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Breastfeeding and HIV

From Wikipedia, the free encyclopedia

Breastfeeding by HIV-infected mothers is the practice of breastfeeding of HIV-infected mothers and include those who may want to or are currently breastfeeding. HIV can be transmitted to the infant through breastfeeding.[1] The risk of transmission varies and depends on the viral load in the mother's milk.[2] An infant can be infected with HIV throughout the duration of the pregnancy or during childbirth (intrapartum).[3][4]

YouTube Encyclopedic

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  • Preventing Mother-to-Child Transmission (MTCT) of HIV/AIDS
  • Preventing HIV transmission in Breastfeeding
  • Mother to Child Transmission of HIV - Episode 3
  • Flash-Heating Breast Milk Kills HIV, 5/21/07
  • Risk of HIV Transmission from Breastfeeding when the mother is on HAART

Transcription

Hi, my name is Dr. Becky Kun. I'm a physician who specializes in HIV/AIDS. Welcome to "Preventing Mother-to-Child Transmission of HIV." Are you pregnant or thinking about having a baby? Then this video is for you. If you are HIV positive, it is entirely possible to have an HIV negative baby. However, your child may become infected with HIV during pregnancy, childbirth or while breastfeeding. If you take NO steps to protect your child from HIV and breastfeed the baby, there is between one chance in five and almost one chance in two that your child will become HIV positive. If you take NO steps to protect your child and do not breastfeed, there is between one chance in six and one chance in three that your child will become HIV positive. But if you follow your doctor's instructions, including the use of AIDS medications, the World Health Organization estimates that you can reduce the risk that your child will become HIV positive to less than one chance in twenty. The United States Centers for Disease Control and Prevention estimates that the risk can be reduced to one chance in fifty or less. If you are pregnant or thinking about having a baby, the information in this video could save your child's life, so please watch the whole video and listen carefully. See a Doctor If you know you are pregnant or are thinking about having a baby, see a doctor. They can give you health advice that will give you the best chance of a safe pregnancy and a healthy baby whether or not you have HIV. Get Tested for HIV and Other Sexually Transmitted Infections No matter how far along you are in your pregnancy, get tested for HIV and other sexually transmitted infections right away. The United States Centers for Disease Control and Prevention recommend that all pregnant women be tested for HIV and other sexually transmitted infections including chlamydia, Hepatitis B, and syphilis. The World Health Organization recommends that all pregnant women be tested for HIV and syphilis and asked about symptoms of other sexually transmitted infections. You may be HIV positive or have another sexually transmitted infection and not know it. In most places, testing for HIV and other sexually transmitted infections is free. If You're HIV Positive or Have Another Sexually Transmitted Infection, See a Doctor Right Away If you are HIV positive or have a sexually transmitted infection, do not despair. With modern AIDS medications, HIV positive people may remain healthy for years or decades. Many other sexually transmitted infections can be cured with antibiotics. The rest of this video will tell you about some of the steps your doctor may recommend to protect your infant if you are pregnant and HIV positive. Remember, different people have different needs, and different medications and treatment options are available depending upon where you live. Watching a video is no substitute for seeing a doctor and getting personal advice that's right for you. AIDS Medications HIV is the virus that causes AIDS. AIDS medications known as Antiretroviral Medications (ARVs) can prevent HIV from reproducing within your body. Your doctor will recommend that you take AIDS medications to protect your baby. When your doctor prescribes AIDS medications, it's extremely important to take every dose of the medications on schedule. A separate video called "Adherence for Life" explains why this is so important. If You're Already Taking AIDS Medications, Talk With Your Doctor and Keep Taking What They Recommend If you are already taking AIDS medications, your doctor will keep you on AIDS medications in order to protect both you and the baby. Starting AIDS Medications Immediately Your doctor may start you on AIDS medications immediately if you are not already on them. Your doctor is especially likely to do this if you are showing symptoms of clinical AIDS, your CD4 immune cell count is low, or the amount of HIV in your body is high. Starting AIDS Medications Later During Pregnancy Even if your doctor doesn't recommend that you start AIDS medications immediately, where possible, they will put you on AIDS medications later in your pregnancy to protect the