HIV and Breastfeeding

By George Kent, PhD
Issue 94, May/June 1999

In the shadow of AIDS, we face new and wrenching issues of how best to care for children.

One expert says: Don’t forget whose needs must be paramount – the child’s.

There is a serious debate now underway regarding the feeding of infants by mothers who are HIV positive. The major tension arises out of the fact that under some circumstances the dangers of breastmilk substitutes may outweigh the risk of being infected with the HIV virus through breastfeeding. Factual information is scarce, and opinions tend to be strong.

Most observers agree that parents should have the freedom to make informed choices, but this freedom is of little value when the information available is grossly inadequate. Yet some parents are being told they must avoid breastfeeding or their children will be taken from them.

Thus the core question of how to feed infants in the context of HIV/AIDS raises serious human rights issues. My purpose in writing this article is to look at some of these issues, many of which have been overlooked by policy makers and journalists.

Infant Feeding in the Age of Aids
In recent years there has been a great deal of concern about the possibility of transmission of HIV from mother to child. Predictably, the suggestion that the virus might be transmitted through breastmilk has raised concern about whether mothers who are HIV positive should breastfeed their infants. But most experts in the field are having trouble agreeing on appropriate guidelines, leaving parents hopelessly confused.

In October 1995, for instance, the US Food and Drug Administration’s FDA Consumer magazine published an article that said without qualification, "Women who are HIV positive should not breast-feed." Presumably it referred only to the US.

On the other hand, the Joint United Nations Programme on HIV/ AIDS (UNAIDS), the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF) issued a joint "HIV and Infant Feeding" policy statement in May, 1997. It called for "informed choice," meaning that mothers should be free to choose the method of infant feeding, but to do so, must be fully informed of all the benefits and risks.

Laying out these benefits and risks a year later, the UN issued an update of its Facts for Life booklet, which covers many aspects of child care. In the section on AIDS, it stated, in effect: If a mother is infected with HIV/AIDS there is a risk that breastfeeding may give the virus to her uninfected baby; if, however, she chooses to use formula, there’s a risk of her baby getting diarrhea and other life-threatening illnesses; and finally, for mothers who do not have HIV/ AIDS, breastfeeding is the best way to ensure the survival and healthy development of their babies.

Only months after this booklet was first published, the UN significantly shifted its position on breastfeeding, officially announcing that it would discourage all women who are HIV positive from breastfeeding their babies.

The reaction to this announcement was swift and strong, reigniting many old debates about the merits and demerits of formula feeding. In a letter to the influential British medical journal The Lancet, two experts on breastfeeding, Michael Latham and Ted Greiner, said they were troubled by "the new proposals to . . . replace breastfeeding with formula feeding in HIV-1 positive mothers. We are concerned that WHO and UNICEF will invest major resources in formula feeding and few into alternatives, such as modified breastfeeding, heat treatment of expressed breastmilk to kill the virus, wet nursing, donation (or even sales) of breastmilk, and use of animal milks or homemade formulas. These options are preferable to the use of infant formulas in poor communities. None of them are easy, nor ideal, but they warrant careful study.