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HIV-Positive: OK to Breast-feed?

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HIV-Positive: OK to Breast-feed?

Health Care

HIV-Positive: OK to Breast-feed?

HIV-Positive: OK to Breast-feed?

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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It might seem like common sense for mothers: If you have HIV, don't breast-feed your baby. But recent research in developing countries suggests that it might be a risk worth taking. South African pediatrician Hoosen Covadia explains.


I'm Michel Martin. This is TELL ME MORE from NPR News.

Later in the program, the men of the Barbershop mixed it up over the presidential debates, football star Michael Vick's dog fighting scandal and the dominance of Latinos in baseball.

But first, AIDS in the developing world. The annual South African AIDS Conference this week has been exploring ways to combat HIV/AIDS in South Africa and around the world. One of the most serious issues the conference explored was slowing the transmission of HIV between mother and child. Now it seems like a no-brainer, because the virus is passed through bodily fluids, mothers with HIV should probably not breastfeed their babies, right?

Well, it turns out that advice is being challenged. Some studies suggest that babies of HIV-positive mothers in the developing world are actually better off if their mothers breastfeed.

Here to tell us more is Dr. Hoosen Coovadia. He's a pediatrician and professor for HIV/AIDS research at the University of KwaZulu-Natal in Durban in South Africa. He's with us from our studios at NPR West in California. Dr. Coovadia, thanks for joining us.

Dr. HOOSEN COOVADIA (Pediatrician; Professor, University of KwaZulu-Natal, South Africa): It's good to be here.

MARTIN: It just seems so obvious that bodily fluids like breast milk would transmit the virus. What made researchers question whether HIV-positive mothers should not immediately switch to formula?

Dr. COOVADIA: Well, it's been the policy in the U.S. and developed countries to stop women who are HIV positive from breastfeeding, and it's been enormously successful here. This was immediately taken up by the developing world, and many people tried to do the same thing there. But it isn't so easy, and it's turned to be quite dangerous to do so. This new studies have reawaken our interest and forced us to face the fact that providing formula feeding for poor women in developing countries is not the best option.

MARTIN: Is the issue that breast milk is not an effective transmitter of the virus, or is the issue that formula feeding poses so many other problems that turned out to be more dangerous to babies in the developing world?

Dr. COOVADIA: Although the virus is in breast milk, it isn't that easily transmitted. It is transmitted, but not that easily. Sort of - let's say a hundred women who are HIV positive and who breastfeed, about 75 of them would not transmit the virus to the baby, and that's a majority of occasions. And you got to balance that against the enormous dangers of formula feeding.

The problem is that with formula milk, one has to prepare it with - often with water, and it may get contaminated with other food in the hospitals. And once you contaminate that milk, it results in diarrhea mostly, but occasionally even gives these kids pneumonia and causes malnutrition. So the consequences of formula feeding in poor countries and poor families is very, very serious indeed. And the consensus now is beginning to develop that breastfeeding for poor women is a much safer option, even if the woman is HIV infected.

MARTIN: Have most doctors and health workers in the region accepted this idea that now breastfeeding is to be preferred? Is that generally accepted wisdom now?

Dr. COOVADIA: Well, it's accepted by the scientific community, but I must say, you know, it's an issue, which is driven with dissent. So you have people who would insist that what's good for the West is good for Africa and Asia, and we must try and provide formula and so on and so forth. So there are people who might still opposed it.

MARTIN: Did formula feeding actually ever take hold?

Dr. COOVADIA: Absolutely. They did. It was facilitated in my country, in South Africa and Botswana, because our countries are middle-income countries by the state, which provided free formula. So in Botswana, they provided free formula for such HIV-positive women, and in South Africa, they provided it for about six months. So if you're a poor woman and the state gives you free formula, even if you're not too sold on the idea, you will take that formula. And Botswana is really one of the most stable and democratic countries with a very, very rapid growth rate.

You know, if you were to ask me, which country would I choose to give formula to? I would have chosen Botswana. And what happened in Botswana in 2005, early 2006, they had a massive diarrhea epidemic. It really was stunning, because it was - it were almost as if nature was taken a vengeance, or whatever. And these kids all got about - thousands of them got sick with diarrhea and many, many of them died. And when the CDC from the USA was called in to investigate the likely causes and what could be recommended to improve things, they found the main risk factor - that means what mainly led to this - was women had stopped breastfeeding.

And because HIV-positive women had adapted formula - as I said, it was given free and they had started using formula and stopped breastfeeding - many other women, women who are not HIV-infected who should have been breastfeeding, because there's no danger in that, I mean, they got enormous advantages. Women who are not HIV-infected also stopped breastfeeding, and they started a formula feeding. So you had this whole population. And therefore, the kids lost some of the immunity.

MARTIN: When you think about all that is going on in your field, are you mainly hopeful, or are you not as hopeful about the progress that's being made in fighting this disease?

Dr. COOVADIA: Entirely hopeful. I'm pretty sure that within the next two to three years, we would have resolved the problem in principle of what needs to be done. When you translate that principle into actual practice by governments, it will take much longer.

MARTIN: Dr. Coovadia, thank you so much.

Dr. COOVADIA: Thank you very much for asking the right questions.

MARTIN: Dr. Hoosen Coovadia is a pediatrician and professor for HIV/AIDS research at the University of KwaZulu-Natal in South Africa. He joined us from our studios in Culver City. Doctor, thank you so much again for joining us.

Dr. COOVADIA: Thank you. Bye-bye.

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