>I guess I'll go out on a limb here and argue for the position that it should
be the mother's (or parents') decision to make whether she takes the risk of
the baby getting HIV from breastfeeding <

Welcome out here on the limb, Kathy.

I agree that issues of choice should not be thrown out in the face of HIV.

I also think it is vital that those of us involved in the field of breastfeeding
support / lactation management should begin to familiarise ourselves with the
practical ways we might support HIV+ women who choose to breastfeed.  The
research is scanty, but the interesting implications for practice *I am aware
of* so far are:

*  *exclusive* breastfeeding offers a different transmission rate than using
water / other milks/ teas, etc alongside breastmilk

*  the onset of mastitis -- even sub-clinical mastitis, it is suggested, may
increase rates of transmission

*  there is a theoretical risk of increased transmission if the mother has a
cracked nipple

*  there is a suggestion that there could be a risk of increased trnasmission if
the mother (???or infant???) has a thrush overgrowth

(I don't know much about the dabate on expressed, treated milk.  One question I
woudl have is, if treated, would the consideration about exclusivity still
apply?)

What does the above tell you?  That if a mother who is HIV+ chooses to
breastfeed, she will need A1 support to get breastfeeding going pretty
optimally!!

HIV poses huge threats to breastfeeding for all women --  I heard a presentation
from the Mass Media unit in Glasgow which included comments from a woman in a
focus group doubting the benefits of breastfeeding because she had heard that it
could transmit HIV -- and this confirmed her choice not even to try
breastfeedign her baby.

But -- it also provides a huge opportunity to recognise the skills involved in
enabling women to get breastfeeding going while avoiding supplements, breast
over-fullness/mastitis, etc etc.  If we can make the case that enabling
successful establishment of breastfeeding is going to be important in the
context of child health and HIV, maybe it will improve the lot of breastfeeding
women everywhere.

Magda Sachs
(the millenarian)
Breastfeeding Supporter, BfN, UK

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