Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117979

Cathy Liles, MPH, Center for Community Health Development, School of Rural Public Health, Texas A&M University System Health Science Center, 1103 University Drive, Suite 100, College Station, TX 77840, 979-862-4350, cliles@srph.tamhsc.edu and Marian Tompson, AnotherLook, P.O. Box 383, Evanston, IL 60204-0383.

The latest UN policy statement on HIV and infant feeding, issued in 2001, states: “When replacement feeding is acceptable, feasible, affordable, sustainable, and safe, avoidance of all breastfeeding by HIV infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life. To minimize HIV transmission risk, breastfeeding should be discontinued as soon as feasible (usually interpreted to be six months).” A review of references does not provide sufficient evidence to support this policy. There is a preponderance of reliance on risk of viral transmission without regard to impact on morbidity and mortality as outcome measures. There is no baseline natural history of infants born to HIV+ mothers. Route of transmission through breastfeeding has not been conclusively established. There is little consistency in the definition of breastfeeding, little identification of exclusive breastfeeding or of mixed feeding (higher risk than exclusive breastfeeding.) Mother's disease status and history of breast disease, cracked nipples or Candida infection are ignored as potential confounders. Control groups of infants born to HIV- mothers are not used. Non-water related safety issues associated with replacement feeding (acute respiratory infection risk) and evaluation of spillover morbidity/mortality associated with replacement feeding are not addressed. Mortality shifts from post-infant mortality due to AIDs versus neonatal mortality related to replacement feeding are not discussed. There is no evidence to support better outcomes in terms of morbidity/mortality for abrupt weaning or early discontinuation of breastfeeding. Reliance on mother-to-child-transmission as the primary outcome measure falls short of providing evidentiary policy support

Learning Objectives: After the presentation, the participant will be able to

• Recognize 2 components of the current UN policy statement
• Identify 3 critical areas lacking sufficient evidence to support the current policy
• Evaluate the policy as it relates to evidence-based practice

Keywords: Breastfeeding, HIV/AIDS

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.