Monday, November 11, 2013

Infected or Protected? HIV & Breastfeeding

I just read, "Discovered:  A Natural Protein in Breast Milk that Fights HIV."  It was written in the Smithsonian magazine blog under Surprising Science.  I like surprises, don't you??  Except this wasn't much of a surprise for me.  Although, I honestly had not heard of this particular human milk protein called Tenascin C.  But then again maybe I just don't remember, getting older and my memory sometimes short-circuits.

I wrote a position paper for AnotherLook  entitled "Patents, Breastfeeding and HIV," in 2001.  It was all about the patents at the US Patent Office that were using various human milk components to inactivate hiv.  The infant formula, food, supplement, drug and vaccine industries, educational and governmental institutions have patented various human milk components to treat or inactivate hiv.  Those components have been:  Lactoferrin, HMFG (Human Milk Fat Globule), HMO (Human Milk Oligosaccharides), etc. So now they have found this Tenascin C and hope to create a drug (according to this particular article).    In Health News the lead author of this study, Dr. Sallie Permar says they hope to create
a vaccine to "eliminate mother-to-child transmission."

I found myself reading the articles and shaking my head.  This is what Dr. Sallie Permar says according to Health News regarding the statement, "But only one in 10 HIV-infected nursing mothers is known to pass the virus to their infants."  She says, "That is remarkable, because nursing children are exposed multiple times each day during their first year of life."  Now the other article from the Smithsonian states that, "Only 10-20 percent of infants who are breastfed by infected mothers catch the virus."

Here it is 2013 and the statistics for transmission of hiv through breastmilk still vary enormously depending on the article you read.  So some 80-90% of supposedly infected mothers do not transmit hiv through breastfeeding, right??  And some scientists have known that various components of human milk prevent or inactivate hiv.  The CDC does not recomment breastfeeding for hiv-positive mothers because "baby formula is a safe alternative for U.S.-born infants." (article from news).  Tell that to moms in the USA whose babies died from Enterobacter sakazakii that had contaminated infant formula in 2011.

What were the studies on hiv transmission that health authorities accept?  Over and over again it has been a study submitted to the Lancet in 1992 by Dunn et al. in which it is estimated that hiv transmission through breastfeeding is 14%.  This study set public health policy.  And paved the way for world-wide policies of encouraging the use of infant formula and discouraging breastfeeding.  Although I would say that discouragement may not be the proper term.  It was far more drastic in the US in that it became a forced policy in which Child Protective Services were used to enforce compliance of infant formula feeding.  What happened during these years is that slowly world health officials began to recognize in developing nations that babies of hiv positive mothers were dying not from hiv/aids but from the risks of infant formula (diarrhea/dehydration, unsanitary conditions in which to prepare infant formula, lack of ability to pay for infant formula--watering it down, feeding other unsuitable foods).  It became a public health disaster

There is the belief that in some areas of the US, the conditions of poverty are close to some areas in developing nations.  When I worked for the WIC Program from 1994-1998, I worked with women and their babies who lived in their cars, or lived with relatives in small cramped trailers with little sanitation.  What happens when utilities are turned off for lack of payment--no way to heat that bottle of formula, no way to clean those bottles.  So I have never understood this two-prong policy, this magical belief that in the US, that everyone here has access to electricity and clean water and medical care.  And at the rate the politicians are currently pushing everyone into poverty, the numbers of disadvantaged in the US will continue to grow.  We have a two-pronged policy in which the WHO encourages exclusive breastfeeding for hiv positive mothers based on a criteria  called, AFASS

So we have a two-pronged policy on hiv transmission through breastfeeding in which depending on the country you live in,  will depend on whether you are encouraged or "discouraged from breastfeeding."
But what if the studies on hiv transmission through breastfeeding are incorrect?  I invite my readers who are interested in a different viewpoint to read a paper written by David Crowe, George Kent, Pamela Morrison, and Ted Greiner entitled, "Commentary:  Revisiting the Risk of HIV Infection from Breastfeeding."  It is on AnotherLook website and worth reading and considering.

I frankly think that hiv transmission rates through breastfeeding need to be revisited by the scientific community.  I think there were serious mistakes made back during the time because of the panic and need to solve a situation quickly.  But also from my perspective, I see that this policy was an enormous boost to profits for the infant formula industry.

The infant formula industry has financially benefited by these health care policies.  And not just from stopping hiv-positive women from breastfeeding but from the spill-over effect of such policies.  Not only does infant formula feeding become more common in various communities but a new notion appears in the media.  Breastfeeding known as a protector of infant life is now thought to be a carrier of infection, disease, and death.  How much of this policy was driven by narrow views, inadequate understanding of breastfeeding, and mostly the need for profit?
Copyright 2013 Valerie W. McClain

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