Please note.  This article was in the Wall Street Journal, Wednesday, July
12, 2000.

My comments:
The fact that drug manufacturers also make formula must make it very tempting
for the companies to say, "We won't give you these cheap or free drugs unless
you promise to require mothers to formula-feed."  And where is the funding
for more research to follow up on Coutsoudis' finding that exclusively
breastfed South African babies developed HIV infection at a rate not
significantly different from babies who had no breastfeeding?

This is SUCH a thorny situation.

Re "...the vast majority of whom probably contracted the virus from their
mothers..."
I have heard that one of our African colleagues refers to what is commonly
called "mother-to-child-transmission" of HIV as
"father-to-child-transmission."  Let's all be clear on where the HIV virus
comes from that is infecting so many African children.

When I was in Geneva, I heard Peter Piot, head of UNAIDS, say in addressing a
plenary meeting of the ILO Conference, "it is male sexual behavior that
drives this epidemic."  At last someone is saying that the Emperor has no
clothes.  Of course we want to save babies, but how about keeping women from
being infected in the first place---that would save babies AND their mothers!
 People see babies as the innocent victims of this epidemic.  Babies haven't
done anything wrong, yet they get this rotten disease!  Well, most women in
Africa who get AIDS haven't done anything "wrong" either, unless you think
heterosexual relations are "wrong".

Chris Mulford, RN, IBCLC
Swarthmore  PA  USA

Officials at AIDS Meeting Debate Drugs' Effects on Unborn Children

By MICHAEL WALDHOLZ

Staff Reporter of THE WALL STREET JOURNAL

DURBAN, South Africa -- An emotionally charged debate has erupted here
regarding one of the most pressing concerns of the fast-spreading AIDS
pandemic: whether an easy-to-use and inexpensive drug therapy can prevent
millions of pregnant women from passing to their unborn children the deadly
virus they carry.

"The scientific evidence we now have is dramatic. We can, without any doubt,
block transmission of the virus from infected mothers to their children,"
said Glenda Gray, an AIDS-research doctor at Baragwanath Hospital in
Johannesburg. "The only question to me is why aren't we doing everything we
can" to do it?

That question has become one of the major issues to arise among the estimated
10,000 researchers, doctors, health activists, and government and
public-health officials attending the 13th International AIDS Conference here
this week. Central to the clash of opinions being expressed at formal
meetings and in hallway encounters is a dispute that has raged on the African
continent for decades as to whether newborn babies should be fed infant
formula or breast milk alone.

"Resolving this issue is crucial if we are going to promote, as we should,
the aggressive use of drugs to block mother-to-child transmission," said
Helene Gayle, who runs the HIV/AIDS-prevention program at the U.S. Centers
for Disease Control in Atlanta. The World Health Organization estimates that
one million children in sub-Saharan Africa under age 15 are living with
HIV/AIDS, the vast majority of whom probably contracted the virus from their
mothers.

Studies Fan the Flames

Several recent clinical studies, the results of which have been leaking since
the meeting began Sunday, are expected to show that a dose of one of several
anti-AIDS drugs given to infected pregnant women during labor, and then to
their newborn children immediately after delivery, can significantly reduce
at birth the rate of transmission of HIV, the virus that causes AIDS, to
children.

But data from several of the studies, which will be presented formally
Thursday, suggest the benefits of the drug therapy can be significantly
undermined in some instances if the mothers breast-feed their babies and pass
on the virus through infected breast milk. Since the vast majority of women
in Africa, especially in poor rural areas, breast-feed, some public-health
experts are saying the drug therapy is less effective than had been hoped.

But others here are strongly urging, for the first time, that women on the
continent be encouraged to bottle-feed instead, a policy that is counter to
deeply entrenched attitudes and behavior here. Indeed, the view that infected
mothers in developing nations such as Africa and India should choose bottles
instead of the breast is resurrecting a 30-year old, intensely passionate
argument about the health benefits of nursing versus bottle-feeding.

Formula for Controversy

In the 1970s, public-health advocates fought a ferocious battle with Nestle
SA and other infant-formula makers about their marketing tactics in the
developing world that, many people charged, induced poor women to rely
heavily on infant-formula products. These critics argued that the use of the
infant formula posed a threat to babies because many women used contaminated
water or diluted the formula to save money. As a result, prior to the AIDS
epidemic, promoting the natural benefits of breast milk had become a major
public-health campaign in many nations.

But the surge of children born with HIV is forcing health experts to revisit
the issue. The outcome of the debate is important because many nations, as
well as wealthy donor foundations, are trying to decide if they should fund
numerous programs to provide the transmission-blocking drugs regularly to
women as they are about to give birth.

The Elizabeth Glaser Pediatric AIDS Foundation is expected to announce here
Wednesday that it received $15 million from the Bill and Melinda Gates
Foundation to support the use of the drugs. Boehringer-Ingelheim Gmbh, the
German drug maker, said last week it will donate its drug Viramune to clinics
and other programs that can demonstrate need.

One of the studies to be reported later this week is expected to show that a
single Viramune pill given to a mother before delivery, and a single dose
given to babies a week after birth, can drastically reduce transmission of
the virus. The study is expected to fuel the breast-bottle dispute because
many of the test subjects in Johannesburg used infant formula.

Special Session Called

"The evidence strongly suggests we should now be aggressively promoting the
use of infant formula for infected mothers who have been treated" with the
anti-AIDS drugs, said Stephen Spector, a University of California, San Diego,
researcher, at a special debate on the issue held here.

But Hoosen M. Coovadia, chief of pediatrics at King Edward Hospital in
Durban, said many women won't bottle-feed because they can't afford formula.
Others refuse to bottle-feed out of fear that they would be stigmatized by
using infant formula since it could identify them as being infected with HIV.

Dr. Coovadia said he thinks one solution may be to encourage infected women
to breast-feed exclusively for at least six months after giving birth. That
is because another study presented this week suggested that babies given
breast milk exclusively from their infected mothers didn't get infected at
high rates. Researchers said they believe that the natural immunities
contained in breast milk may protect children. Others here argued, however,
that those results are far from conclusive.

"Right now I think we should use the drugs and mothers should be given a
choice," he said. "Where it makes sense for mothers to bottle-feed, that's
what they should do. And if breast-feeding is what is the norm, then we
should encourage its exclusive use."

Write to Michael Waldholz at [log in to unmask]

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