Vuyiseka Dubula talks to mothers about the discontinuing of free formula milk at government clinics.
Durban - The government is discontinuing the provision of free formula milk at public health facilities. This policy is intended to promote exclusive breast-feeding for all mothers, including those with HIV.
Children who are not breast-fed are six times more likely to die from diarrhoea and have a higher chance of contracting respiratory illnesses. Breast-feeding is vital for preventing child deaths.
Reports by mothers include the following:
I am 35 years old, HIV-positive and a mother of two. I began my antiretroviral treatment two years before my first daughter was conceived. I started the treatment in June 2004 and my CD4 count was a low 352 at the time. In healthy people, CD4 is usually well above 500. I did not qualify to be on treatment then because at the time treatment guidelines said the CD4 had to be 200 or below to qualify.
But I convinced my doctor and he put me on treatment. By the end of three months my viral load (the amount of HIV) was undetectable and has stayed undetectable since.
I had my first child, a girl, in December 2006 and my viral load was still undetectable. I chose Caesarean section and did not want to breastfeed. My child was negative at six weeks and my husband remains negative. I have just had my second child, a boy, after nine years on antiretroviral treatment. I am still on the same regimen. Again, I chose to have a Caesarean section and to formula-feed my baby.
Many women, because of the fact that they come to know about their HIV status during pregnancy, may struggle to decide about treatment. Even when they do start during pregnancy, they may struggle to remain in care after delivery.
Our health system should aim to identify women with HIV with CD4 below 500 and offer them treatment, as per the new World Health Organisation guidelines, even before pregnancy is reported.
This will free many HIV-positive women to deal with the challenges of taking treatment so that if they become pregnant they do not have the added burden of treatment during a challenging time.
There is overwhelming evidence for breast-feeding, I support this for those mothers who can do it, even while working. I salute them. But most jobs make it difficult to breast-feed. I am a full-time working mother whose job requires travelling outside the province. Sometimes I work overtime.
If I had a husband who earned enough for both of us then I would consider breast-feeding. But at present I know it would not work for me.
Balancing the risk of my child getting HIV through breast-feeding against the risk of death from causes other than HIV, in particular diarrhoea, is not easy.
Recent studies have shown that giving antiretrovirals to either the HIV-positive mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV. Hence women living with HIV who choose to breastfeed must make sure that their viral loads are undetectable. Starting antiretroviral regimen early is the key to making the new breast-feeding policy successful.
We also need to change how workplaces support breast-feeding. Women need counselling.
But I have done all that I can to reduce the risk of transmission for both my kids. We need to teach women about the benefits and risks of both feeding options without forcing a decision upon women. Conditions for women vary and we need to take this into account.
Formula milk must not be taken off shelves and it must be made available in public health facilities for mothers who choose to use it. We must keep options open for women. - The Mercury
* Dubula is the general secretary of the Treatment Action Campaign. Follow her on Twitter @VuyisekaDubula. This article first appeared on www.groundup.org.za.
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