Youths are currently the hardest hit by HIV, but are at the same time are targets of exclusive breastfeeding campaigns.
Experts say babies should be breastfed exclusively for the first six months, then other foods introduced with continued breastfeeding until they are 24 months, or even beyond.
But should this also be extended to mothers living with HIV?
Olivia Vilembwa, a nutritionist from the Jaramogi Oginga Odinga Teaching and Referral Hospital, says all mothers should nurse their children exclusively for six months to aid in effective nutrition.
She advises working mothers to keep a milk bank so the baby can still have plenty of milk during the day. Vilembwa says a healthy mother is capable of producing up to 1.5 litres of milk a day, and can express most of this, especially in the first three months when the milk is plenty and the baby feeds on very little. The best time to express milk is at night. The milk should be frozen to create a milk bank, she says.
Vilembwa adds that infants should not be given anything else, not even water, before they are six months old. “The mother’s milk has everything the baby needs, including for quenching the baby’s thirst,” she says.
This is supported by nutrition expert Grace Gitau’s sentiments that breastfeeding, especially early and exclusive breastfeeding, “is one of the most significant ways to improve infant survival rates”.
Gitau also supports HIV-infected mothers breastfeeding their babies, saying: “Evidence on HIV and infant feeding shows that giving ARVs to HIV-infected mothers can significantly reduce the risk of transmission through breastfeeding and also improve her health.” She says this enables infants of HIV-infected mothers to be breastfed with a low risk of transmission (1-2 per cent). Gitau says, however, breastfeeding should only stop once “a nutritionally adequate and safe diet without breast milk can be provided”.
The World Health Organisation says health authorities should endorse either breastfeeding while receiving ARVs for the mother or infant, or avoid breastfeeding at all. If mothers opt to breastfeed, they should only stop after the child’s first birthday. Earlier, mothers with HIV were to breastfeed for six months then decide whether to stop or continue breastfeeding. But WHO now insists that if the mother chooses to breastfeed, she should only stop after 12 months.
The mother’s milk has a rich array of nutrients and is balanced, keeping the baby healthy and strong. Besides nutrients, the milk contains anti-bodies that prevent the baby from getting infections and also fights germs and other foreign elements in the baby. The milk comes in two forms, the fore milk is a watery form that quenches the baby’s thirst, and the later milk is thick and contains fats and most nutrients, Vilembwa says.
She further says that in case a baby needs supplements or medicine for an illness, the mother will be advised on what to give at the hospital. Otherwise, she should ensure her baby feeds only on breast milk for the first six months.
However, for HIV positive mothers, there is a lot more to do than just breastfeeding. They also need to keep healthy and follow guidelines to reduce chances of transmission of the virus to the baby and still keep the baby healthy and well-nourished. Vilembwa insists that for HIV positive mothers, the ministry’s guidelines on feeding should be followed to ensure proper care for both mother and baby.
HIV-positive mothers are advised on the challenges and benefits of different feeding options – exclusive breastfeeding with antiretroviral drugs (ARVs) and exclusive replacement feeding – so they can make an informed decision on how to feed their babies, according to the Health ministry’s Guidelines for Prevention of Mother to Child Transmission (PMTCT) of HIV/Aids in Kenya, 2012.
The ministry and WHO guidelines 2010 say that if the mother chooses to breastfeed, she will do so exclusively for the first six months, just like HIV-negative mothers, and breastfeed up to one year with appropriate complimentary feeds. She should only stop breastfeeding after 12 months.
But the babies should be provided with nevirapine prophylaxis for up to one week after the complete cessation of breastfeeding, according to the ministry guidelines. The ministry says the use of ARVs for the mother and child reduce the risk of transmission of HIV from mother to child.
WHO says countries should implement guidelines on breastfeeding according to factors such as “HIV prevalence, background infant and child mortality rates, current infant and young child feeding practices ad nutritional status of infants, availability of clean water and sanitation, socio-economic status of the population and quality of health services, including provision of interventions for PMTCT”.
In some countries, especially those with low infant and mortality rates, replacement feeding may remain the best strategy to promote HIV-free survival among HIV-exposed infants, according to WHO.
Gitau says those who do not have access to ARVs should be counselled to exclusively breastfeed for six months and continue breastfeeding thereafter or give the children infant formula if the environmental and social circumstances are safe for, and supportive of, feeding with formula.