Mar 7, 2004
I'm wondering if there is any new research and info available regarding HIV and breastfeeding and what/if alternative choices/options may be available for expectant women who would prefer to have their babies breastfed, such as "wet nursing" or breast-milk banks (like they have in Sweden), etc. as a healthier alternative to formula feeding.
La Leeche has published a couple of articles that pose conflicting and questionable statistics in regards to studies done in Africa of HIV women who have breastfed solely with low transmission rates; and some who have breast and bottle-fed with increased risk of transmission.
And then there is the "boil-sterilizing" of breastmilk question; which if could truly eliminate any virus within the breastmilk would still be a better alternative to the formulas available if possible.
Why is none of this research being done, or if it is can anyone on this forum supply the resources? The formula only-option for women with HIV has many drawbacks that are not discussed such as constipation in infants, soy-based formulas now being shown to create allergies in children, and the most obvious are the ingredients contained in mass-marketed formulas.
Since breastfeeding is the "best food" for an infant and supplies so many benefits why is there no alternative sources being researched in this area, especially within HIV and women?
Thank you for your input and it's fine to leave out the basic-known evidence that has already been discussed here on the forum as within other findings already published I'm really looking for up-to date and alternative options for this issue or any good recommendations for sources that can be delved into further.
Response from Dr. Lee
You are asking some important and very sophisticated questions for which there are few scientifically proven answers. I am unsure if your questions are from a personal interest, or merely curiosity, but let me give you my opinions as a doctor and as a mother who believes strongly in breastfeeding (and did breast feed two daughters for a total of almost six years).
When mothers are healthy, breastfeeding is indeed the preferred form of nutrition for infants. However, in the case of HIV, breastmilk (which is composed of many elements which make it similar to blood- including live white blood cells) carries not only the nutritional and other benefits, but a deadly passenger in the white cells- HIV.
Certainly the use of formula has drawbacks. In some parts of the world the conditions are such that in fact the high risk of HIV transmission is outweighed by the even greater risks of death due to other causes such as the infectious agents in the water.
However, in the developed world many, many children have been raised on formula and have done well. For example, the risks you mention of constipation or allergies are certainly far less significant than the risk of HIV infection.
Wet-nursing is an option. In the US a couple of decades ago there were milk banks (sort of like blood banks) where women could give milk for babies whose mom's couldn't nurse. Those have mostly closed because of the risks we have just covered. If a mom knows of another mom who could wet-nurse the baby, it could still work. But, remember that diseases, etc. including HIV can be passed. So, again this may not always be a "healthier alternative".
Boiling human milk destroys many of the sought-after nutrients and immunologic substances in the milk. It also may alter the proteins and thus the milk may not be as easily digested.
The studies in Africa are difficult to interpret because the environment for women is so different. In fact there is significant pressure in some communities to breast feed. In those areas, mothers who wish to avoid the social ostracism and stigma attached to HIV may intermittently bottle feed at home and publicly breast feed to please their mothers-in-law or other community members. Thus the babies are getting the worst of both. That is they may be exposed to the negative aspects of formula (including infections that may make them in fact more susceptible to HIV) and also to HIV from their mothers.
The problems with soy based formulas causing allergies and other digestive problems have been known for more than twenty years. The comparisons of milk from various sources led scientists to base the best formulations of substitute milk on cow's milk which has the most similar proteins to human milk. Many of the other additives in formulas are attempts to approximate the proportions of fats, sugars, and other characteristics of human milk.
Even the formulas available in the 1940's and 1950's gave many children a good start in life. Today's formulas are more digestible and have more similarities to human milk than ever before.
Some studies are underway in areas of the world where choices are more difficult. However, in developed countries with good water supplies and the availability of adequate substitute formulas, it is ethically questionable to study HIV+ mothers breastfeeding. I would find it very difficult to justify such studies. To be quite honest, I would not recommend breastfeeding to any HIV+ mother in my community.
La Leche League does a great deal of good in supporting mothers who have a difficulties breastfeeding or wish social support and for whom there are no contra-indications. But, the extreme zealots who speak of "always" or "never" may be harmful for some. In the case of HIV infected mothers in the developed world, breast is not always the best.
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