[pronut-hiv] IS reduction of postnatal HIV transmission the overriding goal?

["Ted Greiner" <tedgreiner@yahoo.com>]

Rachel,

Many do believe, like you, that the overriding goal is
to reduce HIV transmission. If postnatal transmission
rates are the only health outcome indicator we need to
pay attention to, then you are right that the best way
to make it appear that a program is successful is to
artificially feed all the infants--and free or
subsidized formula will indeed support such an
approach.

UNICEF, for example, stopped distributing free infant
formula on the realization that such a goal was too
narrow. Chopra recently pointed out in an IFPRI
symposium in Durban that providing formula to women
who choose replacement feeding is an unfair and biased
income transfer to the women in the community who are
likely to be the wealthier ones for whom replacement
feeding is AFASS. If formula is to be distributed
free, an equivalent subsidy in food should thus be
offered to mothers who choose breastfeeding--also to
support their nutritional status. (I would love to
hear about it if anyone knows of anyplace where such
an enlightened policy is pursued.)

Fortunately, increasing numbers of policy makers are
recognizing that a better goal is to optimize HIV-free
survival rates and that to achieve this we need a
balanced approach to infant feeding counselling that
recogizes the need to balance risks. 

We desperately also need more research on health
outcomes of different feeding patterns in different
settings in the real life PMTCT context (as opposed to
longitudinal studies, which result in biased data
since researchers have to try to keep participating
infants from dying of diarrhea, ARI etc) to help guide
future counselling efforts. The only place from which
I've seen a reasonably good effort made and reported
on is Pune India (Phadke et al 2003 and Shankar et al
2005). 

Ted Greiner
Senior Nutritionist
PATH


Ted Greiner, PhD
Senior Nutritionist
PATH 
Suite 800
1800 K St NW
Washington DC 20006 USA
tel +1 202 822-0033
www.path.org


Personal website: http://www.geocities.com/tedgreiner


---"Rachel Stern"-wrote:


Is the cost of this medicine subsidized? If so, 
couldn't the cost of formula be subsidized in the 
same way? True the overriding goal is to prevent 
HIV transmission, and antiretrovirals certainly 
do that, but these are potent drugs to be given 
daily to babies. Formula seems safer to me.

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