Breastfeeding with HIV- the details

I remember in the year 2003, a cousin’s girlfriend gave birth to a baby boy and promptly named him Marc Viviene Foe, after the Cameroonian player who collapsed on the pitch and died shortly afterwards during the semi- finals of the FIFA Confederations Cup in France. The story is not so much about the footballer’s name but of how my cousin broke the news to us. He walked into a room where two of my friends and I were watching a reality TV show (Big Brother Africa), sat down without saying a word, and asked for a glass of water. He swallowed the water heavily, sighed and then spoke.

‘It’s a boy, his name is Marc Vivienne Foe, and the mother is breastfeeding, thank God.’ He went on and on about how he had patiently waited at the hospital for the baby to wake up so that he could see whether it was being breastfed or not.

‘You can’t believe how relieved I am that Jenny is breastfeeding, I was so nervous: he said. ‘Kwani does she have a problem with her breasts?’ One of my friends inquired.

‘You just don’t understand you guys: my cousin went on. ‘If she is  breastfeeding, it means we are safe. ‘Safe?’ I was getting curious.’Yeaa, safe, kwani hamjui hizi vitu, mtu ako nayo huwa hanyonyeshi,’ (someone who has it does not breastfeed)’ he went on excitedly. ‘Mmmmh!’ nodded my friend, ‘Now I understand. You thought you were positive, my friend. Stop jumping around, this thing is finishing people.’

Anyway the conversation went on and on. Now as I look back, I realize how naive we all were as we sat there thinking that the only way to ascertain a new mother’s HIV status is by her breastfeeding. The second largest percentage of new HIV infections after sex is mother to child during the process of labour and birth and at breastfeeding.

Dr. John Ong’ech a HIV specialist is very optimistic. He says if the latest World Health Organization (WHO) recommendations are anything to go by, we may soon have more and more HIV positive women breastfeeding their new born babies for as long as one year with minimal risk of infection. In the newest guidelines, the WHO is recommending that babies born of HIV positive mothers should be put on NEVIRAPINE for one year while the mother continues to breastfeed normally. The mother would also have to be on an ART (anti-retroviral treatment) course. This will come as good news especially to under privileged women to whom formula feeds are beyond their means.

As it is now, HIV positive mothers are encouraged to breastfeed exclusively for six months if they cannot afford formula feed, or formula feed exclusively. The key word here is exclusively. Living up to the word ‘exclusive’ has been the biggest challenge to mothers. Dr. Daltone Wamalwa, a pediatrician at the Kenyatta National Hospital, says breast milk is the best feed for any baby, whether borne of a HIV positive mother or not. Apart from being readily available, at the right temperatures and in hygienic conditions, it is the biggest immune builder in babies.

‘One of the leading causes of death in infants is diarrhea and pneumonia. These illnesses are well tolerated in breastfed babies than in formula fed babies. Reason being, breast-milk, in itself, is packed with nutrients that offer protection from such infections’ he says. The biggest challenge to Kenyan mothers living with HIV today is not whether or not to breastfeed but if they can afford the alternative formula feeds.

Florence Anjiko is living positively in the sprawling slums of Korogocho. I found her nursing Darren, her two year old son. She has lived with the virus for the last seven years. ‘Darren was a big mistake. If I had a choice, I would never have got him. But I still love him,’ she says.

Florence works as a social worker at the nearby VCT center, where she counsels and tests clients. Initially she would do odd jobs like washing clothes and cleaning up lodges at the nearby Eastleigh residential estate. On a good day, she would make up to Kshs 300. A bad day would give her as low as Kshs 50. With her pregnancy, she was in no position to continue with such odd jobs. Luckily, when she went to health centre for her routine check up, the nurse in charge offered her the chance to train and later work at the centre for minimal pay. After weighing the financial options, she decided that she would breastfeed the baby. As we chat she opens up to me as to why she chose this option.

‘Formula feed is quite expensive. The brand the doctor was recommending costs at least KShs 600. In addition, I would need bottles, a flask and jug to keep the water for making the feeds. I would have to boil the water to mix the milk, and put it in the bottles-it’s not easy. Then water is on and off in this place. Where would I even keep the clean bottles in this single room?’

Listening to her, I understand why she decided to breastfeed despite the fact that there is a chance she could have infected her baby with the virus. ‘So, how is the baby?’ I ask after some time. ‘He is fine, I mean, he did not get the virus. I think because I was on ARVs and I breastfed without giving him anything else, not even water for six months. Then I stopped, and introduced porridge. He is very ok. In fact he has never gotten sick apart from once when I travelled with him and he got a cold.’

Dr. Wamalwa says this is the typical case for most Kenyan women. ‘This is not to say that breast milk is 100 per cent safe in women on ART. However in an ideal situation, where the other can comfortably afford formula milk, has access to clean water and can maintain high standards of hygiene, formula feed is advisable as this will mean the baby has almost zero chance of getting the virus if they did not get it during birth,’ he concludes.

END: PG 31 /28-29