Breastfeeding provides a baby the best possible start in life. It contains antibodies and protects the baby against diarrhoea, respiratory and other infections. It also stimulates mother-to-child bonding and helps in the emotional, psychological and neurological development of the baby.
Breastfeeding is the norm in most developing countries. However, the spread of AIDS in the past two decades, especially in Africa, has brought up new challenges because human immunodeficiency virus can be transmitted through breastfeeding. According to UNICEF, 90 percent of children infected with HIV contracted the virus through mother-to-child transmission (MTCT). Mother-to-child transmission can occur during pregnancy, childbirth or through breastfeeding.
Breastfeeding Options for Mothers with HIV
Approximately one-third of the children infected through MTCT contract the virus through breastfeeding. It is essential that mothers with HIV take adequate precautions to prevent the transmission. The WHO guidelines give four options for mothers with HIV:
- Give suitable replacements for breast milk. This is the best option, provided these are affordable and can be prepared hygienically.
- When suitable replacements are not available, breastfeed exclusively for three to six months. A recent study has found that in the absence of suitable replacements, breastfeeding exclusively for three to six months followed by early weaning substantially reduces the risk of transmission.
- Manually express and heat-treat breast milk or use a breast milk bank.
- Use a wet-nurse who is HIV-negative and accepts that there is a small chance of infection from the baby through breastfeeding.
Of all the options available, suitable replacements are recommended for HIV-positive mothers in the developed countries. In resource-deficient developing countries, breastfeeding exclusively for three to six months followed by early weaning has been found to reduce the risk of infection by one-third.
Breastfeeding protects the baby against other diseases like diarrhea and respiratory infections, a leading cause of infant death in developing countries. Supplements such as juice, water and formula might be contaminated and when given to the infant can injure the immature gastrointestinal tract, and may expedite the HIV infection. Thus exclusive breastfeeding may be the only viable option when hygienic replacements are not available.
Prevention of HIV-infection if the Woman is Breastfeeding
If the HIV-positive mother chooses to breastfeed, breastfeeding exclusively for three to six months is the most suitable course of action. The longer the woman continue to breastfeed, the higher the risk of infection, so early weaning is recommended. The risk of infection is higher with cracked nipples, mastitis and other inflammations in the breast or if there are sores or thrush in the mouth of the baby. Prevention and early treatment of these will prevent the infection to an extent.
The viral load and the chances of transmission is higher shortly after an infection, so taking steps to prevent infection to breastfeeding mothers is highly recommended. Similarly, women with fully developed AIDS have higher viral loads and the probability of transmission is also higher in them.
Sources:
1. UNICEF
2. Pathfinder Organization
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