Breastfeeding and HIV April 9, 2007 Introduction Human Immunodeficiency Virus (HIV) is growing rapidly around the world. HIV can be transmitted in many ways. It can be transmitted from an infected HIV mother to her child during pregnancy and delivery, and sometimes through breast-feeding. It is one of the leading causes of death in Sub-Saharan Africa. It was estimated that 5 million people became infected with HIV, and many cases are young adults. (Piot and Pinstrup-Andersen, 2001-2002) Recent studies found about one-third of babies born worldwide to HIV infected mothers become infected. The United Nations Program on HIV/AIDS advises HIV-infected mothers to avoid breastfeeding in order to lower the risk of babies getting exposed to HIV. Breastfeeding is a controversial issue. On one side, breastfeeding can increase the risk of babies getting infected with HIV. On another side, people cannot afford to buy infant formula in many poor countries. While breastfeeding increases the risk of HIV, it is the best way to provide babies with nutrition needs and prevent malnutrition. Also, it protects children from deadly diseases such as pneumonia and diarrhea. Cons Breastfeeding Studies have shown that during the early months of breastfeeding, there are greater chances of HIV transmission from mother to child. It is known that HIV transmits through sex, contaminated needles, pregnancy and delivery, and breastfeeding. It attacks a person’s T cells. Through time, HIV will become Acquired Immune Deficiency (AIDS). AIDS carriers will eventually die. There are more than a half-million cases of HIV each year as a result of HIV mother-to-child transmission, and the mortality rate of HIV infected children is increasing. Babies can get infected through breastfeeding because breast milk contains HIV virus. In 2000, Dr. Ruth Nduati and her associates at the Department of Pediatrics, University of Nairobi, conducted a study on 401 HIV-positive mothers in Nairobi, Kenya, to assess the risk of HIV transmission in breast feeding. Over a period of two years, they found that the HIV infection rate was 36.7% and 20.5% for breast-fed and formula-fed infants, respectively. The HIV-free survival rate for formula-fed infants was much lower than for breast-fed ones. Furthermore, the study showed that seventy-five percent of mother-to-child transmission (MTCT) occurred during the early months of breast feeding. Although not exclusively on breast feeding and MTCT, a similar study was also conducted by Coutsoudis (2005) in Cato Manor, Durban, South Africa, in 2000. The study was done mainly to evaluate the effectiveness of the Safer Breastfeeding Programme for HIV-infected mothers. However, the results of this study gave researchers a better insight on breast feeding and the risk of MTCT. Initially, there were 315 mothers participated in the study. Data were collected from infants and their mothers at 6, 10, and 14 weeks and also at 9, 12, and 15 months. Out of 315 participants, there were only 275 infants who had six-week HIV results. Fifteen percent or 42 infants tested positive. During the study, they lost to follow-up 80 participants. As a result, there were only nine months of HIV results for 193 participants. Out of 193, five infants were never breast-fed. Therefore, there were only 188 mothers who continued breastfeeding their infants. Among those 188 participants, four infants tested positive for HIV. Based on this study, the longer the infants stayed on breastfeeding, the greater the risk of the infants being exposed to HIV. Pros Breastfeeding A breastfeeding supporter might contend that breastfeeding is the only well-known way to avoid infant malnutrition. Breast milk is the most available, safest, and primary nutritional resource for new born babies. Breast milk contains many nutrients, such as: 1. Vitamins and Minerals 2. Lactose 3. Bile-salt-stimulated lipase 4. Cytokines 5. Taurine 6. Immunoglobulin 7. White Blood cells 8. Lactoferrin 9. Lysozyme 10. Bifidus factor 11. Polyunsaturated fatty acids 12. Whey protein These nutrients are important because they provide infants’ needs for survival for the first six months. Infant formulas do not contain many nutrients that breast milk provides. Breastfeeding helps to prevent millions of child deaths every year from diarrhea and other infections (Giles & Mijch, 2005). Breast milk has immunoglobulin and white blood cells, which are essential for infants during the early months of life. It helps the immune system to operate efficiently and protects young infants against many diseases such as diarrhea, diabetes, asthma, allergies, urinary tract infection, and ear infection. According to Piot and Pinstrup-Andersen, breast milk consumption will assist development of infant teeth and speech organs (Piot and Pinstrup-Andersen, 2002). During the manufacturing process, formula milk may contain poisonous ingredients, such as lead and aluminum, that will pose health risks for infants. (Shiff, 2006). As a result, the World Health Organization (WHO) issued the “International Code of Marketing of Breast Milk Substitutes” in 1981. The code restricted formula companies from marketing or promoting their products in health-care facilities. In many poor countries, breast feeding is the only option people have, because infant formula costs outweigh the risks of mother-to-child-transmission of HIV. (Doherty & et al., 2006). Doherty, Chopra, Nkonki, Jackson, & Greiner (2006) stated that many of the mothers of their studies informed them that they have difficulty accessing formula milk or have difficulty deciding to use formula milk for the following reason. Many mothers are afraid to go to clinics when formula milk runs out before their scheduled date to receive formula milk. By using formula feeding, they are disclosing the fact to those around them that they may have HIV. Mothers with HIV are facing “ridicule and scorn” (Doherty & et al., 2006). As a result, most of them felt “isolation, despair and powerlessness”. According to Giles and Mijch (2005), mixed feeding can increase the rate of HIV transmission. Mixed feeding includes breast, formula, or bottle feeding (Giles and Mijch, 2005). Nevertheless, prolonged breastfeeding may increase the risk of mother-to-child HIV transmission. Conclusion Based on my understanding of the research, I am pro for breastfeeding for the early months of infancy. If you don’t breastfeed, the infants will not have the necessary nutrients to strengthen their immune system to fight diseases. If you prolong breastfeeding, there is a higher risk that you expose your child to HIV transmission. I believe effective assistance programs can educate HIV-infected mothers to better understand proper breastfeeding. Before doing the paper, I thought that I would support non-breastfeeding because I have learned breastfeeding is one of the root causes of HIV. However, I am now a proponent of exclusive breastfeeding, since seeing the infant feeding dilemmas created by HIV and the real challenges that a large majority of HIV-positive African mothers have been facing, especially after reading the study exploring the effect of the HIV epidemic on infant feeding by Doherty and et al. Hunger and disease are indeed reinforcing each other in many African regions, making safe replacement breast milk unattainable, so breastfeeding is still the most favorable method. References Coutsoudis, A. (2005). Infant feeding dilemmas created by HIV: South African Experiences. Journal of Nutritional, 135 (4), 956-959. Doherty, T., Chopra, M., Nkonki, L., Jackson, D., & Greiner, T. (2006). Effect of the HIV epidemic on infant in South Africa: “When they see me coming with the tins they laugh at me. Journal of Bulletin of the World Health Organization, 84 (2), 90-96. Giles, M., & Mijch. A. (2005). Breast milk pasteurization in developed countries to reduce HIV transmission. Do the benefits outweigh the risk? Journal of Infectious Diseases in Obstetric & Gynecology, 13(4), 237-240. Piot, P & Pinstrup-Andersen, P. (2001-2002). AIDS: The New Challenge to Food Security. 3/1/06, http://www.ifpri.org/pubs/books/ar2001/ar2001e.pdf Schiff, L. (2006). Breastfeeding makes for better health. Mount Sinai Journal of Medicine, 73 (2), 571-572.