Infant feeding dilemmas created by HIV: South African experiences

Breast-feeding is a route of HIV transmission from an HIV infected mother to her infant. However, breast-feeding is an important pillar of child survival and part of a mother's womanhood. This paper highlights the dilemma created by the risks and the benefits of breast-feeding and will discuss the implementation in South Africa, of the Safer Breastfeeding Programme, to reduce some of the known risk factors associated with HIV transmission. Operations research was carried out, including infant HIV testing at 6 wk, and 9, 12, and 15 mo. Among 188 breast-fed infants enrolled in the program who were HIV negative at 6 wk, 4 became infected by 9 mo of age (2.6%). Infants enrolled in the Safer Breastfeeding Programme had less breast pathology than is usually reported for HIV infected women. Limited success was attained in promoting heat treatment of expressed breast milk; however, it does appear to be a feasible option after 6 mo of age, and it is believed that mothers would practice it more widely if sufficient promotion and support was given to it. Mothers found it difficult to stop breast-feeding earlier than the norm, and it therefore is important that mothers considering early cessation of breast-feeding be given sufficient preparation and support.