[pronut-hiv] Stopping breast feeding

["Ann Burgess" <annburgess@sol.co.uk>]

Stopping breastfeeding for the HIV positive mother

Regarding my recent question to the group on how to advise HIV+ mothers to stop breastfeeding quickly, some of you might be interested in this reply I
had from a colleague, Lida Lhotska, of IBFAN-GIFA.

Lida writes:
" I am afraid there is not any definitive answer to HOW HIV-positive mothers can stop breastfeeding exclusively so that it is safe (for both the mum and
the baby) and quick. I understand that the evidence from operational research is trickling in and that, for example, in Uganda, Zambia and Botswana this
option was considered possible. It is easier to say than do and mothers do need, just like with other aspects of breastfeeding, adequate support and
possibly assistance to be able to make this transfer within several days.
Trained counselors were able, as reported from the above mentioned countries, to help mothers overcome difficulties and problems they encountered.  Support
from families and provision of replacement feeds had also positive impact. The main problems encountered were: breast engorgement, mastitis, crying babies,
problems with sleeping, loss of appetite and diarhoea. Some mothers met with objections from the family becuase of the economic constraints linked with
replacement feeding. Botswana reported more problems when cesation occured < 6 months. I am not certain whether there is now an evaluation of the intervantion available which would assess impact on the HIV transmission and child survival. Colleagues from the LINKAGES Project have been working on this
particular question so you may find them a good source of the latest information. You find more information about their work at http://www.linkagesproject.org "

Lida also tells me that, as many of you know,  the WHO/UNICEF/UNAIDS 'Infant Feeding and HIV guidelines' are being revised.

Thank you to those who also sent ideas for dealing with this topic. I was
interested in the one that suggested separating mother and baby. In Uganda, when we worked there long ago, young children were sometimes sent to grandma
when the mother wanted to stop breastfeeding - it seemed that this was one trigger for severe malnutrition. I wonder if this practice still exists -and whether the group feels it should be promoted or discouraged?

Best wishes
Ann  Burgess

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