>Has the wrongly fed baby been totally exclusively breastfed, if so share
the
Coutsoudis studies (see archive for more info if needed) with the mom.  They
should be very reassuring.<

Ummm, this research is about a baby fed exclusively on its mother's milk
(near as I can tell, though the fact that practices of cross-nursing were
not addressed is actually one of the weak points in this research imo -- not
that any other hiv/breastmilk transmission research talks about that
either).  But for this to be comforting, surely the other woman, who appears
to have given one feed, would need to be exclusively breastfeeding, too.  We
have indidcations that mastitis -- even 'subclinical' masitits may increase
the rates of transmission (and sub-clinical mastitis could arise from any
old day-to-day causes -- like having your child in day care and being away
from her for too (physiologically) long OR could, as Valerie points out in
her letter to JHL recently, be in itself a marker for introducing other
foods or liquids to the baby).  So, if the other woman is only partially
breastfeeding. or leaving her child in care for long periods, she might be
inducing 'sub-clinical' masititis in herself.  I think we are only in the
very earliest stages of understanding how hiv may be transmitted during
breastfeeding and what factors make it less, or more, likely.

However, it might be of interest to this mother to know that even where a
baby is breastfed daily, many times a day, by her hiv+ mother from birth,
transmission is not a sure thing.  It may be of interest, but here is a
quote that illustrates that part of the emotional basis of this concern may
not 'be about' hiv at all:

Lupton, Deborah, Risk, 1999

" Except in very special cases (such as consentual sexual intercourse,
medical encounters and carers dealing with the bodily fluids of infants and
young children), contact with the bodily substances deemed to be
contaminating or having one's bodily orifices penetrated by the bodily parts
or bodily substances of others tends to invoke a host of strong emotions,
including fear, anger, revulsion, horror, disgust and anxiety. These
emotions may be produced not only in relation to one's own body but also to
those bodies with whom one has an intimate relationship. This was
graphically illustrated by a highly publicised case in New Zealand in 1996,
in which a woman who breastfed another woman's eight-month old infant while
she was being cared for in a child-care centre was accused by the mother of
risking her child's health. The other woman argued the at the child was
inconsolable with hunger and the mother could not be found to breastfeed
her. The ostensible cause of this risk, argued by the mother, was that the
other woman could have carried HIV or hepatitis in her breast milk which may
have been passed on to the child. She demanded that the woman undergo blood
tests for these infections, considered laying an assault charge against her
and took the matter to the New Zealand's Commission for Children as well as
the Human Right's Commission. She argued that the woman 'didn't care about
my baby's health when she did it. How could she positively know that she
didn't have any infections at the time?'

At the bottom of the mother's outrage, however, was her sense that her
intimate relationship with her child, developed partly through breastfeeding
her, had somehow been destroyed by the other woman's act. The mother
tellingly compared the incident with 'finding your partner in bed with
someone else' and went on to assert that 'Breastfeeding isn't just about
feeding your baby. It's an intimate and dynamic relationship I don't wish
to share with a stranger.' She also noted that her main concern was that '
a stranger put her nipple in my child's mouth'. The idea that another
woman's bodily part -- the nipple -- and bodily fluid -- breast milk -- had
entered her child's body via the process of breastfeeding was distressing
for this woman. It transgressed ideas about the relationship between
mothers and their infants and the role played by breast milk in this as well
as norms about whose bodily parts and fluids should interact with one's
infant. At risk was the integrity and purity of the child's body and her
relationship with her mother."

Magda Sachs
Breastfeeding Supporter, BfN, UK

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