HIV and Breastfeeding: The Fear. The Misconceptions. The Facts.

By Celia Farber
Issue 108, September/October 2001

Teresa Hansen, HIV-positive, and a mother of two who lives near Los Angeles, came home one day to find social workers from the bureau of Child and Family Services (CFS) waiting for her. An anonymous caller, who Hansen suspects was either her estranged husband or else his family, had informed CFS that Hansen, despite being HIV positive, was breastfeeding her child.

"They told me I had two choices," Hansen recalls. "Either I could go with them and get myself and the baby tested right away, or they would take the baby with them. It was very threatening."

Needless to say, she went along. She left her elder daughter, who is HIV negative, with a neighbor, and got into the car with the CFS officials. On the way to the testing site, the officials stopped at a supermarket to buy infant formula, demanding that Hansen cease breastfeeding her child then and there. They told her that many studies had shown that HIV can transmit via breastfeeding.

As a conscientious woman who had delivered both of her children at home and describes herself as "very healthy," Hansen was appalled when she read the label. "It was nothing but sugar and corn syrup. That’s supposed to keep a baby healthy?"

When the results came back, both Hansen (who at one time had -reverted to negative) and the baby tested positive for HIV, although the little girl was tested only with an extremely unreliable version of the AIDS test. From that point on, Hansen found herself being cornered by the very social-services infrastructure that was supposedly there to protect her. Her ex-husband, Jack, who remained staunchly orthodox in his views on HIV, AIDS, and medication, took her to court, arguing that Hansen was "in denial" of her illness and hence a dangerous mother. The judge eventually told Hansen she had to put the child on AZT or lose custody. (Jack, who had been taking several HIV medications, died last year.)

But Hansen had little faith in AZT, believing instead that good health requires eating well and avoiding most contaminants, including drugs. For her, breastfeeding represented an extremely crucial element in bolstering her child’s immunity, regardless of her HIV status. So she continues to breastfeed secretly (which is why she wished that her real name be withheld), hiding it even from her older daughter, who is occasionally questioned about her mother’s activities. "This is all so surreal," says Hansen. "They keep calling me, telling me that they’re only here to ‘help’ me, that I need to plan a will, and all this. I’m perfectly fine."

Protection, intervention, and treatment efforts aimed at beating back HIV have grown much more intensive over the years, culminating today in a barrage of new, high-tech drugs - often as many as eight at one time - that are euphemistically called "cocktails." At the same time, in the name of fighting HIV, several long-established medical practices have been disregarded, chief among them the once-sacrosanct practice of withholding virtually any drug from a woman during her pregnancy. The standard prescription now for a pregnant HIV-positive woman is to take AZT throughout her pregnancy, and to bottle-feed her baby afterward. Some doctors casually claim that "studies have shown" the HIV virus to be transmissible via breastmilk, but this is by no means clear.

The Joint United Nations Program on HIV/AIDS (UNAIDS) claims that 20 percent of babies born to HIV-positive mothers become infected during pregnancy and delivery, while about 14 percent become infected during breastfeeding. Worldwide, it estimates, 300 children are infected each day through breastfeeding, a figure that represents about 20 percent of the 1,500 children infected each day with HIV.¹

But if 1,500 children per day are said to be infected with HIV, 33,000 children under the age of five die each day from preventable diseases and malnutrition, "against which breastfeeding can provide an essential defense," according to the International Lactation Consultants Association’s Position Statement on this subject.² For mothers and babies in developing countries, breastmilk is not a lifestyle choice, but the difference between life and death.

For this reason, the World Health Organization (WHO) and UNICEF have consistently and strongly recommended breastfeeding in the Third World, even for HIV-positive women, as a first line of immune defense against the scores of health problems and diseases that ravage those populations. WHO recommends that all babies be breastfed for at least two years.

But in a major reversal of its previous position, UNICEF earlier this year announced that it was beginning a new, "stepped-up drive to prevent HIV-AIDS in children," explaining that the agency would henceforth distribute AZT to pregnant women in developing countries and call for access to "safe alternatives" to breastfeeding.³ The disadvantages of formula are described in terms of cost, not health.