In sub-Saharan Africa, women may face stigma and discrimination if they don't breastfeed their babies. That's because many believe those women have HIV/AIDS.
However, new research shows treatment can allow women to breastfeed despite their HIV-positive status. The findings were released this week at a major AIDS conference in Cape Town, South Africa.
Research conducted in Cameroon, Ivory Coast, South Africa and Zambia shows that the risk of HIV transmission can be greatly reduced during breastfeeding.
Dr. Laura Guay is vice-president of research for the Elizabeth Glaser Pediatric AIDS Foundation, which supported the research.
"We know that women who breastfeed are at risk of transmitting the infection to their baby in a small percent during breastfeeding. But that the risk of not breastfeeding is quite high in terms of death or illnesses. So, the studies were looking at ways that would allow women who are HIV infected to continue to breastfeed," she says.
Keeping infants HIV free
Guay says two studies looked at the best ways to prevent HIV infection in infants.
"One was to provide the mother who HIV was infected with three anti-HIV drugs that she would continue to take during the breastfeeding period for up to six months during breastfeeding," she says.
The other method tested, she says, "was instead of giving the mother multiple drugs, could you provide the baby that is HIV negative with one anti HIV drug. And give the baby the drug everyday while breastfeeding for six months."
Both methods proved effective. Shorter studies had been done earlier on giving infants anti-retrovirals.
Protecting HIV positive women
The women taking part in the study had not been on AIDS drugs because their immune systems had not yet been ravaged by HIV.
However, the emerging view is that anyone infected with HIV should be on anti-retrovirals. This could help prevent immune system damage in the first place.
"We know for sure that all women who are immune- compromised or don't have a strong immune system needing HIV therapy should be on it. And that is across the board," she says.
The findings have not been put into general practice yet.
"So the challenge will now be to take the information that we know and see how these practices would be implemented in the field," he says.
Getting women to treatment and treatment to women
A report known as the PEARL study shows that women who actually took part and completed treatment "varied greatly by country and facility."
The problem is access. The Glaser Foundation says few women in sub-Saharan Africa have access to even simple drug regimens.
"We know that only about 33 percent of women… have access to a program that actually has services in place to prevent mother-to-child transmission. So the first challenge is how do we reach all the women who do not have access to a prevention program.
And once treatment is made available, another challenge is to make sure women stay on it.
"Can you do outreach in the community, educating the population? Having community health workers try to identify where pregnant women are. Using peers or women that have been through the program to try to get the message out there," she says.
She says men should play a role as well.
"If you have a partner that's pregnant, it's important for all of her health to come to (an)ante-natal clinic," she says.
Not breastfeeding when HIV positive is the best way to prevent infection in infants. But it cancause other problems. Over the HIV/AIDS pandemic, many women became outcasts for not breastfeeding.
"We knew that the most important part that we could do was to allow women to breastfeed - but really look at ways they could do it safely," Guay says.
The Elizabeth Glaser Pediatric AIDS Foundation is one of the leading groups providing treatment for women and children in Africa. It's operated programs in developing countries for the past 20 years.