Mail & Guardian (Johannesburg) - July 14 2000
Belinda Beresford

In the United States mother-to-child transmission of HIV has dropped by about 75%, according to the US Centers for Disease Control (CDC). By far the largest number of infections of children are now in sub- Saharan Africa.

Giving a short course of anti- retroviral drugs, such as AZT, has been shown to reduce the chances of a mother transmitting the virus to her infant during pregnancy and labour.

However, repeated studies have shown that the protective effects of the anti-retrovirals decline if the mother breastfeeds, although indications are that at two years the child has a better chance of not having the virus than if its mother had not had the anti-retrovirals. Safety also appears to be established, at least for AZT. Research looking at multiple studies has found that children may have some side effects, such as being slightly anaemic at birth, and having slightly more febrile fits than the control group whose mothers were not treated with AZT.

The problem is that the longer the mother breastfeeds her child, the greater the chances of her transmitting the virus. But in the developing world not breastfeeding carries its own risks of the child dying of any of a number of infections. Research has found in Thailand that even when a mother had access to a communal tap with potable water, the necessity of storing water outside a fridge meant that the bacterial count rapidly rose, with commensurate risk to the child.

However, there has been hope from research in KwaZulu-Natal which indicates that breastfeeding a child exclusively reduces the chances of HIV infection down to levels similar to those of a formula-fed infant.

The problem is that such feeding has to be exclusive; the child cannot be given anything else, even water, tea or gruel. This can be hard to enforce, especially when the mother has to work and so is not near her child throughout the day. A doctor familiar with the work said this issue reinforces the difficulties of public health. The optimum action in scientific terms could be for mothers to breastfeed, but in reality formula feeding from a cup could be the more realistic solution.

There are alternative ways of reducing transmission of HIV. For example, a child can be given antiretroviral drugs in the first few weeks of life in an attempt to prevent the virus from getting a hold.

Alternatively, the mother can be given the drugs, reducing the viral load in her body - which means a decrease in the chances of passing it on to her child.

But again, such interventions are hard in the developing world, where cost and lack of medical skills and infrastructure makes distributing anti- retrovirals extremely difficult.

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