Dear all
I've just found out that the British HIV Association and Children's
HIV Association have issued a Position Statement on HIV and infant
feeding, which will soon be published in HIV Medicine. Meanwhile,
you can access
it at
<http://www.bhiva.org/documents/Publications/InfantFeeding10.pdf>http://www.bhiva.org/documents/Publications/InfantFeeding10.pdf
I'm pretty thrilled with this document. Some of us in the UK have
worked quite hard on this, including responding to the BHIVA
invitation to submit comments to a draft last May and I think we can
be well pleased with the outcome. It's not perfect, and it does omit
specific mention of heat-treatment of expressed breastmilk, although
that could be understood to be a form of breastmilk-feeding. But my
overall first impression of this quite revolutionary document is that it:
a) continues to clearly recommend formula-feeding for HIV+ mothers, but ....
b) opens the door to mothers who really want to breastfeed being
supported to do so, and ...
c) eliminates all possibility of coersion by social services or child
protection agency personnel threatening removal of the baby from the
mother (at birth or afterwards) if she wants to consider, or actually
decides to breastfeed..
d) is clear about the need to exclusively breastfeed during the first
six months and is clear about the risks of mixed feeding (although
this section illustrates the complete lack of published data about
the risk of transmission of HIV during mixed breastfeeding after six
months for babies who have received exclusive breastfeeding for the
recommended first six months of life, and clearly there is a need to
ask researchers to help fill this knowledge gap)
d) suggests that viral load of the breastfeeding mother and the HIV
status of the breastfed baby be checked monthly; this could provide
us with some firm UK data eventually as well as protect the health of
the mothers and babies,
e) recommends that failed asylum-seekers and illegal aliens who are
formula-feeding should be helped to access free (medically indicated) formula
f) clarifies that HIV-exposed formula-fed babies of failed
asylum-seekers and illegal aliens should not be deported due to the
risks to their health, survival and food security in resource-poor settings.
What is especially significant is that this Position Paper is so
inclusive, protecting babies, mothers and healthcare providers. It
also manages to include both the infant feeding options (either
formula-feeding or breastfeeding with maternal antiretroviral
therapy/prophylaxis) which are actually set out as single option
strategies in the current global WHO recommendations (see
<http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html>http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html
) This is a win-win situation! Furthermore, it's very likely that
these recommendations form the first from any industrialized country
which envisage that HIV+ mothers sometimes do want to breastfeed, and
endorses their need for support rather than coercion. It also means
that colleagues and Lactnetters may be able to use the UK
recommendations as a precedent in future consultations with other
health authorities in other industrialized countries. Let us know if
we can help! Meanwhile it does mean that, at least in the UK, HIV+
mothers who have special or personal reasons for wanting to
breastfeed can now do so!
Pamela Morrison, IBCLC
Rustington, England
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