) on the World Wide Web:
http://proquest.umi.com/pqdweb
Miner, M. (1998). A study of breastfeeding and HIV. Special Delivery, 21
(4), 2. Retrieved from Electronic Library database (Health Reference
Center) on the World Wide Web: http://web7.infotrac.galegroup.com/itw
Miotti, P., Taha, T., Kumwenda, N., Broadhead, R., Mtimavalye, L., Hoeven,
L., Chiphangwi, J., Liomba, G., & Biggar, R. (1999, Aug.). HIV
transmission through breastfeeding: A study in Malawi. The Journal of the
American Medical Association, 282, 744-749. Retrieved February 6, 2001 from
the World Wide Web:
http://www.ama-assn.org/special/hiv/library/readroom/vol_282/joc81538.htm
Smith, M. & Kuhn, L. (2000, Nov.). Exclusive breast-feeding: Does it have
the potential to reduce breast-feeding transmission of HIV-1? Nutrition
Reviews, 58 (11), 333-340. Retrieved February 12, 2001 from Electronic
Library database (Proquest) on the World Wide Web:
http://proquest.umi.com/pqdweb
World Health Organization. (1997). HIV and infant feeding: an interim
statement. World Health, 50 (2), 30. Retrieved February 6, 2001 from
Electronic Library database (Health Reference Center) on the World Wide
Web: http://web7.infotrac.galegroup.com/itw
***********************************************
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
|
