On March 26, 1998 UNICEF issued a press release "New HIV/AIDS treatment
will save thousands of children." UNICEF noted the success of short-term
AZT in preventing mother-to-child HIV transmission.  UNICEF also
announced that it will become involved with the distribution of (no
brand name) infant formula for babies of HIV+ mothers in countries with
high prevalence of HIV.  These include Botswana, Cote d'Ivoire, Rwanda,
Uganda, Zambia, Cambodia & Viet Nam.

This is clearly a watershed event.

In the 6-page statement, UNICEF said it will make efforts to include:

"Infant formula, at affordable prices and in the quantity needed for
about six months, for tested women with HIV who make an informed choice
in favour of this alternative. Formula with no brand labels will be
distributed at reduced cost through existing community-based
institutions with careful control, targeting and monitoring."

Later in the statement, UNICEF said:

"UNICEF hopes to engage local, and if necessary, multinational
manufacturers of dairy products, including infant formula, as partners
in this effort, depending on their willingness to provide generically
labeled quality formula that will not represent a commercial gain."

I honor UNICEF for this courageous step and I weep with them that this
horrid virus has necessitated ABM in Third World countres.

I don't know if any Lactnetters know that the late Dr. Margaret Mead was
one of the first people to say that babies of HIV+ mothers in Third
World countries should be formula fed.  In 1988 she urged the infant
formula manufacturers to participate in finding a solution to this
tragedy.  When asked why the formula compnaies would be willing to do
that, Dr. Mead replied: "Because it is the right thing to do."

The reference for this statement is Dana Rapahel's chapter
"Breastfeeding and HIV" in the 1994 book "Global AIDS Policy" editor is
Douglas A. Feldman.  (Dana Rapahel is the PhD anthropologist who
introduced the entire doula concept.)

If UNICEF is now ready to distribute ABM in Third World countries, I
hope that we in First World countries, can now become ready to do more.
I would like to see us, in the United States, routinely tell all
pregnant women two things:
1)  HIV testing and use of antiretroviral drugs such as AZT can prevent
mothre-to-child HIV transmission in 95-98% of cases.
2) While breastfeeding offers tremendous advantages for mothers and
babies, it is contraindicated for HIV+ women.

When New York and New Jersey required their WIC staff to routinely make
these two points to all pregnant women, breastfeeding rates still went
up.

In my opinion, the arguement in favor of withholding such information
from pregnant women (except for those who self-disclose seropositivity
or "high risk" behaviors) is not supported by an enmormous body of
resarch evidence.  I think that it is fallacious reasoning to think that
we can tell which women are "high risk" and which are "low risk."
Women, overwhelmingly become HIV-infected by the past and current
behaviors of their male partners.  In the year of their HIV infection,
most women have had only one sexual partner.  He is usually their boy
friend or husband.

Just as people are trained to think horses (not zebras) when they hear
hoofbeats, we need to re-train ourselves in the way we think about HIV
infection in women.  We need to think *husband* -- not one-night stand.
We need to think *boy friend* -- not needle stick.  We need to realize
that *we" cannot tell which pregnant women are "high risk."

AIDS is the third leading cause of death among all US women of
childbearing age.  AIDS is the leading cause of death among African
American women of childbearing age.  HIV is *not* an uncommon disease
among women.

I remember the night when it hit me emotionally -- breastmilk really
really transmits HIV.  I started sobbing hysterically, in a pizza
parlor; my date was not thrilled.  I am still grieving for the good old
days when breast was always best; now breast is only best, almost all of
the time.

If UNICEF can distribute ABM in Uganda and Rwanda, we can adjust too,
although with much pain, but ideally by working together.

You can find the UNICEF statement at
www.unicef.org/newsline/98pr15.htm

Edith White (grandmothered in as one of the original IBCLC pioneers in
1985)