Guidelines on Infant Feeding and HIV
Here the final press release of the 20-22 March meeting at WHO:
1 May 1998
WHO, UNICEF, UNAIDS ANNOUNCE GUIDELINES ON INFANT FEEDING AND HIV
In a concerted effort to stop the mother-to-child transmission of
HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its
co-sponsors the World Health Organization (WHO) and the United Nations
Children's Fund (UNICEF) have developed a comprehensive set of guide-
lines that support the use of alternatives to breastfeeding for in-
fants born to women infected with HIV, the virus that causes AIDS.
The guidelines are intended to help governments devise national poli-
cies to reduce the risk of HIV transmission through breastfeeding and
to assist health care managers in providing services and support to
this end. The guidelines stress the importance of protecting, pro-
moting and supporting breastfeeding as the best method of feeding for
infants whose mothers are HIV-negative or who do not know their HIV
status. But at the same time, they recognize the need to support al-
ternatives to breastfeeding for mothers who test positive for the hu-
man immunodeficiency virus.
Implementation of the guidelines was the subject of an intensive two-
day meeting recently hosted by WHO in Geneva. The meeting was at-
tended by: experts from WHO, UNICEF and UNAIDS; government officials
responsible for maternal and child health, nutrition and HIV/AIDS
programmes; representatives of nongovernmental organizations; and
scientists with expertise in infant feeding and HIV/AIDS.
The Right to Know and Choose
The guidelines emphasize the need to support HIV-positive mothers in
their right to know their HIV status, through voluntary counselling
and testing, and to choose an infant feeding method appropriate to
their needs. They stress that those mothers who decide not to breast-
feed their children must be ensured access to sufficient quantities
of nutritionally adequate breastmilk substitutes. WHO, UNICEF and
UNAIDS agree that there is an urgent need for the resources and in-
formation required to enable women to prepare these substitutes as
safely as possible.
Breastfeeding to be Protected
"These guidelines bring together two important goals: reducing
mother-to-child HIV transmission, and affirming the benefits of
breastfeeding, which is the optimal source of nutrition for most in-
fants", said Dr Tomris Tuermen, Executive Director, Family and Repro-
ductive Health, WHO.
WHO, UNICEF and UNAIDS also endorse the need to implement measures to
prevent breastfeeding from being undermined among HIV-negative women
and among those whose HIV status is unknown. There is a consensus
that methods for procuring, distributing and making available re-
placements for breastmilk must comply with the International Code of
Marketing of Breastmilk Substitutes, and subsequent resolutions of
the World Health Assembly.
Three Million Children Infected Worldwide
HIV can be transmitted vertically from an infected mother to her
baby: if breastfed, children born to HIV-positive mothers have a one-
in-three chance of contracting the virus. Of those infected, one-
third acquire the virus through breastmilk, with the other two-thirds
infected in utero or during birth.
To date, three million children worldwide have been infected with
HIV, and the rapid and accelerating spread of the virus has rein-
forced predictions that HIV/AIDS is becoming a major killer of chil-
dren, especially in the developing world. In 1997 alone, more than
half a million children were infected globally.
Offering a Solution
Ways now exist of helping women to reduce the HIV risk to their in-
fants both before and after birth. Recent results from a study con-
ducted in Thailand among non-breastfed infants showed a 50% reduction
in HIV transmission when women were given a short-course regimen of
AZT (zidovudine) during pregnancy and delivery. Participants at a
meeting convened by UNAIDS in March 1998, reviewed issues related to
the implementation of effective interventions in developing coun-
tries, particularly those involving the short-course AZT regimen.
For short-course AZT to confer its full benefits, it should logically
be coupled with measures after birth to help reduce the HIV risk
through breastmilk. As the HIV infant feeding guidelines state,
this means giving HIV-positive mothers better access to alternatives
to breastfeeding. The guidelines stress the need to improve women's
access to voluntary and confidential HIV counselling and testing, be-
fore and during pregnancy, and to proper counselling on infant feed-
ing. And they emphasize the importance of health care and social sup-
port for HIV-positive mothers and their children as they cope with
HIV-related illness and with possible stigma or discrimination.
Health care services, especially in developing countries, are a pri-
ority for WHO, UNICEF and UNAIDS. Unless reproductive and child
health services in particular are strengthened, they will not be able
to help prevent HIV infection in women and reduce mother-to-child
transmission of HIV.
UNAIDS and its two cosponsors underline that the best prevention ap-
proach is to help women of childbearing age to remain free of HIV,
and they will continue working toward this goal.
Working Together to Prevent HIV/AIDS
As a result of a consensus at both the March and April meetings, a
working group will be established to facilitate and support acceler-
ated action on the part of the United Nations agencies and organiza-
tions, UNAIDS and others. This working group will move as quickly as
possible to implement interventions to reduce mother-to-child trans-
mission, including adequate infant feeding alternatives.
Dr. Eric van Praag
CH-1211 Geneva 27
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