The recent release of UNICEF's statement on HIV and infant feeding was
certainly somewhat of a disappointment. If we look at Dr. G. Mukasa's (Uganda)
worse case scenario description, he looks at HIV vertical transmission as
follows:

1. 80 out of 100 pregnant women will be HIV free and have 80 uninfected
children
2. of the 20 women with HIV, 26% of 5.2 will have infected children, the other
74% or 14.8 will have uninfected children
3. in this scenario 5 out of 100 will be HIV infected
4. supposing that 20% of the overall transmission is through breastmilk, this
would mean that 20% of the 5 children, one child, would actually become
infected through breastfeeding

Now the problem comes of course in identifying those infants with their own
viral load and those with maternal antibodies to HIV. Putting this aside for a
minute, we are still left with how to feed all of these infants and I am left
with the following questions:

1. why is the safe provision of human milk to these babies being
systematically ignored? Where are the feasibility studies and cost estimates
of HIV positive mothers having their own milk heat treated for use with their
own infant? If activities are being undertaken to provide powdered formula
that must be mixed with local water, fed by bottle and artificial nipple,
cleaned with more water and soap, and monitored for safety and proper mixing
and feeding, and provided for a year--how is this more expensive than heat
treating human milk? Or do the formula companies intend on donating this
formula? Will any of this formula be provided in liquid, ready-to-feed form
with one-use throw away bottles? (the most expensive form). If the formula is
donated, someone still has to pay for it. Ultimately this will be all the
other bottle-feeding mothers of the world who will pay more money as the
retail price of formula is raised to offset this "humanitarian" gesture.

I certainly hope that this does not backfire on us all and wind up with other
mothers in the community choosing not to breastfeed because they fear their
milk will harm their babies. UNICEF's partnership with infant formula
companies is distressing especially in light of the ommission in their
statement of any possibility of providing safe human milk to these infants.

Marsha Walker
Weston, MA