[procaare] Re: Breastfeeding and nutrition approaches for infants of HIV+ mothers (2)

["Uzodinma Adirieje" <afrepton@yahoo.com>]

Re: Breastfeeding and nutrition approaches for infants of HIV+ mothers (2)
- Uzodinma Adirieje, Nigeria
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Dear Everyone,
   
The contribution below raises some fundamental questions:

[*Mod note: please see below for comment that Uzo is responding to.]

1. Assuming there is no stigma in the families, should HIV+ mothers be professionally advised to exclusively breastfeed their babies for 6 months? (Para. 2 and 4 below)
   
2. If an HIV+ mother can afford substitutes regularly, should she be encouraged to still breastfeed, or use only substitutes, or a combination of the two i.e. mixed feeding? (Para 3 below)
   
3. If and when substitute is deemed as the option, how much, how frequently and for how long should it be given to the infant? 
   
4. What are/is the scientific evidence that "mixed feeding puts the infant at a higher risk of contracting HIV from the mother compared to exclusive breastfeeding" (para 4 below)
   
Cross-cutting responses are solicited.
   
Better Health,
   

Uzo?
   
****************************
Dr. Uzodinma A. Adirieje
Resource Centre Manager
Health Reform Foundation of Nigeria [HERFON]
Email: uadirieje@herfon.org, uaadirieje@yahoo.com
  

Eunice Ndirangu <eunice.ndirangu@aku.ac.ke> wrote:
  Re: Breastfeeding and nutrition approaches for infants of HIV+ mothers (1)
- Eunice Ndirangu, Kenya
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Dear all,

Breastfeeding in developing countries especially among women who are
living with HIV/AIDS has become a big challenge for several reasons.

First is the cultural aspect of breastfeeding whereby a woman who has
had a baby is culturally expected to breastfeed. For some cultures, it
is considered a taboo when a mother does not breastfeed and in other
cases the relatives and family ask too many questions as to why the
mother is not breastfeeding. To make the latter scenario even worse, the
community is becoming enlightened to the fact that mothers who are HIV
positive are asked not to breastfeed. As a result some women who are HIV
positive prefer to breastfeed to avoid being stigmatized (due to a HIV
positive status) by their families.

Secondly, majority of the mothers in developing countries cannot afford
baby milk substitutes. This means that telling mothers not to breastfeed
is likely to result in malnutrition and hence increased infant mortality
due to poor nutrition. 

However, to go round these problems healthcare workers have taken some
initiatives. For example, in cases where mothers are not willing or not
in a position to avoid breastfeeding, exclusive breastfeeding is
encouraged for the first 6 months. During this period the mother is told
not to introduce any other feeds because mixed feeding puts the infant
at a higher risk of contracting HIV from the mother compared to
exclusive breastfeeding. The other alternative has been the provision of
baby substitutes by organizations / various projects for mothers who are
willing to avoid breastfeeding but cannot afford alternative feeds.
However, the disadvantage is that these projects do not serve a large
number of mothers who are in need of the substitutes and hence majority
are still left with not option but to breastfeed.

In conclusion, I feel that in as much as there are policies and
guidelines on breastfeeding and nutrition in HIV/AIDS, a lot of the
implementation interventions will depend on the context and the needs of
the community and the country one is dealing with.

Kind regards,

Eunice Ndirangu,
Faculty,
Aga Khan University, Nairobi Kenya
Email: eunice.ndirangu@aku.ac.ke