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In the 18 prevention of mother-to-child transmission (PMTCT) test sites, government has been offering formula milk to HIV positive mothers and encouraging those with access to clean running water to forego breastfeeding in favour of the formula.

A government commissioned report written by the Health Systems Trust provides an overview of the 18 sites and warns that with all the publicity surrounding government’s position on nevirapine, the more important and serious issue of its policy on infant feeding and providing free formula has been neglected.

Dr David McCoy, programme director at HST and lead author of the report, said that although the long-term aim should be to enable all HIV positive women to provide safe and affordable exclusive formula feeding, under the current circumstances, the policy may lead to higher rates of mortality and morbidity due to other diseases, as well as higher rates of mixed (formula plus breast) feeding. His views are backed up by leading nutrition experts at the University of the Western Cape’s School of Public Health, Drs David Sanders and Mickey Chopra.

Other infections

Sanders and Chopra said that if all HIV positive women elected to bottle feed, all of their infants would be susceptible to the dangers attendant thereto, with increased risk of death from other infections especially diarrhoea, one of the commonest causes of child death in South Africa. They pointed out that there was very little known about the psychosocial effects on a HIV positive mother when she is told that she might infect her child by breastfeeding.

Professor Jerry Coovadia, paediatrician and Head of Research at the Nelson Mandela Medical School at Natal University, also believes that government should not be providing formula milk – the most expensive aspect of its PMTCT programme – but rather encouraging women to breastfeed exclusively.

Less than 5%

According to a study done by the University of Natal, the risk of HIV transmission from exclusive breastfeeding for six months and then rapid weaning was "less than 5%", said Coovadia. Head of the HIV/AIDS programme in the health department, Dr Nono Simelela confirmed that in places where women don’t have access to clean running water, they have been advised to exclusively breastfeed – "and exclusively means just that – no water, no tea, just breastmilk".

Sanders, Chopra and Dr Jon Rohde of the Equity Project in the Eastern Cape, supported the call in the HST report for a national commission of experts to be urgently set up to review the current policy and guidelines on infant feeding and mother-to-child transmission. It was suggested that the so-called national commission of experts should incorporate experts from the field of nutrition, HIV and child health, and not just HIV.

Health minister Dr Manto Tshabalala-Msimang recently recognised the issues in the HST report while addressing parliament. She said she was particularly interested in the HST assertion that the key policy issue that confronted government was not the provision of anti-retrovirals, but the question of infant feeding. She said it broadened the debate from an HIV issue to a general public health issue. "The challenge is not only to reduce HIV rates among the babies, but ultimately to reduce the overall infant mortality and morbidity rates.

- (Source: Health-e News Service, 19 March 2002)

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