Dear Friends:
    The Coutsoudis study is fabulous in that the international definitions of
breastfeeding were followed. It found that HIV transmission was highest to
the mixed feed infants. However, we need to remember that this is only one
study, and the results will need to be replicated before they can be applied
clinically.
    Also, while lack of breastfeeding increases chances of other diseases
(diabetes, SIDS, and others), each individual  mother  that is HIV+ would
have to balance the chances of her baby developing those diseases against the
chances of HIV transmission via breastfeeding in her particular environment.
So the decision becomes a complex statistical analysis, hopefully made in
conjunction with informed, objective, and dedicated providers.
    Heat treatment of her own milk is an option that can be time consuming
and difficult: pumping full time, plus the heat treatment, plus the time to
feed the baby. Heat treatment can be an expensive option in some countries,
where fuel is scarce. I don't know of any evidence-based protocol for heat
treatment of human milk on an in-home basis. Does anyone?
    Mothers who are HIV+ and choose to breastfeed run the risk of legal
battles with protective services, and potential loss of custody, as we have
seen in several countries.
    A thoroughly difficult and painful situation no matter what the decision.
    Warmly, Nikki Lee

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