Mothers With AIDS Face a Dilemma

CYNTHIA, * a woman living in the West Indies, had a choice between breast-feeding or bottle-feeding her newborn. The decision might seem simple. After all, for decades health experts have been promoting mother’s milk as “the ultimate health food” for babies. Besides, bottle-fed babies in poor communities are about 15 times more likely to die from diarrheic disease than those who are breast-fed. In fact, the United Nations Children’s Fund (UNICEF) reports that some 4,000 children die every day as a result of hazards associated with breast-milk substitutes.

In Cynthia’s case, however, the decision regarding breast-feeding involved another danger altogether. Her husband had infected her with the human immunodeficiency virus (HIV), which causes AIDS. After giving birth, Cynthia learned that a child of an HIV-positive mother stands a 1-in-7 chance of becoming infected through breast milk. * Thus, she had to make an agonizing choice: expose her baby to the risks of breast-feeding or subject it to the hazards of bottle-feeding.

In parts of the world where the AIDS epidemic has hit the hardest, 2 or 3 out of every 10 pregnant women are HIV positive. In one country, more than half of all pregnant women tested were infected. “These alarming figures,” reports UN Radio, “have had scientists racing to find a remedy.” To respond to this threat, six UN organizations have pooled their experience, efforts, and resources to form the Joint United Nations Programme on HIV/AIDS, known as UNAIDS. * But what UNAIDS has found is that the solution to the AIDS dilemma is not so simple.

Complex Obstacles Blocking a Simple Solution

According to Edith White, a specialist on breast-feeding and mother-to-child transmission of HIV, health workers are advising HIV-positive women in industrialized countries not to breast-feed their babies, since this  nearly doubles the risk of the baby’s being infected. The use of infant formula seems like a logical alternative. But in the developing world—where idealistic theories quickly give way to harsh realities—this simple solution is hard to carry out.

One of the obstacles is a social one. In countries where breast-feeding is the norm, women who bottle-feed their babies may be advertising the fact that they have been infected with HIV. A woman may fear that she will be blamed, abandoned, or even beaten when her condition becomes known. Some women in this circumstance feel that they have no choice but to breast-feed their baby to keep their HIV-positive condition a secret.

There are other obstacles too. For example, consider 20-year-old Margaret. She, like at least 95 percent of Uganda’s village women, has never been tested for HIV. But Margaret has reason to be concerned. Her first child died, and her second is frail and sickly. Margaret is breast-feeding her third child ten times a day, despite the fact that she may have HIV. “I would never be able to feed my baby with formula,” she says. Why not? The cost of feeding one child infant formula, Margaret says, is one and a half times the sum that a family in her village earns in an entire year. Even if formula were available free of charge, there would still be the problem of finding clean water to make the formula into safe baby food. *

Some of these obstacles can be reduced if HIV-infected mothers are provided proper sanitation, adequate amounts of breast-milk substitutes, and access to safe water. Expensive? Perhaps. Yet, surprisingly, making such provisions seems to be more a matter of setting priorities than finding funds. Indeed, the UN reports that some of the world’s poorest developing countries spend about twice as much on the military as they do on health and education.

What About Anti-AIDS Drugs?

UN scientists have reported that a simple and relatively inexpensive drug called AZT can significantly reduce mother-to-infant transmission of HIV. With the help of UNAIDS, the cost of this treatment has been lowered to $50. Moreover, AIDS researchers announced in July of 1999 that treating HIV-positive mothers and their newborns with only $3 worth of the drug nevirapine appears to be even more effective than AZT in preventing HIV transmission. Health experts say that nevirapine could prevent up to 400,000 newborns per year from beginning their life infected with HIV.

However, some criticize such drug treatments, claiming that since they are limited to preventing HIV transmission from mother to baby, the mother will eventually succumb to AIDS and leave the child orphaned. The UN counters that the grim alternative is letting babies contract HIV, thus condemning these innocent victims to a slow and sad death. They also contend that HIV-infected mothers may live on for years. Consider Cynthia, mentioned earlier. She learned that she had HIV in 1985, when her baby was born, but she did not become ill until eight years later. And even though her baby had HIV at birth, by age two the child was free of it.

The Bible’s comforting assurance is that a truly safe environment and the lasting solution to scourges like AIDS are in sight. (Revelation 21:1-4) Jehovah God promises a new world in which “no resident will say: ‘I am sick.’” (Isaiah 33:24) Jehovah’s Witnesses would like to tell you about this lasting solution. For more information, please contact the publishers of this magazine or Jehovah’s Witnesses in your community.

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[Picture Credit Line on page 20]

WHO/E. Hooper