Kathy wrote, "The copy of the N.Y. Times article says "...the United Nations
intends to  conduct pilot projects in 11 countries in Africa and Asia where
women have high (H.I.V.)  infection rates, and it is seeking donations from
governments and foundations to pay for it."  Why don't  we suggest ( to our
local reps or through letters) that  the formula companies DONATE all this
free formula, instead of governments paying for it?  After all, it is a
humane, wonderful P.R. thing to do. For once they can put their money where
their mouths have been.  (And also leave less $$ for free formula packs and
subliminal advertising, etc. for the non H.I.V. moms ?) Anyone else's thoughts?"

Kathy, on the face of it this is a nice thought.  But before donations of
formula are solicited from anyone please let us all consider how women who
live in the middle of nowhere in little huts, who cook on wood fires, who
have no electricity, nor running water, and who cannot afford to pay
doctors/hospital fees, are going to keep their babies healthy while feeding
them a substance which requires a clean environment, sterile utensils,
boiled water etc.  While we think about the 15 babies in 100 who may be
saved from being infected by HIV if their mother's milk is withheld from
them, let us also remember that we don't yet have any way of knowing which
15 they are. Let us also not forget the other 85 who will be placed at
serious risk of dying from diarrhoea, respiratory infections and other
diseases if they are formula-fed in such circumstances, nor the 20 who are
born already infected who will live twice as long if they are breastfed.

African babies need many things, but mostly they need their mothers. What
will happen to the Thai mothers who received AZT for a mere month in order
to reduce the risk of transmission of the virus to their babies? Where are
the pilot studies to see if AZT given during *breastfeeding* reduces the
rate of HIV-transmission?  Where are the massive education campaigns that
are needed to protect women (and thus babies) from infection via semen?  How
come it has been 13 years since the discovery that breastfeeding could
provide a route of transmission of the virus, and yet there has been *no*
research to explore ways that HIV+ mothers could easily provide the most
obvious alternative to breastfeeding - their own treated EBM?  How come
African children have been dying of malaria and other diseases for centuries
but now suddenly pilot studies involving formula-feeding need to be done
because they are dying of HIV?

The possibility that Africa's breastfeeding culture is about to be sabotaged
by fears of the risk of HIV-transmission via breastfeeding on the one hand
and promises of "free" formula on the other, brings us to the brink of a
catastrophe.  Currently it is estimated that 25% of all mothers delivering
babies in Zimbabwe are infected with HIV, but very few of them know their
status.  In real terms this means that less than 4% of all babies born will
acquire HIV via *breastfeeding*.  The other 96% are more likely to make it
to adulthood if breastfeeding *continues* to be the norm and IMHO we do not
need formula feeding to be promoted under any pretext.

Stepping down now ...

Pamela Morrison IBCLC, Zimbabwe