Thanks to so many who wrote supportive notes in response to my HIV and
donated formula rant.  In particular, thanks to Kathleen Miller for opening
the door for me to express my concerns on this very vexing topic by asking
about donations of formula;  to Jack for outlining some of the logistical
and administrative glitches that would ensue;  and to Heather for her vision
of how formula-feeding could take hold in Africa.  The words "disaster",
"catastrophe" and "sick at heart" are all apt.

You cannot mention breastfeeding anywhere without being quizzed about the
risks of HIV-transmission.  Our national World Breastfeeding Week has been
toned down so that breastfeeding is not promoted *too* vigourously.  Our
beautiful new Code has no Committee to enforce it, no doubt to leave the
door open for the donations of formula that are about to land in our midst.


Heather makes some excellent points, "Please don't lets suggest that ABM
manufacturers donate their product to Africa free of charge...
multinationals .. who could easily cope with the temporary blip in profits.
Then, when bf is virtually destroyed as a cultural option, they can start
charging realistic prices once more - with a market they have created
themselves...I asked the list yesterday if it was a practical option for
rural mothers to heat-treat their own EBM. If it is, should we be pressing
UNICEF and the aid agencies to help mothers do just that? Can we write to
relevant organisations urging this?"

There are a few of us here who have been thinking along similar lines.  In
the absence of further research, and with the knowledge that the HIV virus
is heat-labile, the mother's own EBM, which has been brought just up to
boiling point, would seem like the safest feeding alternative for the HIV+
mother who is advised not to breastfeed.

Mothers can be taught how to manually express their milk, and they *can*
maintain breastmilk production for many months and sometimes even for years
according to Lactnet subscribers who have so kindly responded to my request
for case-histories. Rural mothers cook on wood fires two or three times per
day so a little container of EBM could be heated at the same time. If
mothers were encouraged to provide their own EBM for their babies, there
would be no need for dependence on outside sources of supply which could
"dry up" at any time, as Jack points out.  There would be virtually no cost
to mothers, communities or governments.  Furthermore (and probably best of
all) mothers could retain control over their babies' food security while
still providing the safest alternative.

So YES, let's press UNICEF, WHO, UNAIDS and other aid agencies to support
the research and the feasibility studies. (Does breastmilk need to be
boiled, or will a lower temp kill the virus?  How long can you keep boiled
EBM at temps ranging from 22 - 35 degrees C before bacterial proliferation
makes it unsafe to be fed to the baby?  What kind of bacteria is found in
EBM expressed in a little hut in the bush, or a little tin shack in the
city? Do HIV+ mothers see this as an option if we can assure them it is
safe?  What kind of assistance do they need?  And, good Heavens, if this
option proves to be the safest alternative for African babies, should we not
be promoting it for American and European babies too?)

And YES please.  Do let's write to the relevant organizations requesting
them to take up this issue. I have already written to ILCA.  LLL South
Africa has already issued a statement from their recent Conference.  I have
been told that breastfeeding advocates are speaking "in whispers", and that
their voices are "muffled".  It is time for us to start speaking up.

Pamela Morrison IBCLC, Zimbabwe (hoping that all is not lost yet, while we
can still keep asking questions!)