Intended for healthcare professionals

Education And Debate

Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan AfricaCommentary: The feeding debate is still unresolved and of secondary importance

BMJ 2000; 320 doi: (Published 17 June 2000) Cite this as: BMJ 2000;320:1656

Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa

  1. Michael C Latham, professor of international nutrition (,
  2. Elizabeth A Preble, international health consultantb
  1. a Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
  2. b Santa Fe, NM 87501, USA
  3. a Department of Paediatrics, University of the Witwatersrand and Chris Hani Baragwanath Hospital, Johannesburg, South Africa
  4. b Centre for Health Policy, University of the Witwatersrand
  1. Correspondence to: M C Latham
  • Accepted 17 May 2000

HIV and AIDS have seriously affected women of reproductive age in sub-Saharan Africa. In 1998, an estimated 590 000 infants worldwide acquired HIV-1 from their mothers; 90% of these infants were in Africa.1 Transmission of HIV from mother to child mainly occurs in utero and during delivery, but in a few cases it happens through breast feeding.2 Increased attention is being focused on strategies to prevent vertical transmission of HIV.3 These strategies need to be based on risk assessment and on cost effectiveness analysis. Interventions are aimed at preventing transmission in utero and during delivery or during breast feeding. Here we discuss only the appropriate infant feeding practices for HIV-1 infected mothers living in poor households in sub-Saharan Africa.

Summary points

Concern is increasing over mother to child transmission of HIV in sub-Saharan Africa

Decisions about interventions must be based on assessment of risks, costs, and benefits

The role of breast feeding in the vertical transmission of HIV has been exaggerated

Exclusive breast feeding reduces HIV transmission

Promoting infant formula feeding to prevent HIV infection might increase infant morbidity, malnutrition, and mortality

More research on alternative infant feeding methods is urgently needed

Exaggerated role

In many African countries, the HIV and AIDS pandemic is a major tragedy of unprecedented proportions that is increasingly affecting mothers and their children. However, even responsible health agencies have tended to exaggerate the role of breast feeding in transmission. It is estimated that in countries with a low seroprevalence of HIV (5% of women infected) fewer than 1% of all infants are likely to become infected through breast feeding, whereas in those with a high prevalence (25% of women infected) fewer than 4% of infants will be affected through lengthy breast feeding.4

The poverty factor

If preventing a child from acquiring HIV infection through breast milk were the …

Correspondence to: K Zwi, 1/10 Oaks Avenue, Cremorne, NSW 2090, Australia

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