The JAMA web site has a paper on the topic of perinatal transmission of
HIV.  It has a good overview of the topic for those of us, like me, who
need to read up on this topic.  However, I was dismayed that they state
that treatment and prevention has included "avoiding breastfeeding (for
women in the United States and other countries that have safe
alternatives to breast milk)" (emphasis mine)

Perhaps I am being picky, but I don't like their choice of words.
"Safe" is not the right word.  ABM is not "safe" but for some
populations it may be "safer".  Isn't this the same argument that was
made about condoms?  Not "safe sex" but "reduced risk"?    Perhaps
babies of HIV+ mums will have less likelihood of HIV transmission if
mums don't breastfeed, but those babies are still exposed to the various
hazards of ABM.

My other concern is that the JAMA article does not mention the use of
pasteurized breastmilk or donor milk.  Is someone making a paternalistic
judgment that "these mothers" couldn't accomplish either of these two
options? Or is donor milk or milk treatment not seen as an alternatives
to ABM because breastmilk is not being valued? Has there been any study
of the financial impact of providing pasteurization or donor milk to
HIV+ mums?  Would the health care cost savings of these children offset
the cost of such a program?

Article located at:
http://www.ama-assn.org/special/hiv/treatmnt/guide/rr4407/hiv2.htm

Janet Vandenberg
RN, LLLC Leader
Newmarket, Ontario, Canada