Wall Street Journal, Wednesday, July 12, 2000
Michael Waldholz, Staff Reporter

"The scientific evidence we now have is dramatic. We can, without any doubt, block transmission of the virus from infected mothers to their children," said Glenda Gray, an AIDS-research doctor at Baragwanath Hospital in Johannesburg. "The only question to me is why aren't we doing everything we can" to do it?

That question has become one of the major issues to arise among the estimated 10,000 researchers, doctors, health activists, and government and public-health officials attending the 13th International AIDS Conference here this week. Central to the clash of opinions being expressed at formal meetings and in hallway encounters is a dispute that has raged on the African continent for decades as to whether newborn babies should be fed infant formula or breast milk alone.

"Resolving this issue is crucial if we are going to promote, as we should, the aggressive use of drugs to block mother-to-child transmission," said Helene Gayle, who runs the HIV/AIDS-prevention program at the U.S. Centers for Disease Control in Atlanta. The World Health Organization estimates that one million children in sub-Saharan Africa under age 15 are living with HIV/AIDS, the vast majority of whom probably contracted the virus from their mothers.

Studies Fan the Flames

Several recent clinical studies, the results of which have been leaking since the meeting began Sunday, are expected to show that a dose of one of several anti-AIDS drugs given to infected pregnant women during labor, and then to their newborn children immediately after delivery, can significantly reduce at birth the rate of transmission of HIV, the virus that causes AIDS, to children.

But data from several of the studies, which will be presented formally Thursday, suggest the benefits of the drug therapy can be significantly undermined in some instances if the mothers breast-feed their babies and pass on the virus through infected breast milk. Since the vast majority of women in Africa, especially in poor rural areas, breast-feed, some public-health experts are saying the drug therapy is less effective than had been hoped.

But others here are strongly urging, for the first time, that women on the continent be encouraged to bottle-feed instead, a policy that is counter to deeply entrenched attitudes and behavior here. Indeed, the view that infected mothers in developing nations such as Africa and India should choose bottles instead of the breast is resurrecting a 30-year old, intensely passionate argument about the health benefits of nursing versus bottle-feeding.

Formula for Controversy

In the 1970s, public-health advocates fought a ferocious battle with Nestle SA and other infant-formula makers about their marketing tactics in the developing world that, many people charged, induced poor women to rely heavily on infant-formula products. These critics argued that the use of the infant formula posed a threat to babies because many women used contaminated water or diluted the formula to save money. As a result, prior to the AIDS epidemic, promoting the natural benefits of breast milk had become a major public-health campaign in many nations.

But the surge of children born with HIV is forcing health experts to revisit the issue. The outcome of the debate is important because many nations, as well as wealthy donor foundations, are trying to decide if they should fund numerous programs to provide the transmission-blocking drugs regularly to women as they are about to give birth.

The Elizabeth Glaser Pediatric AIDS Foundation is expected to announce here Wednesday that it received $15 million from the Bill and Melinda Gates Foundation to support the use of the drugs. Boehringer-Ingelheim Gmbh, the German drug maker, said last week it will donate its drug Viramune to clinics and other programs that can demonstrate need.

One of the studies to be reported later this week is expected to show that a single Viramune pill given to a mother before delivery, and a single dose given to babies a week after birth, can drastically reduce transmission of the virus. The study is expected to fuel the breast- bottle dispute because many of the test subjects in Johannesburg used infant formula.

Special Session Called

"The evidence strongly suggests we should now be aggressively promoting the use of infant formula for infected mothers who have been treated" with the anti-AIDS drugs, said Stephen Spector, a University of California, San Diego, researcher, at a special debate on the issue held here.

But Hoosen M. Coovadia, chief of pediatrics at King Edward Hospital in Durban, said many women won't bottle-feed because they can't afford formula. Others refuse to bottle-feed out of fear that they would be stigmatized by using infant formula since it could identify them as being infected with HIV.

Dr. Coovadia said he thinks one solution may be to encourage infected women to breast-feed exclusively for at least six months after giving birth. That is because another study presented this week suggested that babies given breast milk exclusively from their infected mothers didn't get infected at high rates. Researchers said they believe that the natural immunities contained in breast milk may protect children. Others here argued, however, that those results are far from conclusive.

"Right now I think we should use the drugs and mothers should be given a choice," he said. "Where it makes sense for mothers to bottle-feed, that's what they should do. And if breast-feeding is what is the norm, then we should encourage its exclusive use."

Write to Michael Waldholz at mike.waldholz@wsj.com

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