Breastfeeding and HIV risk to babies

The issue of breastfeeding for HIV positive mums was discussed in detail at a special session today. I tend to forget the legacy of previous advice to not breastfeed, combined with heavy marketing of formula feed. Would you have ever guessed that breastfeeding rates in some parts of South Africa are 6-8%! The WHO guidelines recommend exclusive breastfeeding for at least 6 months, since the mortality of HIV negative bottle-fed babies was increased 6 fold in resource poor settings. Plus the Mma Bana and Kisumu breastfeeding studies showed that cART could reduce the postnatal MTCT transmission rates.

How to tackle re-educate and change practice was discussed by Yogen Pillay from South Africa. They have taken both a top down (ministerial statements and the restriction of formula to prescription-only), and a bottom up approach (involvement of traditional healers and community peer workers), and are reaping slow but steady success. Ensuring time and space for women to breastfeed was key.  Prof Tyllaskar from Norway’s group also showed that a focus on the whole community was crucial to changing breastfeeding practice, not just targeting HIV positive women. He doubled breastfeeding rates over a year with a program of peer-counsellors as part of the larger PROMISE study in South Africa, Burkina Faso and Uganda. 

Not so relevant in the Australian context when safe, affordable, reliable and quality formulas are available if necessary for HIV positive mums, but a sobering insight into the impact the guidelines of the WHO and the advertising from formula companies can have on a vulnerable population who just want to protect their babies from HIV.