Washington Symposium addresses issues of maternal HIV status and breastfeeding
LLLI/WABA symposium brings breastfeeding experts together
Breaking the myths surrounding breastfeeding and child survival in the face of the HIV pandemic was one of the key goals of a symposium organized by the World Alliance for Breastfeeding Action (WABA) and the International La Leche League (LLLI), July 2, in Washington DC. Shifting the criteria for survival from the risk of transmission to the known risks of mortality, malnutrition and illness when infants are given replacement feeds (primarily formula) instead of breastmilk was a key point for action.
The group of discussants, which included Dr. Michael Latham from Cornell University, Dr. Ted Greiner Executive Director of Path International, Marta Trejos from IBFAN Latin America, Sarah Amin from WABA Malaysia, and Rebecca Margaellis and others representing LLLI, Dr. Arun Gupta from the Breastfeeding Protection Network of India, Pamela Morrison, formerly of Zimbabwe, and Ray Maseko from IBFAN Africa and others, worked at formulating objectives and strategies for action to increase survival rates for mothers and babies.
"The HIV community and its apparent lack of knowledge of breastfeeding or its willingness to ignore breastfeeding is an important consideration as policies are set and materials are developed. Are they just too focused on HIV and AIDS to be able to give time to breastfeeding, or are they really unaware of the consequences of ignoring breastfeeding? How can we get the message of breastfeeding to them?"
Their discussion centred around evaluating the risk of infants contracting HIV through breastmilk, a phenomenon widely referred to as Mother To Child Transmission (MTCT). "Why is this disease named by the source of transmission? No other disease is identi .ed by the mode of transmission," noted Michael Latham. More suitable terminology would be to simply use "vertical transmission," or "childhood HIV." In order to shift the perceived fault of transmission from mothers, whose source of infection is not identi .ed when naming the disease, puts an extraordinary burden and blame on women and mothers when we use the term "mother to child transmission."
Global recommendations (WHO, UNICEF and UNAIDS) for infant feeding when mothers are HIV+ is that replacement feeding should be recommended when the conditions under which formulas or other substitutes are used are acceptable, affordable, sustainable and safe (AFASS). The goals for such policies are focused on decreasing transmission rates, yet the potential for meeting all the AFASS criteria is nearly impossible in the majority of situations. When an infant’s mortality risk of not receiving breastmilk is weighed against the risk of HIV transmission, the former remains the biggest potential for death, not to mention the side effects of malnutrition and increased illness. Hence, there is a need to change policy objectives to infant and young child health and mortality outcomes and away from the current aim of reducing HIV transmission.
"…with regard to HIV, the breastfeeding community were only ‘speaking in whispers.’ That is no longer true."
Research in exclusive breastfeeding by HIV positive mothers is confirmation that the risk of vertical transmission is the same as for no breastfeeding. It is, however, when mixed feeding of formula (formula is the most commonly used replacement feed) and breastfeeding takes place that the transmission rates increase. For many mothers mixed feeding remains a cultural practice. The need to comfort and feed her child at the breast is not easily abandoned. Additionally, there is a singling out of the HIV positive mother who is instructed to formula feed by the "authoritative" health care system. Formula feeding risks marking her as a positive mother and may put her and her child at risk for social isolation. Other questions of concern are the reestablishment of formula and artificial feeding and the subtle endorsement of this when formula is distributed and demonstrated by the health care system. To what extent will there be a "spill-over" effect to other mothers and infants?
Many more questions were addressed. Much emphasis was placed on the importance of establishing exclusive breastfeeding as a normal practice for all mothers, both HIV negative and positive and how to achieve this. As well, the need to give full nutritional and health care support to all mothers and children was acknowledged. Much concern was expressed about how to change the current practice of short term anti-retro-viral treatments during reproduction only and how this must be extended treatment to fully respect the health requirements of a mother for whatever duration is required.
Ongoing dialogue and action is needed. A full report of the meeting’s outcomes will be produced in the near future.
As Pamela Morrison so passionately stated, "Many years ago, someone told me that, in her opinion, and with regard to HIV, the breastfeeding community were only ‘speaking in whispers.’ That is no longer true. It’s the pooling of our collective voices, energies, expertise and experience which is so valuable. I see our Washington Symposium as another chance for us to combine our efforts and to be ‘heard’ more clearly."