Breast-Is-Best Policy Even For HIV Positive Patients?
South Africa has one of the highest rates of HIV infection in the world, with some areas in the country affected worse than others, notably some of the rural areas.
Last year the South African health minister (Aaron Motsoaledi) implemented a drastic and contentious measure by withdrawing the free distribution of formula milk to HIV infected mothers and encouraging them to exclusively breastfeed their babies for the first six months.
Seeing that it has long been accepted that there is an increased risk of infection through mother-to-baby transference of the HIV virus through breast milk, this was seen as a very contentious move.
Despite the increased risk of infection through the transmittance of the virus through breast milk, there is support for this decision from some doctors dealing with HIV positive patients, especially in rural districts. One example is Dr Ben Gaunt, head of the rural hospital Zithulele in the Eastern Cape.
Dr Gaunt maintains that even though there is a risk of infection, there is a bigger risk of malnutrition that arises from feeding the babies with a mix of formula, water and solids in the first few months of their lives. In the first place, babies build up their immune system through taking in anti-bodies present in the breast milk of the mother, and in the second place, this mix of food can damage the baby's intestinal lining thereby increasing the risk of infection from other diseases and disorders. Additional research points to the fact that a baby that is fed formula is six times more likely to die of an infectious disease in the first two months of life than a baby who is breastfed, even with HIV positive mothers.
What can be done then to decrease the risk of transferring the HIV virus through breast milk if it is so beneficial to breastfeed, even if the mother is HIV positive?
It has been found that treating the mother with the drug Nevirapine drastically reduces the risk of transmitting the virus through breastfeeding.
But getting rural mothers to breastfeed exclusively is a bigger problem than might be immediately apparent.
The following issues arise:
Using formula to feed babies is perceived to have a higher social status than breastfeeding and therefore it is deemed more desirable to use formula. Most mothers cannot afford to use the formula exclusively however, and tend to mix it with flour and water, or even porridge, to make it go further. This type of feed is not suitable for small babies and they end up severely malnourished.
Apart from that, the water in a lot of rural areas is polluted due to inadequate water supplies. Some babies are given this water to drink instead of formula, or mothers mix the formula with polluted water, giving rise to high incidence of diarrhea in these babies.
The doctors at the Zithulele hospital spend a huge proportion of time and effort in trying to educate the mothers as to the positive effects of exclusive breastfeeding, which is probably not happening in other parts of the country. This means that in most other parts of the country, mix feeding of babies is prevalent and ironically enough, contributes to a higher infant mortality rate than for exclusively breastfed babies.
Despite these challenges, the doctors at the Zithulele hospital remain positive that exclusive breastfeeding for HIV positive mothers is the right thing to do and would like to see a greater focus from other public and private hospitals to promote this practice.
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