Hello Leila and Lactnetters,

Your post caught my eye, Leila.  I wish more people were concerned as
you are about the ethical dilemma of formula companies involving
themselves in the care of mothers who are HIV+.  Since I have not posted
in ages, I will briefly introduce myself:  I am Kendall Cox, an LLLL,
IBCLC and a BFing Coordinator for WIC here in the Mississippi Delta.

I just recently returned from a trip to South Africa with a
breastfeeding delegation.  We met with many wonderful bfing advocates in
and around Jo'burg as well as Cape Town.  Our delegation leader was
Marian Tompson and our group was made up of LLLLs, IBCLCs, Marian's
daughter, a doctor and her mom and a LLL Leader Applicant and her
toddler.

Our trip was unbelievable in many ways:  Meeting LLLLs, PCs and LCs,
their hospitality and excitement, sharing our frustrations and
successes. For me, it was a return to a part of the world I think of as
a second home since I had lived in Botswana from 88-92 and felt I'd
learned much about mothering and breastfeeding during that time.  At one
point during our trip I was able to journey back up to Kanye, Botswana,
the village where I'd taught, and visit with many old friends and
students.

HIV and AIDS discussion dominated a large part of our trip.  Our first
visit was to Baragwanth Hospital where Dr. Glenda Gray is conducting HIV
research.  I know some of you are familiar with her name.  She is
recommending a one month AZT regimen for women who are HIV+ in their
eighth month of pregnancy and subsidized formula as a way to lower the
risk of HIV transmission.  (Last I heard, Deputy President Mbeki said
that they had decided to put their available funds into public awareness
and prevention rather than AZT).

I do not doubt that a solution or solutions to HIV/AIDS/BFing will be
found.  I also do not doubt that formula will *probably* be viewed by
many as part of that solution, if not *the* solution.  But here is the
need for concern:  the solution will not only have to fit the country,
but the culture, the community, and, ultimately, the mother and baby
involved.  Otherwise we may kill more babies with our solution than
would have died had we taken another path.  We visited several
communities (Alexandra, for example) where I believe this would be the
case.

I don't mean to suggest we should ignore what is going on and pretend it
isn't happening.  More research needs to be done before we go full-steam
ahead with any sort of plan.  What some are worried about is that
governments will only look at one side of the issue, whoever happens to
have the ear of WHO/UNICEF or the most funding and take their research
as unquestionable gospel and then take their findings and apply it
across the board, making it their policy, whether it fits their
community or not.

That's one thing we have no idea of knowing, isn't it?  If we start
advocating formula feeding as the solution to HIV in communities where
bfing is the culture, what consequences will it have for the majority of
mothers and babies who are HIV-?  How will we control this bandwagon if
we all jump on before we check the brakes?  What is to keep formula
companies from saying, "Well, if you haven't been tested for HIV, you
don't know your status.  Maybe everyone should bottlefeed formula, just
as a precaution.  You never know...."  We have no way of knowing the
ramifications in advance but if what has happened to breastfeeding in
the US as formula use has proliferated is any indication, we better
think long and hard before letting formula companies take a seat at the
head of the discussion table.

Leila, what you said about commitment to the bottom line supplanting
care is unfortunately the case.  Profit will almost always win out over
human need in today's world and the HIV/formula situation is no
different.  Unless... unless we get people who are not motivated by
profit but by protecting mothers and babies, people who have nothing to
gain from the outcome, to look at all the possibilities before choosing
which one/ones might work for their community.  In other words, we can't
take a solution from here and export it anywhere else without
questioning first whether it will really work in the other culture.

I hope to post more on our delegation's South Africa visit and the
amazing people we met--but I'll save that for my next post!

Stay well,
Kendall Cox
Greenville, MS