HIV, AIDS and infant feeding.

On World AIDS Day, December 1, 2006, the World Alliance for Breastfeeding Action (WABA) issued a statement warning that infant feeding policies aimed to avert transmission of HIV from mother to child can put babies at risk of death from the dangers of formula feeding:

'Worldwide, HIV-infection

'Research from Nigeria, Uganda, South Africa and Botswana documents high rates of young child morbidity and elevated mortality due to diarrhoea, acute respiratory infection and sepsis when formula-feeding replaces breastfeeding.

'... In an effort to prevent paediatric HIV infection, with a water supply generally regarded as safe, Botswana recommended replacement feeding by all HIV-positive women, accompanied by provision of a year's supply of free formula. Indeed, formula has been promoted so strongly that one in five uninfected or untested mothers have also stopped breastfeeding before their babies reach six months of age.

'But late last year Botswana suffered a catastrophic outbreak of gastrointestinal illness. Hospitals throughout the country were overwhelmed by 35,000 cases and 532 deaths. The most affected group was infants aged 0-12 months who were not breastfed. Assistance was requested from the US Centers for Disease Control, WHO and UNICEF. A closer evaluation found that a variety of pathogens was responsible, including cryptosporidium, enteropathogenic E. coli and salmonella. Over half the affected infants were already malnourished, and had received only 51% of the quantity of formula they needed before their illness. However, the most significant risk factor was that 93% were not breastfeeding, resulting in a 50-fold higher risk of diarrhoea and an 8-fold risk of dying from diarrhoeal illness. One village reporte the loss of 30% of its formula-fed babies.

'... Calls have been made for ethical and standardised research, monitoring and evaluation at all levels. In the face of inequitably distributed resources in an unequal world the events of 2006 constitute a tipping point for reassessment of the competing risks of postnatal HIV transmission and formula feeding.

'The recent WHO Technical Consultation on HIV and infant feeding, held in Geneva on 25-27 October 2006, was the first to be convened in six years to discuss this issue. WABA calls for formula feeding not to be recommended in communities that cannot safely support it, and for optimal breastfeeding to be revitalised and recommended where appropriate to maximise HIV-free young child survival in each different setting.

Endorse the Joint Statement on Gender, Child Survival and HIV/AIDS: From Evidence to Policy at www.waba.org.my/hiv/conference2006.htm