The 3 Minute Activist
As the World Turns

"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
e-mail: letters@nytimes.com
fax: (212) 556-3622

Dear Editor:

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 the Times.

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 their babies.

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" them.

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.