I actually knew a Ministry of Health Official from China, who started working on their AIDS prevention campaign back in the early 1990s. From the inside information he told me even back then and subsequent news reports since, I regret to say that HIV is actually far more prevalent than the government will ever admit. It is a huge problem and I pains me to say that I think it would be wise to let adoptive mothers know that this is something that they should be checking for. I'm recovering from a post IBCLE exam slump (yes, I passed!!!) compounded by becoming a class mom which is far more work than I expected. But I have starting to recover and returning to LACTNET. I appreciated some of the recent discussions about HIV and breastfeeding which helped me greatly when I read, to my disgust, a posting on the other listserv I frequent that is for nongovernmental organizations that work on international health and development projects. A recent message went out about HIV and breastfeeding that I had to read it three times before I realized it was not written by a formula company representative, but actually by a public health nutritionist who hadn't really done her homework. The message claimed that providing full information to mothers would help them make informed decisions about infant feeding choices, yet the message did not include any information about comparisons of HIV-free survival, only postnatal transmission rates. It ONLY presented the option replacement feeding with formula after 3-6 months of exclusive breastfeeding. There was no mention of the fact that wet nursing is a far more culturally acceptable option in developing countries than developed countries. So, I had to point out that formula is actually the fourth choice after exclusive breastfeeding. Then the message listed shortening the duration of breastfeeding (and later abrupt weaning) with no discussion whatsoever of how to set up a program to do so and the incredible problems associated with abrupt weaning that may actually lead to greater transmission of HIV. Let alone what every self- respecting nutritionist knows about one of the worst forms of malnutrition, kwashiorkor, which was named after the Ghanian practice of abrupt weaning. The mesage also twisted around the research on thrush in an infant's mouth being related to greater HIV transmission and suggested that oral thrush be used as an indicator for preventive messures. One of the most common mistakes in public health is to look at a risk factor and then try to use it for prevention when the appearance of the risk factor is far too late for any form of prevention. So, I tried to explain about how oral thrush is a late sign of a candidiasis infection. I wish I could say that my former colleagues in international public health were on top of this issue, but I actually did review a proposal a few years back where the one and only intervention was to discourage HIV postive women from breastfeeding. They had none of the treatments for preventing transmission during pregnancy nor any breastfeeding promotion activities for the HIV negative population. The group proposing this intervention also had no knowledge of the fact that the stigma of being HIV postive in Uganda (and bottle feeding is a definite clue) could lead to a woman being stoned to death. Anyone interested in educating the international public health community further please feel free to email me privately. Susan Burger *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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