HIV and Breastfeeding: Challenges and the way forward

Aug 3, 2016

Welcome back to our series for World Breastfeeding Week!  So far we’ve covered the basics of breastfeeding as well as some of the main issues that women face in one of HAI’s countries, Timor-Leste.  Today we’ll swing around the world to two other HAI countries, Côte d’Ivoire and Mozambique, where HIV is still a major public health issue.

Breastfeeding can be challenging no matter where you live in the world, but HIV presents special difficulties for women and their families when it comes to ensuring that infants receive proper, safe nutrition during their first year of life.

As we have seen, the WHO recommends that all women breastfeed exclusively for the first six months of life, as it offers a wealth of nutritional and emotional benefits to both the mother and the child.  But breast milk can transmit HIV from the mother to the child, leaving HIV-positive mothers and families in a tricky position.  As we have scaled up HIV programs in Côte d’Ivoire and Mozambique, HAI has found that this issue weighs heavily on the minds of health workers and people living with HIV – so what to do?

SARAH_CI_FEB_2010

Photo credit: Sarah Gimbel, HAI

Replacement, or formula, feeding is one option for HIV-positive mothers to consider, and is indeed what the CDC recommends for women living in the US.  However, in other parts of the world, formula is expensive and can present health dangers to infants if unclean water is used to prepare it.  Replacement feeding can also be a source of stigma in places with high HIV prevalence, as it can single women out as potentially being HIV-positive in their community if they do not follow culturally accepted breastfeeding practices.  In 2010, HAI worked with Heather Buesseler as she prepared her MPH thesis in Bouaké, Côte d’Ivoire, and we found that breastfeeding was the single greatest challenge faced by new mothers who were HIV-positive.

More recently, a new approach, known as Option B+, has been embraced by the public health community and is being implemented in HAI countries Mozambique and Côte d’Ivoire.  Using this approach, HIV-positive pregnant and breastfeeding women begin lifelong antiretroviral treatment, which reduces the transmission of HIV through breast milk to less than 5%.  Option B+ has many other benefits as well, including protecting the health of the mother and preventing the transmission of HIV throughout the community.  Public health officials believe that for the first time in the history of HIV, we may finally have an approach that can actually eliminate new infections – if implemented properly.

For all its benefits, Option B+ requires a great deal of effort to implement and support.  HAI is supporting health workers in Côte d’Ivoire and Mozambique by offering training, on-site mentoring and coaching, and using Operations Research and Implementation Science to improve the capacity of the health center to deliver quality services – and to support all women in their efforts to provide the best nutrition for infants and newborns.  In Côte d’Ivoire, we also work closely with local, community-based organizations to ensure that women stay on their treatments and remaine linked into the health system.

 


Stay tuned! Tomorrow’s post will discuss the big WHY? Given the benefits of breast milk, WHY don’t more women breastfeed? Find out on tomorrow’s post.

 

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