by Keiron Audain

Created on: September 24, 2009   Last Updated: September 25, 2009

When it comes to HIV and its progression to AIDS, babies are at the greatest risk as their immune systems are not yet fully functional. Thus HIV progresses rapidly, especially if the mother has a high amount of virus particles in her blood, and if both she and the baby are malnourished.

There are three possible time periods in which mothers can transmit HIV to their children - during pregnancy, delivery, or breastfeeding. Out of all three, the breastfeeding route is arguably the most complicated one to deal with.

In developed countries, no HIV positive mother is advised to breastfeed, and if they choose to do so, they are provided with the necessary drugs to prevent them from passing the infection on to their baby. In Africa, women are told to breastfeed their children if they don't have access to clean water to prepare the formula for a bottle feed. This obvious fact has been backed up by numerous studies that show more children die due to contaminants in formula prepared with dirty water as opposed to HIV from breastfeeding.

This issue continues to bother me, and despite my reservations, I must concede that exclusive breastfeeding for six months will be better in the short-term than formula feeding with unsafe water - keyword in that sentence being short-term. Surely in the context of development, it will be beneficial to set up a medium to long term plan to provide access to clean water to anyone who doesn't have it, which would include those who need to prepare formula to cut down the risk of passing on HIV to their child.

As simple and obvious as that might sound, the reason why it is an issue for me is that I have heard so-called expert opinions comment on the lack of economic sense it would make to invest in alternative breastfeeding as it costs just as much to provide free formula as it does to provide free drugs for mothers to take while breastfeeding. So my issue is when and why has the emphasis been diverted to a battle between formula feeding and drug treatment, rather than on providing access to clean water, which is needed to administer BOTH formula feeding AND drug treatment?

You cannot escape the fact that some women would prefer to breastfeed even though they know they are infected, even in the West, as disclosing their status to family and friends can be difficult. And just like in the West, women who make this decision should be afforded the necessary protection, and this is where drug treatment comes in, so I would never enter an argument over which is better, but rather I relentlessly challenge the very existence of the argument in the first place.

Is it because extreme poverty is seen as a permanently established fixture within Africa, that Africans can only have one or the other, but never both?

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