Following on Laureen's question, and Virginia's and Lois' replies, I have
just received copies of the 1998 WHO/UNICEF/UNAIDS HIV and Infant Feeding: A
Guide for health care managers and supervisors, and Guidelines for
Decision-makers.  In page 3 of the Introduction of the Guide for health care
managers and supervisors, it states ".... provide infant feeding counselling
for all pregnant women and mothers.  This includes support of and
counselling about breastfeeding for mothers who are HIV-negative or of
unknown status, and counselling about replacement feeding for women who are
HIV-positive."

Page 7 - 8 of the Guidelines for decision makers says "Implement
interventions to prevent MTCT (mother to child transmission).  Possible
interventions to reduce the risk of MTCT by women who have been diagnosed as
HIV-infected include ... avoidance of breastfeeding.  Women need counselling
about infant feeding options and support for their decision.  They may need
help with alternative feeding methods if they choose not to breastfeed."

The guidelines mention formula as a replacement, or the use of modified
animal milks such as cow, goat, buffalo, sheep and camel.  They also include
a "recipes" for making modified animal milks and a section "Making
breast-milk substitutes available to infants of mothers living with HIV",
the last para of which reads, "A general reduction is permitted in the
wholesale price of breast-milk substitutes by manufacturers as a part of a
pricing policy intended to provide products at low prices on a long-term
basis."  The use of EBM is also mentioned, but *last*, after formula and
animal milks.

I was at a meeting yesterday where 26 organizations involved in counselling
HIV+ people were represented.  One of the counsellors assured me that goat's
milk was almost identical to human milk so that this was "the best choice"
for the babies of HIV+ mothers.  Oh dear ...

Pamela Morrison IBCLC, Zimbabwe