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HIV AND INFANT FEEDING

Breastfeeding is the optimal way to feed an infant. It greatly improves quality of life by providing unique nutritional, immunological, economic, ecological, psychological and child spacing benefits. Breastfeeding also enhances maternal health.

Breastfeeding saves lives. Infant mortality continues to be very high in India and artificial feeding contributes to a major part of this. Malnutrition is rampant among infants and this can be prevented to a significant extent by Breastfeeding.

HIV transmission and infant feeding

Transmission via Breastfeeding to uninfected infants born to women with HIV infection is estimated to occur in 1 in 7 cases. The risk of HIV transmission through Breastfeeding is highest among women who become infected whilst Breastfeeding.

Mothers, health workers and organisations such as BPNI are faced with a dilemma concerning decisions about infant feeding. Given the evidence regarding the risk of HIV transmission through Breastmilk, it is vital for policies to be developed with regard to Breastfeeding by HIV positive mothers.

Recommendations

	Priority should be given to policies and programmes, which aim to prevent women of childbearing age and their partners from becoming infected with HIV in the first place. Appropriate preventive measures should be taken to reduce mother to infant HIV transmission.
	The general principle "irrespective of HIV infection rates, Breastfeeding should continue to be protected, promoted and supported" as enunciated by UNAIDS1 should be followed.
	Women should be "empowered to make fully informed decisions"1 about infant feeding and supported in their decision.
	Voluntary and confidential counselling and HIV testing should be made available for women of childbearing age and their partners. For those women who are aware of their HIV status, information should include the benefits of Breastfeeding, additional risk of transmission of HIV via Breastmilk, risks and possible advantages and disadvantages associated with other methods of feeding. This should be done in a supportive environment, which minimizes any possible discrimination or stigmatization.
	Women should be informed about the alternative methods of feeding such as using heat-treated (62.50C for 30 minutes) expressed Breastmilk, wet nursing, etc. and the use of a cup rather than bottle to minimize risks of artificial feeding.
	BPNI advocates adherence to the "Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992"2 and the World Health Assembly Resolution, 19943 which also recommends that there are no donations or low cost supplies within any part of the health care system.
	Research Needs There is an urgent need for more research on HIV transmission through Breastfeeding, and interventions that may permit Breastfeeding to be available to the infants of HIV infected women in Indian situation. Research should be funded and conducted in a transparent and independent manner by those who do not have a commercial interest in the outcome. Financial support for research and information of HIV and infant feeding matters should not create conflicts of interest.
	References:
	HIV and Infant Feeding. A Policy Statement Developed Collaboratively by UNAIDS, WHO and UNICEF May 1997.
	Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992. No 41 of 1992.
	WHA Resolution 47.5, 9 May 1994. Eleventh Plenary W.H.O. Geneva.
	World Health Assembly. Infant and Young Child Nutrition. Geneva: World Health Organization, 2001. Resolution WHA54.2.

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