Comments on: A further response to Dr. Binagwaho on human rights for infants of HIV-positive mothers http://www.hhropenforum.org/2009/06/a-further-response-to-dr-binagwaho-on-human-rights-for-infants-of-hiv-positive-mothers/ a blog by the Health and Human Rights community Thu, 04 Feb 2010 18:40:41 -0700 http://wordpress.org/?v=2.8.3 hourly 1 By: George Kent http://www.hhropenforum.org/2009/06/a-further-response-to-dr-binagwaho-on-human-rights-for-infants-of-hiv-positive-mothers/comment-page-1/#comment-879 George Kent Mon, 17 Aug 2009 19:06:38 +0000 http://www.hhropenforum.org/?p=676#comment-879 In the discussion among Binagwaho, Schuftan, and Greiner, there is an implicit assumption that for infants of mothers diagnosed as HIV-positive, if AFASS conditions are met (as they generally are in the richer countries), infant health outcomes are likely to be better with replacement feeding than with breastfeeding. Where is the evidence to support that proposition? Ardent belief does not constitute evidence. Binagwaho cites a study that shows lower mortality rates for children born to mothers diagnosed as HIV-positive if they were fed with breastmilk replacements compared with the mortality rate for the rest of the population in Rwanda. How is that relevant? As Schuftan points out, the question is, among children born to mothers diagnosed as HIV-positive, how do those fed with breastmilk replacements fare compared with those who were breastfed? Comparisons should be made with both optimal (early initiation, six months exclusive breastfeeding, continued breastfeeding to two years and beyond) and non-optimal breastfeeding. If there were convincing evidence that, in resource-rich conditions, for children of mothers diagnosed as HIV-positive, replacement feeding is better than breastfeeding, I would agree with Schuftan’s view that the fundamental problem is about access to economic resources. Just as poor women should have access to life-saving medicines, they should have access to life-saving means for feeding their children. Where is the evidence that, in resource-rich conditions, replacement feeding is in fact life-saving for children of mothers diagnosed as HIV-positive? Aloha, George Kent In the discussion among Binagwaho, Schuftan, and Greiner, there is an implicit assumption that for infants of mothers diagnosed as HIV-positive, if AFASS conditions are met (as they generally are in the richer countries), infant health outcomes are likely to be better with replacement feeding than with breastfeeding. Where is the evidence to support that proposition? Ardent belief does not constitute evidence.

Binagwaho cites a study that shows lower mortality rates for children born to mothers diagnosed as HIV-positive if they were fed with breastmilk replacements compared with the mortality rate for the rest of the population in Rwanda. How is that relevant? As Schuftan points out, the question is, among children born to mothers diagnosed as HIV-positive, how do those fed with breastmilk replacements fare compared with those who were breastfed? Comparisons should be made with both optimal (early initiation, six months exclusive breastfeeding, continued breastfeeding to two years and beyond) and non-optimal breastfeeding.

If there were convincing evidence that, in resource-rich conditions, for children of mothers diagnosed as HIV-positive, replacement feeding is better than breastfeeding, I would agree with Schuftan’s view that the fundamental problem is about access to economic resources. Just as poor women should have access to life-saving medicines, they should have access to life-saving means for feeding their children. Where is the evidence that, in resource-rich conditions, replacement feeding is in fact life-saving for children of mothers diagnosed as HIV-positive?

Aloha, George Kent

]]>