HIV-Positive Mothers Not Convinced to Exclusively Breastfeed

Conditions on the ground in Botswana could thwart updated World Health Organization (WHO) guidelines, which recommend that new mothers with HIV breastfeed their infants, provided either or both are on antiretroviral (ARV) therapy, until at least the infant's first birthday.

Influencing the WHO decision was the randomized study by the Botswana-Harvard Partnership (BHP). In it, HIV-positive pregnant women in Botswana were given ARVs at 28 weeks of pregnancy, and they were told to breastfeed exclusively while taking ARVs until the infant was weaned at six months. The mother-to-child transmission rate was 1 percent.

"The [WHO] recommendations have not been instilled in government medical institutions, and I doubt it would be because it is not practical," said Dr. Unabatsho Maposa of the Princess Marina Referral Hospital. "The baby should not be given any other liquids except the mother's milk. Therefore, there is no woman who can do that because they are bound to give the baby something, and that is when it becomes dangerous for the baby."

However, Botswana's current protocol discouraging HIV-positive mothers from breastfeeding has its own dangers, said Dr. Joseph Makhema, BHP's project director.

"Currently, the protocol has been that women on treatment could not breastfeed their babies, while the babies had to take one month treatment while feeding on formula," Makhema said. "This exposes children to illnesses as the formula is not always prepared well or the bottles got exposed to infections."

And due to occasional formula shortages, Makhema noted it is "necessary to find a method that would be affordable and sustainable to control transmission of the virus from mothers to babies."

Botswana's Ministry of Health is drafting domestic guidelines and will disseminate them for implementation when they are finalized, said Koona Keapoletswe, acting director of the ministry's HIV/AIDS department.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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