baby. As of 2011, the World Health Organization recommends that if you don't need AIDS medications for your own health, you should still begin taking them as early as 14 weeks into the pregnancy to reduce the risk of HIV transmission to the baby. Scheduled Caesarian Section In some cases, such as a woman with a high amount of HIV in her body, the risk of mother-to-child transmission of HIV may be lower if the child is delivered via a scheduled Caesarian section rather than by a natural vaginal delivery. However, Caesarian sections have their own risks for the mother and the child. If a woman is on AIDS medications and the amount of virus in her body is low, vaginal delivery may have no more risk of HIV transmission than Caesarian section and is commonly chosen. Intravenous (IV) AIDS Medications During Labor and Delivery Where possible, every HIV positive woman should receive intravenous AIDS medications during delivery, once her water has broken. Where this is not possible, your doctor may give you oral AIDS medications to take when you go into labor. AIDS Medications for the Child After Delivery You can further reduce the risk that your baby will contract HIV by giving your baby oral AIDS medications after delivery. It's critical that you give the baby every dose of medication on schedule. If you are breastfeeding the child, you must give the child AIDS medications until at least one "week after all exposure to breast milk has ended." If you stop breastfeeding the child before the child is six weeks old, or if you are feeding the child only infant formula, you must give the child AIDS medications until at least four to six weeks after birth. Feeding the Child Formula Instead of Breastfeeding HIV can be transmitted to the baby through breast milk. Feeding your baby only infant formula can further reduce the risk your child will contract HIV. For infant formula to be considered, it must be safe for you and your child. For example, you must have reliable access to clean water and infant formula. Your doctor may recommend that you feed the child infant formula instead of breastfeeding. If you follow all your doctor's instructions and feed the child only infant formula, you can reduce the risk that your child will contract HIV to as little as one chance in fifty. AIDS Medications During Breastfeeding Feeding your child with infant formula may not be possible. For example, you may not have reliable access to clean water or may not be able to afford infant formula. When infant formula can't be used, your doctor will recommend that you breastfeed your baby. The doctor will also recommend that you take AIDS medications for at least as long as you are breastfeeding. This will reduce the risk that HIV will be transmitted to your baby through your breast milk. If you follow all your doctor's instructions and breastfeed the child, you can reduce the risk that your child will contract HIV to less than one chance in twenty. Don't Mix Breastfeeding and Feeding with Infant Formula Either breastfeed your child or feed your child infant formula, but don't do both. Feeding the child both breast milk and infant formula increases the risk that the child will contract HIV, become ill, or die. AIDS Medications for the Mother After Delivery or After Breastfeeding Ends Your doctor may tell you to stay on AIDS medications permanently to protect your own health. In a number of developed countries, many women who start taking AIDS medications stay on them. However, depending on treatment guidelines in your country, the doctor may have you continue taking AIDS medications for only a short period after delivery (if you are feeding the infant with formula) or after breastfeeding ends to reduce the risk that AIDS medications won't work against HIV in the future. Testing the Baby for HIV All babies born to HIV positive mothers should be tested for HIV. Your doctor will tell you when and how your baby should be tested for HIV. Babies can't be tested for HIV using ordinary adult HIV tests until at least one year after delivery, but they can be tested using a special test that looks for HIV in their blood. If a baby tests HIV negative one year after delivery, the baby is considered HIV negative. If Your Child is HIV Positive If your child turns out to be HIV positive, do not despair. With appropriate treatment, HIV positive children may be able to live a healthy life. There are college students today who were born as HIV positive infants. If your child is HIV positive, talk with your doctor about how to keep them healthy and make sure to follow the doctor's instructions exactly. Important Things to Remember Let's close by reviewing some of the most important lessons from this video. If you think you are pregnant or want to become pregnant, see a doctor and get tested for HIV. If you are pregnant and HIV positive, there are many things you can do to reduce the risk of mother-to-child transmission of HIV. Talk to your doctor about what to do and follow the doctor's instructions exactly. For AIDSvideos.org, this is Dr. Becky Kuhn.

