DOCTOR DROPS BREASTFEEDING BOMBSHELL
Push to allow HIV-infected mothers to nurse sparks outcry
By Rosie DiManno
Toronto Star 12 July 2000
Durban -- To breastfeed or not to breastfeed: That is the
Certainly suckling was the most emotional debate yesterday at the 13th
International AIDS Conference, and the seminar which drew the keenest
interest - or skepticism, even alarm - among the 12,000 delegates in
"I came here thinking I knew at least one thing for sure, that
HIV-positive women should not breastfeed their babies,'' complained Dr.
Steve Thomas, from the University of Pennsylvania, after listening to
the much-anticipated presentation of South African researcher Dr. Anna
Coutsoudis, who strongly favours breastfeeding.
"Now I feel like I know nothing at all.''
Thomas wasn't alone. There was befuddlement and consternation among the
delegates, be they scientists or physicians or health-care workers. This
controversy has enforced the suspicion by lay people, especially here in
Africa, that the experts may not know very much.
"What are you telling us?'' Thomas continued, after rising to speak
from the audience. "And how can we now prevent this from turning into
another international controversy about AIDS? There's already been
enough of that at this conference. I promise you that this disagreement
about breastfeeding will be on the front pages of newspapers all over
the world tomorrow.''
Along the west-east or north-south divide between developed and
developing nations, the issue of breastfeeding by HIV-infected mothers
has suddenly turned into an area of impassioned debate among scientists.
This after it had been roundly agreed in the past decade that women with
HIV, the virus that causes AIDS, should definitely not nurse their
babies with mother's milk.
There's no doubt the HIV virus can be transmitted from mother to child
through breastfeeding, with women aged 15-49 now representing 43 per
cent of all new HIV infections.
Breastfeeding has been one of the most common means of infection for
infants who come into the world healthy, despite being born to afflicted
mothers. Having avoided infection in the womb or while emerging through
the birth canal, these babies have been immediately and exclusively put
Studies of HIV-positive women have shown that if the mothers are given a
four to five week course of the anti-retroviral drug AZT and provided
with safe alternatives to breast milk, the risk of mother-to-child
transmission can be reduced by half, from around 18 per cent to 9 per
Further, the largest clinical trial ever undertaken in the area of
transmission during birth or in the womb concluded the risk of infants
becoming infected can be reduced by 37 per cent if women are given
anti-retroviral drugs at the time of delivery. With no anti-retroviral
drugs, there is a 20 per cent risk of the mother passing on the virus at
These findings prompted UNAIDS, UNICEF and the World Health
Organization, two years ago, to negotiate with pharmaceutical companies
for the donation of anti-retroviral drugs that are now propelling health
projects for pregnant women in 11 pilot countries.
It was one of the few feel-good breakthroughs in the global HIV/AIDS
crisis. And in affluent Western countries, where cost is not a problem
and proper health coverage exists, mother-to-child transmission has been
That's not the case in Africa, Eastern Europe, South and Central America
or Asia, where breastfeeding (or a combination of breastfeeding and
formula) is the cultural norm and where drugs are out of reach for
The pro-formula undertaking in Third World countries, in this era of
AIDS, has also reversed the impetus of all those years that health-care
workers and feminists fought against the multinational baby formula
producers. Those companies had weaned poor mothers away from their own
milk - by offering free samples - even though the women were routinely
mixing the formulas improperly or used contaminated water, thus
Mother's milk was good. Mother's milk was healthy.
But not, alas, if mother had HIV. That was the consensus, until now.
"Breastfeeding now lies in a conundrum of complexity,'' said Isabelle
de Zoysa, who moderated yesterday's debate. "There has been an
intensive public health effort to promote and protect breastfeeding. Now
our hard-achieved efforts are threatened by HIV and AIDS.
"Affluent women can safely turn to other forms of feedings. But poor
women are expected to make difficult choices in deciding how to feed
their infants. The science here is evolving and the choices are
Coutsoudis, a scientist with the Department of Pediatrics at the
University of Natal, conducted a trial involving 551 mother-and-child
pairs. Of those, 157 were formula feeders, 118 were breastfeeders and
276 mixed both.
The women and babies were tracked over a two-year period, but exclusive
breastfeeding ceased when the infants reached about six months. This is
the customary age when mothers who breastfeed begin feeding their babies
other liquid nourishment or solid food.
Coutsoudis said her study showed a 44 per cent reduction in transmission
among women who breastfed exclusively for six months, even though the
mothers had HIV and were not taking drugs.
`Breastfeeding now lies in a conundrum of complexity'
But infection among those babies jumped once other food was introduced
to the babies' diet. She suggested the introduction of "allergy or
contaminants'' created a more fertile environment in the infant's system
for the HIV virus to take hold, perhaps supplanting whatever natural
It was left to Dr. M. G. Fowler, from the Centres for Disease Control
and Prevention in Atlanta, to carry the other side of the debate: the
predominant anti-breastfeeding view for infected mothers.
"Anna's findings are very compelling but the study was quite limited.
We just don't know enough yet,'' she said.
"I am very much in favour of breastfeeding, in general. But with
HIV-infected mothers, we shouldn't let our hearts lead us with dogma.''