Demystifying HIV Transmission Via Breastfeeding

Chioma Umeha

When Kemi Adeola, a 30-year-old caterer, was diagnosed with HIV about six years ago, it was like giving her a ‘death sentence.’

The health condition had many “unproven’’ accompanying lifestyle rules and regulations, “dos and don’ts’’ that were supposedly aimed at making her live a longer and healthier life.

These ‘groundless’ guidelines also extended to her role as an expectant mother as she must be circumspect in feeding her baby to avoid giving him the infection.

Then, Kemi was pregnant of a baby boy but she lost him, even the next pregnancy which was twins. The three babies were HIV positive following her refusal to take the antiretroviral drugs. At a point, she ran away from home for three days due to fear. She thought she was going to die whether she took the drugs or not.

When she complied with taking her drugs, her fourth baby was diagnosed negative. However, she could not breastfeed her baby due to fear. She was afraid that the baby would become infected with HIV.

The same scenario played out in the case of Mrs. Adaoma Obinze and Hajiya Funmi Adetunji, who, when they were diagnosed with HIV, were told not to give their babies breast milk.

According to them, HIV is highly infectious and if one has it, the person is expected not to share dishes or cutlery and should avoid breastfeeding.

Funmi said that her friends even told her to feed her baby with artificial milk, water and even pap immediately after birth. This, she said, almost cost her the baby who consequently suffered diarrhea. The timely intervention of medical doctors saved the situation.

However, experts, especially Pediatricians, Nutritionists and HIV researchers have debunked these suppositions largely, saying they are all mere myths.

Previously, the World Health Organisation (WHO) advised HIV-positive mothers to avoid breastfeeding if they were able to afford, prepare and store formula milk safely. But research has since emerged which shows that a combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of HIV transmission from breast milk to babies.

However, many Nigerian mothers living with the infection do not breastfeed, despite emerging evidence which has confirmed that breast milk can maximise their babies’ health prospects.

To change the misconception, experts say that there is need for all health care centres for People Living With HIV (PLWH) to provide more education for mothers to comply with new research findings and WHO’s recommendations on breastfeeding.

The world health body recommends Exclusively Breastfeeding (EBF) in the first six months of a baby’s life for mothers who are HIV positive. The UN body enjoins them to continue the exercise, especially if they have access to anti-retroviral therapy.

Exclusive Breastfeeding helps in reducing child mortality by 13 per cent. Sadly, Nigeria loses about 2,300 children under the age of five every day, and over two-thirds of the deaths are often associated with inappropriate feeding and poor practices.

According to the National Demographic Health Survey (NDHS) 2013, the prevalence of EBF in children below the age of six months was only 17 per cent which means that at least 5.4 million Nigerian children each year do not get the benefits of breastfeeding.

However, imagining poor breastfeeding rate is one thing, but beholding the number of deaths, which is put at 103,742 child deaths each year caused by low breastfeeding rate is another thing.

This is in addition to the economic cost which is estimated to $21 billion per year, equivalent of 4.1 per cent of Gross National Income (GNI) of Nigeria. The poor breastfeeding habit is largely becoming a public health emergency.

Experts strongly believe that with the right level of ambition, the right policies and investment, countries can fully realise the potential gains from breastfeeding.

Commenting, Dr. Oliver Ezechi, Deputy Director of Research, Nigerian Institute of Medical Research (NIMR) said, “When mothers who are HIV positive take the ARV drugs, they cannot transmit the virus to their babies.  The rate of HIV transmission to babies is close to zero if their mothers are on ARV.

Ezechi said, “It is left for the health workers to explain to expectant and nursing mothers who are HIV positive that their babies are missing vital nutrients if denied of breast milk. It is also left for the health workers to explain to them that they cannot transmit the virus if they take their ARV as recommended. They should also explain to them how to take their ARV.”

Sharing same thoughts, Professor Chinyere Ezeaka, a Consultant Paediatrician and Head, Neonatology unit at the Lagos State University Teaching Hospital (LASUTH) and College of Medicine, University of Lagos as well as National President, Nigerian Society of Neonatal Medicine, said, “The child who is not on breast milk is likely to have 14 times more diarrhoea, vomiting and 10 times more broncho-pneumonia.

“These children are dying more from diseases that can be prevented rather than from the HIV. Many mothers use contaminated water and feeding bottles that might be infected by flies while giving formula milk,” Prof. Ezeaka further observed.

“If there is no intervention, the risk of HIV transmission through breast milk will be up to 35 to 45 per cent, but with intervention, that is, the mother and child must be on Anti-Retroviral Therapy (ARV), the transmission can be reduced to two percent.”

“Now that the country is moving with the global standard from the WHO, HIV mothers should do exclusive breastfeeding and on no account should these mothers mix exclusive breastfeeding with formula feed,” she warned.

“The HIV positive mother must be on her drugs likewise the child in order to continue exclusive breastfeeding. She has to be sure the child is well positioned and attached to her nipples so that she doesn’t have cracks on her breast. She should make sure the child doesn’t have sores around the mouth, oral thrush, e.t.c. so that there won’t be any form of mixture of maternal blood with the child’s blood.

“This is very critical and with that, Nigeria would be moving forward around infant feeding vis-a-vis HIV prevention from mother to child transmission.”

Prof. Ezeaka said, following the current guideline, the HIV positive mother breastfeeds for one year, adding that, by that time, the child would have got all the immunity and protection from the breast milk and has established complementary feeds.

Corroborating Professor Ezeaka, Dr. Clifford Lo, Associate Professor at Boston University said, “The issue with HIV has changed quite a bit because now we have treatments for mothers who are HIV positive. If they are on treatment, there is no problem with them continuing to breastfeed. If they are untreated then, it’s a major problem.

“There is almost no record of children with HIV in the United States and that should be the case for Africa. Hospitals should test and treat every mother with HIV so that there would be no child with HIV in Africa.”

He also stressed that mothers living with HIV should not be afraid of breastfeeding their children, stressing, “Once they are on treatment, their viral load goes down.”

He added, “Once a mother and her baby are on treatment, there is very little chance that the baby could contact HIV from the mother.”