OpenForum – a blog by the Health and Human Rights community

Claudio Schuftan (CS) and Ted Greiner (TG)

[Editor's note: this post is the latest and last installment of an ongoing discussion on the merits of exclusive breast feeding versus formula feeding for HIV-positive mothers. Dialogue on this issue began with an article by Dr. Binagwaho in Health and Human Rights, followed by a Perspectives piece by Dr. Schuftan. Dr. Binagwaho continued the exchange with a post on OpenForum, to which Dr. Schuftan and Ted Greiner, PhD, have responded below. We encourage readers of OpenForum to weigh in on this issue through comments on this post.]

We are of the opinion that, in her response, Dr. Binagwaho misinterprets the human rights of these newborn infants and somehow tries to turn the tables on the readers of this blog using fallacious arguments. She now tries to directly link my original argument (CS) to the arguments fought around the introduction of ARV treatment in Africa in its early stages. Our disagreement with her now centers around how she uses the AFASS criteria argument (acceptable, feasible, affordable, sustainable and safe) which she, in our view, lightly assumes are realistically achievable in Rwanda. She actually puts the emphasis on the cost-free-distribution-of-infant-formula which she rightly says would in theory be compatible with HR principles. Read more

Dr. Claudio Schuftan’s response to my article advocating that HIV-positive mothers in resource-poor settings bottle-feed according to acceptable, feasible, affordable, sustainable and safe (AFASS) criteria rather than breastfeed their infants employs the same line of reasoning used in the late 1990s to not treat HIV-positive Africans with antiretroviral drugs. In fact, we can see his argument unfold below by replacing the terminology about bottle-feeding (crossed out) with ART (antiretroviral therapy, indicating access to triple therapy) terminology (added in red italics):

• “Economic access to six or more months of infant formula supplies ART is not realistic for poor mothers people living with AIDS in poor countries — nor, either, is access to clean water.”
• “Of course we need to set the same human rights objectives for ourselves in the global South as those set in the North. However, as public health nutrition infectious disease experts, it is our obligation to acknowledge the local reality of HIV and AIDS affecting important segments of the poor population in our respective milieus. That reality shows us that economic access to infant formula ART does not exist for vast numbers of affected women people living with AIDS.”
• “But the choice of whether to bottle-feed take ART or not is not really at the forefront for a woman person living with AIDS who cannot afford adequate food, has no adequate housing or access to safe water and sanitation, employment and education, let alone a right to gender equality health care.”

At that time, this was the same type of controversy, with good people and good intentions on both sides of the discussion. But thank goodness we didn’t listen to the majority of those who believed that the lack of financial resources and lack of education would prevent Africans from being able to take their ART medication correctly. We can now see that in fact these same uneducated, poor Africans are more adherent than Western populations. History has proven that the faithful activists, who believed that lack of financial resources was no excuse for providing substandard care, were right. Read more