I apologise for getting a bit long-winded - let me know if you think
I'm hogging the net....
Thank you to all those who are posting references and extracts from
recent research about HIV transmission.  I am not well read on this
topic and do not have easy access to research articles.  Those of you


who are particularly interested may wish to try and get hold of a
copy of the following booklet:  "AIDS Bulletin, Vol 5, No 3 December
1996", produced by the Corporate Communication Division, Medical
Research Council, PO Box 19070, TYGERBERG, 7505.
 E-mail:  [log in to unmask]
I think this Bulletin comes out about 3xyear and focuses on
the implications of this pandemic for South Africans - "....our
position in Africa in terms of health and scientific infrastructures
and expertise requires us to take leadership in the call for the
people of Africa to benefit from the progress made in treatment and
cures", Malcolm Steinberg, Editor-in-Chief, AIDS Bulletin.

My info. is mostly gleaned from attending talks given over the past
couple of years - some comments on Giselle and Kathleen's posts:
>"...late postnatal transmission was more common among children
>with oral candidosis, and among children whose mothers had a history
>of cracked nipples and  breast abcesses." The authors , having
>studied the risk of late postnatal transmission suggest weaning the
>children at 6 months directly to solid food and not formula.
For HIV+ women who are breastfeeding their babies in South Africa, I
believe that it is suggested that they take the child off the breast
at about 6 months and that they do not breastfeed if there is thrush,
cracked nipples or infection.  HIV+ women need to be especially
careful with positioning and personal hygiene as they are more
susceptible to infection.

>or heating the own mother's expressed milk ?
I have heard that there is research being done in Zimbabwe where
mothers who are HIV+ are pasteurising their own milk.  There is still
quite a lot of resistance to expressing here in S.A. and probably in
other African countries.  Traditionally moms were happy to feed each
other's babies, particularly within families - this is now being
discouraged.

A comment on the Vancouver conference extracted from the Bulletin:
"There seemed to be too little relevant research on cost-effective
treatment or prevention options aimed at women's control
(microbicides or virobicides);  little emphasis on cost-effective
prevention such as vaginal lavage, Caesarean section instead of
vaginal delivery, low-dosage AZT during pregnancy, etc.", Morna
Cornell, AIDS Consortium.
In S.A., the system is doing what it can but we're not geared to
do a Caesarean for every HIV+ woman.  We can't afford to treat
everyone with AZT (I think children are getting priority).

>3. AUTHORS CONCLUSIONS/RECOMMENDATIONS: "It may be more
> reasonable to direct public health efforts in developing countries toward
>preventing seronegative breastfeeding mothers from becoming infected
>with HIV-1 rather than preventing HIV-1-infected women from
>breastfeeding."
Prevention of infection is high on the agenda for all of us.  A
large chunk of our national health budget is being thrown (much of
it, rather randomly it seems) at education programmes - some have
been quite innovative.  In the meantime, many women of child-bearing
age are already HIV+.  Uganda has apparently turned the corner, they
seem to have lower rates of new infection - I understand that
practically every family in Uganda has been directly affected by this
disease.

From: "HIV and Infant Feeding: An Interim Statement, July 1996",
Joint United Nations Programme on HIV/AIDS (*anyone know if there has
been an update on this statement?*):
"Counselling for women who are aware of their HIV status should
include the best available information on the benefits of
breastfeeding, on the risk of HIV transmission through breastfeeding,
and on the risks and possible advantages associated with other
methods of infant feeding............
It is therefore important that women be empowered to make fully
informed decisions about infant feeding, and that they be suitably
*supported* in carrying them out."
(my emphasis - what are the implications of this?)

I realise that I've had a couple of years to start stomaching the
idea of subsidised artificial feeding.  The following is a clause
from a statement that came out of a workshop at the University of
Natal last year "Breastfeeding Choices for the HIV seropositive
mother":
Annotation point iii): "Financial support, within the
constraints of the International Code of Marketing of Breastmilk
Substitutes and all relevant World Health Assembly resolutions,
should be considered for artificial foods to women (ie. seropositive
women) and families who choose not to breastfeed and for whom
artificial foods are not affordable.  It is not clear whether this
will be cost-effective and therefore a cost benefit analysis will
have to be undertaken if these recommendations are accepted."

Okay, okay..., I'll surface out from under these statements.
Regards, Lynn.


--------------------------------------------------
Lynn Moony
Johannesburg, South Africa
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