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October 2003 Breastfeeding and HIV: No Easy Answers An estimated 35 to 40 percent of infants born to HIV-positive women contract the virus during pregnancy, delivery, or breastfeeding if no action is taken to prevent mother-to-child transmission. Yet, breastfeeding is known to give an infant an optimal nutritional start in life—the incidence of infant mortality from diarrhea, malnutrition, and respiratory infection is greatly reduced for children who are breastfed. HIV-positive mothers must make difficult choices about how best to care for their newborns. Antiretroviral drug therapy for mothers and infants, cesarean section deliveries, and the use of infant formula rather than breast milk can significantly reduce the likelihood of HIV transmission. These options are proving successful in reducing transmission in the world’s richer countries. However, these options are not yet viable alternatives for most HIV-positive mothers in sub-Saharan Africa, where as many as 90 percent of new infections among infants worldwide occurred in 2001 and mother-to-child transmission continues to be a major factor in the increase of HIV infection among children. Simple and cost-effective intervention strategies for reducing transmission that can be integrated into existing health clinic settings are helping to stem mother-to-child transmission. UNAIDS, UNICEF, and WHO advise that health-care managers conduct a thorough investigation into local infant feeding options and weigh the relative risks specific to each local context. Research suggests that there are safer ways to breastfeed, namely through exclusive breastfeeding. The chances for transmission are greater the longer children of HIV-positive mothers breastfeed and if children receive solid food in combination with their mother's milk. It is not clear exactly why this is the case--whether solid food causes small tears in the gastrointestinal tract and thus enhances transmission of HIV or if breastfeeding on a more sporadic basis increases the likelihood of infections in the breast, which then can increase the viral load in the mother and thus transmission to the baby. A recent study conducted by Horizons researchers and partners in Ndola, Zambia, showed that mothers-to-be who participated in counseling about HIV transmission during their pregnancies made better-informed choices and maintained practices--including breastfeeding exclusively and weaning their children after four to six months--that reduce transmission of HIV. For more information, see "Breastfeeding education helps PMTCT" at www.popcouncil.org/horizons/articles/ndolapmtct.html. "Empowering communities to respond to HIV," the final report on the Ndola Demonstration Project, can be downloaded from www.popcouncil.org/pdfs/horizons/ndolafnl.pdf. Copies of the report are available free of charge by e-mailing horizons@popcouncil.org. See Also
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