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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