"Below you will find an answer to
the New York Times in
regards to a recent article they did on
breastfeeding and HIV."
Letters to the Editor
The New York Times
229 West 43rd Street
New York, NY 10036
fax: (212) 556-3622
As a breastfeeding mother, I read Michael Specter's piece,
"Breast-Feeding and H.I.V.: Weighing Health Risks"
(August 19, 2020), with great interest. The whole issue of
pregnancy, breastfeeding, and HIV is a volatile one, and
few news outlets tackle it as well as did Mr. Specter and
I am deeply concerned that UNICEF has decided to change its
decades-old policy of recommending breastfeeding to all mothers,
regardless of their HIV status. While there is no argument
that breastfeeding is best for babies of HIV- negative mothers,
the waters become murkier when dealing with a mother with
indeterminate HIV status or who is HIV-positive. However,
current research appears to bear out the claims that a baby
is better off breastfed regardless of a mother's HIV status,
especially in Third World countries. A 1997 study showed
that babies exclusively breastfed by HIV-positive mothers
had a slower progression from HIV to AIDS (an average of
7.5 months for those breastfed, 5 months for those not breastfed).
La Leche League International (LLLI) points out that breastfeeding
helps protect the HIV-positive infant from secondary infections
that can tax its weakened immune system.
According to Dr. Ruth Lawrence, author of, *Breastfeeding:
A Guide for the Medical Profession,* HIV kills about 15 percent
of breastfed HIV-positive babies in the first year of life
in Africa. About 50 percent of non-breastfed babies in Africa,
both those with HIV and without, die before their first birthday
simply because they did not receive breastmilk. The risks
of not breastfeeding in Africa are much more life-threatening
than they are in America. The International Lactation Consultants
Association (ILCA) estimates that approximately 33,000 children
under the age of 5 die every day, mostly from diseases against
which breastfeeding could have provided some defense. While
research appears to show that HIV can be passed to babies
through breastmilk, it's important to understand the mechanisms
of the HIV test. Current HIV tests look for antibodies to
HIV in the mother*s bloodstream, not the actual virus. Unfortunately,
many women who are tested while pregnant receive a false
positive or "indeterminate" result, because pregnancy,
along with about 200 other factors, can cause a positive
test result. These women, under the new UNICEF program, would
be encouraged to use infant formulas instead of breastfeeding
Most child health and lactation organizations from La Leche
League to the American Academy of Pediatrics recognize the
supremacy of breastmilk in most situations for infant feeding.
LLLI and the ILCA recommend HIV-positive women look for other
means of nourishing their babies before relying on commercial
infant formulas that can cost up to 1.5 times the annual
salary of an African village family to purchase. Obtaining
an HIV-negative wet nurse is probably the most cost-effective
and feasible option for HIV-positive mothers, especially
in African cultures where cross-nursing is a common practice.
Purchasing human milk from a milk bank with HIV screening,
or pasteurizing the mother's own milk using the Holder pasteurization
technique (heating the milk to 62 degrees Celsius for 30
minutes), which has been shown to destroy HIV, are other
options. Vitamins may help reduce the risk of transmitting
the disease from mother to baby. A 1998 study published in
the journal _Epidemiology_ noted that adequate amounts of
Vitamin A in a mother*s diet reduced the viral load in her
breastmilk, thus reducing the risk of transmission to her
child. Vitamin A is an inexpensive and side effect-free way
of helping to prevent passing HIV from mother to child.
By changing its policies to allow formula companies back
into the African market, UNICEF is risking the lives of millions
of infants. Formulas cost more than money; they cost lives.
As your story pointed out, three times as many babies die
from preparing formula using unsafe water than die of HIV
passed through the breastmilk. And since many African mothers
are unaware of their HIV status, it's easy to assume that
infant formula manufacturers will soon be pushing to give
formula to all babies born in Africa in an attempt to "save"
The issue of HIV and breastfeeding is one that will not be
solved by throwing formula or AZT at the mothers and hoping
that everything turns out for the best. Adequate nutrition
programs, a better HIV test and prevention programs are needed.
But most importantly, mothers need adequate information about
the choices that face them in order to make an informed decision
regarding breastfeeding and HIV.