Abstract

PIP: The human immunodeficiency virus (HIV) can be passed to the infant during pregnancy, childbirth, or breast feeding. Most infants born to HIV positive mothers do not become infected with HIV. The virus is found in breast milk; available research suggests 1 out of 7 breast fed infants of HIV positive mothers will be infected from breast milk. Mothers with recent or advanced HIV infections have more virus in their body fluids, including breast milk; therefore, a baby is more likely to be infected if the mother becomes infected during pregnancy, childbirth, or breast feeding, or if she is ill with acquired immunodeficiency syndrome (AIDS) related illnesses. If a baby is already infected, breast feeding will help the infant stay healthier longer. Health workers should discuss the benefits of breast feeding with all pregnant women. Information about the spread of HIV and sexually transmitted disease (STD) should be given; safe sex (condom use or abstinence) is important during pregnancy and breast feeding. If a woman's status is unknown, she should be encouraged to breast feed. In most communities, counselling and testing are unavailable. Where these services are available, the risk of infection through breast feeding should never be used to put pressure on a woman to take a test. Counselling prepares her for the possibility of being positive and allows her to make an informed choice about breast feeding. In some situations (especially if she herself is ill), a woman who knows she is HIV positive should not breast feed. However, alternatives may be unavailable, and the benefits may outweigh the risks. Health workers should assist the woman in making an informed choice. Issues to be considered include: 1) access to clean water and ability to pay for fuel or electricity to sterilize feeding utensils; 2) support from family or friends; 3) access to animal milk or shops that carry formula milk; and 4) ability to pay for formula or animal milk. To feed an infant for 6 months, 44 tins (500 grams each) of formula are required. Cow or buffalo milk needs to be diluted and sweetened (1 cup of water to 3 cups of milk, 4 teaspoons of sugar), and boiled to reduce the amount of curd and kill germs. Heating expressed breast milk to 62.5 degrees Centigrade for 30 minutes kills HIV and other organisms. Breast feeding by another woman is another possible alternative, but is not advised in areas where HIV is common.