Now in its fifth year, the Durban-based Ithemba Lethu milk bank has won widespread praise for its grass-roots response to South Africa's AIDS crisis. Ithemba Lethu, which in Zulu means "I have a destiny," is designed to bring the benefits of breast milk to AIDS orphans and sick children.

Anna Coutsoudis, a professor of pediatrics at the University of Natal in Durban, came up with the idea of a milk bank while working with HIV-positive orphans. Coutsoudis asked a friend who was nursing her own child for a donation of breast milk, and she saw an immediate improvement when she gave it to a particularly malnourished child. Coutsoudis said the bank provides infants with the immune-boosting power of breast milk while preventing the transmission of HIV and other blood-borne diseases.

The program spans racial and economic divides in a country that is both deeply polarized and increasingly overwhelmed by its AIDS epidemic. Most donors to the bank are white, while the recipients are primarily black. But the women involved in Ithemba Lethu say race is not an issue. "This land is in crisis, and this is one way that the babies who are in need right now can be helped," said donor Liezel Roome.

UNICEF, which provided the grant money to start Ithemba Lethu, said the bank could be a model for South Africa, where one in nine people are HIV-positive, and antiretroviral treatment for HIV-infected mothers is only now being widely introduced.

But Olive Shisana, a leading AIDS researcher and head of South Africa's Human Sciences Research Council, said while Ithemba Lethu's milk is safe, the idea of encouraging women to share breast milk or downplaying the efficacy of infant formula is concerning. "Using somebody else's milk, in a society where we have so many communicable diseases, presents a challenge," she said. In addition, some program critics say donating breast milk outside the family is contrary to African traditions.

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