Background

Breastfeeding with HIV guidelines established by the WHO suggest that HIV-infected mothers (particularly those in resource-poor countries) practice exclusive breastfeeding only, rather than mixed breastfeeding practices that involve other dietary supplements or fluids.[5] Many studies have revealed the high benefit of exclusive breastfeeding to both mother and child, documenting that exclusive breastfeeding for a period of 6 months significantly reduces transmission, provides the infant with a greater chance of survival in the first year of life, and helps the mother to recover from the negative health effects of birth much more quickly.[6]

Despite these positive indicators, other studies have determined that bottle-fed babies of HIV-infected mothers approximately has a 19 percent chance of becoming infected, in comparison to breastfed babies who had an approximate 49 percent chance of infection.[3] Such a variance in findings makes it difficult to institute a proper set of guidelines for HIV-infected women in third-world or developing countries, where alternative forms of feeding are not always acceptable, feasible, affordable, sustainable, and safe (AFASS).[5] Thus after much research, the benefits and/or consequences of breastfeeding with HIV are still currently under debate.[citation needed]

PMTCT policy challenges

The practice of breastfeeding for HIV positive mothers is a highly contested and controversial global public health concern. Programs for prevention of mother to child transmission (PMTCT) and other international guidelines offer preventative interventions to address mother to child transmission(MTCT) of HIV in Third World countries.[7] PMTCT programs provide HIV-positive women with recommendations and services including antiretroviral therapy (ART), modifications in infant feeding practices (i.e., exclusive breastfeeding or exclusive replacement feeding), and counseling.[8]

Although prevention of mother to child transmission (PMTCT) programs have been implemented across different regions, their success in resource-constrained settings is still widely debated upon.[9] In 2008, the majority of sub-Saharan Africa as a whole had an estimate of 430,000 HIV infections among children under the age of 15.[9] HIV-positive women's lack of participation and adherence to PMTCT services and infant feeding guidelines has made the success of these policies difficult, despite the knowledge and technology that has been dedicated to them.[9] Many women fear knowing their HIV status.[9] Generally speaking, HIV-positive mothers lack support, especially from males, thus resulting in their stigmatization and exclusion by members of the community.[9] It is because of this that most women end up losing contact with development programs, which end soon after the mother delivers.[9] The discontinuation of these programs makes a knowledge and understanding of different feeding options difficult for these mothers, because these programs are not there to present them with the necessary information.[9]

Cross-cultural experiences

Access to available resources for the prevention of MTCT of HIV varies across different cultural regions. "MTCT of HIV has been virtually eliminated in well-resourced settings such as the United States and Europe".[9] Available medical and therapeutic resources in developed countries can include drugs for HIV-positive mothers during pregnancy and labour, cesarean delivery to reduce the infant's exposure to infection; and modifications in infant feeding practices.[10] In third world settings, medical resources and technology can be very hard to find and can serve as a financial burden to HIV-positive mothers. HIV-infected mothers refer to counselors for expert knowledge and recommendations on infant feeding and health.[11] Treatment amenities in resource-constrained settings are also available to HIV-positive mothers in the form of antiretroviral therapy (ART) which is one resource that has contributed to the elimination of MTCT of HIV in first world countries.[10] In order to have access to resources, HIV-positive mothers must be able maintain follow up appointments regularly, however, this is problematic in resource-limited settings due to weak infrastructure in health care systems in countries such as India, Tanzania and Nigeria.[10] This can also serve as a dilemma for HIV-positive mothers because although limited resources are available to them, financial constraint can prevent women from accessing available treatments. This can influence HIV-positive mother's decision to rely solely on breastfeeding as a primary feeding option due to financial instability.[12]

Anthropological research demonstrates that in contexts where breastfeeding is essential to infant survival, such as in resource poor settings, PMTCT infant feeding guidelines challenge notions of motherhood and women's decision-making power over infant care, and colour HIV positive mothers' infant feeding experiences.[13] In eastern Africa, infant mortality is high and breastfeeding is vital for infant survival.[14] Here, motherhood is defined as the responsibility for ensuring the child's proper growth and health.[14] Breastfeeding is also seen as a cultural practice that helps create a social bond between mother and child.[15] However, there is a disjuncture between PMTCT policy's infant feeding guideline and what is considered to be good mothering behaviour.[5] The PMTCT policy promotes replacement feeding because it is believed to prevent the risk of transmission of HIV. However, adhering to such guidelines are difficult for mothers in resource-limited settings who believe that not breastfeeding one's child would be harmful to their health and survival, as well as threaten the "development of close bodily and emotional bonds between mother and child".[16] As such, not breastfeeding, for HIV-positive women, is perceived as failing to be a good mother.[14] Thus, PMTCT programs impact HIV-positive women's agency and decision-making in infant care, as well as challenge their cultural conceptions of good motherhood.[citation needed]

World Health Organization guideline

In an effort to further refine the United Nations guideline for optimal infant feeding options for HIV-infected mothers, the World Health Organization (WHO) held a three-day convention in Geneva in 2006 to review new evidence that had been established since they last established a guideline in 2000. Participants included UN agencies, representative from nongovernmental organizations, researchers, infant feeding experts, and WHO headquarters departments. The convention concluded with the following recommendations: If replacement feeding is acceptable, feasible, affordable and safe, HIV-infected mothers are recommended to use replacement feeding. Otherwise, exclusive breastfeeding is recommended. At six months, if replacement feeding is still not available, HIV-infected mothers are encouraged to slowly introduce food while continuing breastfeeding. Those with HIV-infected infants are recommended to continue breastfeeding even after 6 months.[17]

