The International Code, HIV and breastfeeding

Ref 2. Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai W-Y, Coovadia HM. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: a prospective cohort study from Durban, South Africa. AIDS 2001, 15: 379-387

Making substitutes available to infants of mothers living with HIV Unregulated distribution of free or subsidised formula leads to widespread use by mothers whose infants would benefit from breastfeeding. After voluntary testing and counselling, some mothers may choose not to breastfeed. They should be supported in their choice. Governments that decide to provide HIV-positive mothers with breastmilk substitutes should do so in a manner that: is sustainable does not create dependency on donated or low-cost supplies does not undermine breastfeeding for the majority of infants does not have the effect of promoting artificial feeding assures individual infants sufficient quantities for as long as they need them (six months)

 

Breastmilk magic Some of the very same companies which are trying to promote their products as the solution to HIV transmission are also those which have taken out a patent on certain components of breastmilk, such as lactoferrin, because it is known to have anti-viral properties which denature HIV. It may well turn up as a magic new component of formula. In recent years, more discoveries have been made about the rich composition of breastmilk. For example, it is now known that breastmilk comprises proteins called lysozymes which are said to destroy HIV.

 

 

Exclusive is key because previous studies used a vaguer definition of breastfeeding as meaning mainly breastmilk but also other milks, teas and water which may have been contaminated. In February 2001, a follow-up study (Ref 2) was published which confirmed that 'infants exclusively breastfed for three months or more had no excess risk of HIV infection over six months than those never breastfed'. By 15 months exclusive breastfeeders still had the lowest risk of all three groups. Additional independent research may well point to evidence that exclusive breastfeeding can offer as much protection as artificial feeding, and possibly more.

Article taken from News Straits Times, Malaysia - 17 April 2001.

Meanwhile, governments and agencies trying to control and treat HIV/AIDS, seek ways to make alternative feeding options available to mothers who have been diagnosed positive for HIV and decided not to breastfeed. In a number of countries this has led to companies offering free or low-cost supplies. UNICEF has refused such offers pointing to their promotional effect, the likelihood of abuse and of "spillover" of artificial feeding to infants of mothers who are HIV-negative or whose HIV status is unknown. It has also insisted that purchased formula for its pilot projects carry a generic label rather than a brand name.

Immunological benefits

Studies that focus solely on the risk of transmission of HIV seem to ignore the protection provided by breastfeeding, especially when it is exclusive. AIDS, the Acquired Immune Deficiency Syndrome, attacks the body's immune system and the major causes of death are infections because victims have little or no natural immunity left to fight them off. Breastfeeding provides a great degree of immunity against many of such infections. Should one not seriously consider whether exposing the baby to a higher risk of infection by depriving it of breastmilk outweighs the risk of HIV transmission through breastfeeding?

Now that we know that artificially fed infants and exclusively breastfed infants run the same risk of becoming infected with HIV, it may be time to examine the total potential health outcome for the child. Cultural, emotional and socio-economic patterns in the most affected areas, in addition to the medical knowledge to date, may well weigh the scales in favour of a campaign for exclusive breastfeeding by all mothers.