In areas where HIV/AIDS is widespread, there is often intense debate over whether it?s safe for a woman to breastfeed. Supporters say babies who are breastfed are usually much healthier than those on powdered formula. But critics say breastfeeding results in many thousands of HIV infected babies each year. In Durban, South Africa, one small group that cares for AIDS orphans thinks it has an answer.

Anna Coutsoudis has watched HIV/AIDS spread across her country at an alarming rate. It its wake, the epidemic has left behind AIDS orphans, many of them infants. Ms. Coutsoudis is an associate professor of pediatrics and child health at the University of Natal. She is also the founder of a home for infant AIDS orphans.

She says, "Well, if we don?t do anything about the orphans, we are going to have a huge, huge problem. All these young children are going to be roaming the streets with no one to look after (them). And you know what happens when children don?t have boundaries, when children don?t have parental guidance or any guidance or any authority figures in their lives. They will mostly just run wild. And it?s actually quite a frightening thing. And most people just think of ?shame, the orphans.? But they don?t realize that it actually impacts on society as a whole."

She named her home for infants iThemba Lethu, which she translates as, ?I have a destiny.? It?s not an exact translation.

"iThemba Lethu is a Zulu word. The themba part actually means hope. When I first had the words ?I have a destiny? and I asked some Zulu friends for a translation, there was no actual word for destiny. There?s only a word for hope and hope is actually too soft, whereas destiny is a much stronger word. But unfortunately, there isn?t a Zulu translation directly for destiny."

Ms. Coutsoudis agrees that breastfed babies are healthier than those given formula. And says in poor areas, the use of formula can actually lead to health problems.

"Formula is actually a very risky substance to use. I mean you would only use it in a severe case like HIV. Otherwise, there are huge risks attached to formula feeding, which people don?t often realize," she says.

She says formula can lead to diarrhea in babies, which may not be easily treated in poor areas. Researchers say formula can irritate a baby?s intestinal tract, making it more vulnerable to infection.

"The very first little child that was brought into our home had chronic diarrhea and was very ill. And just because of my background in pediatrics I know the benefits of breast milk for diarrhea. And I thought to myself it would be so wonderful if we had breast milk for this child. In other words, if this child was being breastfed, he would not be getting such severe diarrhea," she says.

It became a case of necessity being the mother of invention.

"I knew a friend of mine who was breastfeeding at the time was also expressing breast milk and storing it for times when she would be away. So I went to her and said please would you just give me some breast milk for a couple of days for this little boy because he?s so ill, which she did. And it was remarkable. Within a few days this child?s diarrhea had cleared up. From that I thought if we could do it for this little boy, why can?t we just do it for all the children who come into the home. And that?s really what we said, let?s start a breast milk bank."

For the breast milk bank to work, it would need deposits. And since iThemba Lethu generally cares for about six infants at any given time, regular deposits ? or in this case donations ? would be needed.

"Well, what we do is go to antenatal classes where women are being prepared for delivery. And we give talks explaining that orphans, especially HIV infected ones, desperately need breast milk because of the immune benefits of breast milk. And women will usually want to do something because many women ? especially middle income women in South Africa ? want to do something about this terrible situation but don?t know how to help. And they almost feel like a surrogate mother for one of the children because they?re providing milk to allow this child to grow beautifully."

In the past two years, iThemba Lethu has cared for twenty babies, some were found abandoned on the side of the road. Foster families have been found for thirteen of them. Six are currently being cared for at the home and one child has died.

Anna Coutsoudis is looking for financial support so she can expand the program both in South Africa and elsewhere. It currently has the support of a local Durban church, Glenridge Church International. The program?s breast milk bank has been operating since August of 2001. It currently has about twenty women who donate breast milk for the AIDS orphans.