See also

References

  1. ^ Health, Australian Government Department of. "Human Immunodeficiency virus (HIV)". www.health.gov.au. Retrieved 2017-12-16.
  2. ^ Moland, K, Blystad A (2008). "Counting on Mother's Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa". In Hahn R, Inhorn M (eds.). Anthropology and Public Health: Bridging Differences in Culture and Society. Oxford University Press. p. 449.
  3. ^ a b White, E. (1999). Breastfeeding and HIV/AIDS: The Research, the Politics, the Women's Perspectives. McFarland & Company, Inc., Publishers. p. 12.
  4. ^ Polin, Richard (2014). Fetal and neonatal secrets. Philadelphia: Elsevier Saunders. ISBN 978-0-323-09139-8.
  5. ^ a b c Moland K, De Paoli M, Sellen D, Van Esterik P, Leshbari S, Blystad A (2010). "Breastfeeding and HIV: Experiences from a Decade of Prevention of Postnatal HIV Transmission in Sub-Saharan Africa". International Breastfeeding Journal. 5 (10): 4. doi:10.1186/1746-4358-5-10. PMC 2987846. PMID 20977709.
  6. ^ Stein Z, Kuhn L (2009). "Breast feeding: A time to craft new policies". J Public Health Policy. 30 (3): 300–10. doi:10.1057/jphp.2009.23. PMC 2813715. PMID 19806071.
  7. ^ Moland, K, Blystad A (2008). "Counting on Mother's Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa". In Hahn R, Inhorn M (eds.). Anthropology and Public Health: Bridging Differences in Culture and Society. Oxford University Press. p. 468.
  8. ^ Moland, K, Blystad A (2008). "Counting on Mother's Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa". In Hahn R, Inhorn M (eds.). Anthropology and Public Health: Bridging Differences in Culture and Society. Oxford University Press. p. 450.
  9. ^ a b c d e f g h Baek C, Rutenberg N (2010). "Implementing programs for the prevention of mother-to-child HIV transmission in resource-constrained settings: Horizons studies, 1999-2007". Public Health Rep. 125 (2): 293–304. doi:10.1177/003335491012500220. PMC 2821859. PMID 20297758.
  10. ^ a b c Bulhões AC, Goldani HA, Oliveira FS, Matte US, Mazzuca RB, Silveira TR (2007). "Correlation between lactose absorption and the C/T-13910 and G/A-22018 mutations of the lactase-phlorizin hydrolase (LCT) gene in adult-type hypolactasia". Brazilian Journal of Medical and Biological Research. 40 (11): 1441–6. doi:10.1590/S0100-879X2007001100004. hdl:10183/21217. PMID 17934640.
  11. ^ Hollen C (2011). "HIV-Positive Women's Responses to Global Policy in Infant Feeding in Canada". Medical Anthropology Quarterly. 5 (4): 503. doi:10.1111/j.1548-1387.2011.01182.x. PMID 22338292.
  12. ^ Krocker L, Beckwith A (2011). "Safe Infant Feeding in Lesotho in the Eras of HIV/AIDS". Annals of Anthropological Practice. 35 (1): 59. doi:10.1111/j.2153-9588.2011.01066.x.
  13. ^ Blystad A, Moland K (2011). "Technologies of Hope? Motherhood, HIV and Infant Feeding in Eastern Africa". Anthropology & Medicine. 16 (2): 105–118. doi:10.1080/13648470902940655. hdl:11250/2481714. PMID 27276404. S2CID 25899112.
  14. ^ a b c Moland, K, Blystad A (2008). "Counting on Mother's Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa". In Hahn R, Inhorn M (eds.). Anthropology and Public Health: Bridging Differences in Culture and Society. Oxford University Press.
  15. ^ Van Esterik P (2002). "Contemporary Trends in Infant Feeding Research". Annual Review of Anthropology. 31: INSERT. doi:10.1146/annurev.anthro.31.040402.085428.
  16. ^ Moland, K, Blystad A (2008). "Counting on Mother's Love: The Global Politics of Prevention of Mother-to-Child Transmission of HIV in Eastern Africa". In Hahn R, Inhorn M (eds.). Anthropology and Public Health: Bridging Differences in Culture and Society. Oxford University Press. p. 471.
  17. ^ "HIV and infant feeding: new evidence and programmatic experience" (PDF). WHO. Geneva, Switzerland. October 2006. Retrieved 9 September 2020.

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This page was last edited on 4 January 2024, at 05:18
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