Reducing HIV risk in breastfeeding

For many HIV-positive mothers in resource-poor settings, breastfeeding is often the only option, despite the risk of HIV transmission. The challenge now is for healthcare workers to accept this reality and make breastfeeding safer, a recent report has said.

A study by LINKAGES, a programme providing technical information on infant feeding, found that breastfeeding remained "one of the most effective child survival interventions available."

While breastfeeding increases the risk of HIV-transmission to the child by up to 15 percent, replacing breast milk increases the risk of infectious diseases like diarrhoea and respiratory infections up to sixfold during the child's first 2 months.

A UN Children's Fund (UNICEF) statement on breastfeeding noted: "When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-positive women is recommended."

Formula feeding reduces the risk of HIV transmission through breast milk by one-third, but this option requires a constant supply of clean water and firewood to ensure sterile feeding. Family and community pressure to breastfeed is strong, and mothers who formula feed are often viewed with suspicion.

According to the LINKAGES report, the risk of HIV transmission through breastfeeding can be reduced by mothers following feeding guidelines, as well as taking care of their own health.

Exclusive breastfeeding for the first six months is one of the report's recommendations, as mixed feeding can damage the baby's fragile gut lining, increasing the risk of infection.

"It sounds like hard work but it is not impossible. This is also the best feeding practice for mothers who don't know their status or are not [HIV] positive," Anna Coutsoudis, a researcher in the Department of Paediatrics and Child Health at the University of Natal's Nelson R Mandela School of Medicine, told PlusNews.

Coutsoudis has developed Africa's first community-based 'breast-milk bank' for babies orphaned by HIV/AIDS, but governments and healthcare facilities also had to play a part. "They should be putting more money into breastfeeding promotion because everybody benefits - not just HIV-positive mothers," she said.

One of the spin-offs of educating women in safer breastfeeding would be fewer breast conditions among women living with the disease, Coutsoudis noted.

Cracked nipples, inflammation of the breast and breast abscesses are three conditions associated with an increased chance of HIV transmission through breastfeeding.

"Studies suggest that approximately 11 to 13 percent of HIV-infected women experience one or more of these conditions during breastfeeding," the report noted.

Coutsoudis believed this could be addressed. "I work in a poor environment in Durban, but hardly any of our mums get these infections because they are managed well by their counsellors. More HIV-positive women need to be taught how to breastfeed properly."

Nevertheless, treating the mother with antiretroviral drugs might be "one of the most important ways of preventing postnatal transmissions", according to the study. But Coutsoudis said more research was needed to see how effective this would be in practice.

The risk of transmission is even higher if the mother becomes infected while breastfeeding. "Condom use is crucial at this stage - partners need to know about all these risks and be encouraged to use condoms," she warned.

Providing nutritional support to the lactating mother was also important, as the high energy demands and sleep deprivation associated with infant care, including breastfeeding, undermined the already weakened immune systems of HIV-positive women.

"We are not talking huge amounts here, but the mothers will need a little bit more food ... an extra peanut butter sandwich and milk," suggested Coutsoudis.

More details: www.linkagesproject.org