Monday, August 14, 2006

The most well-meaning folks are still pushing formula for HIV+ moms in the most vulnerable settings

Response to: “Rwanda: A time for healing”,08/13/2006, Thomas Simonet,
Special to the Post-Dispatch, St. Louis Missouri - excerpt included

Dear Editor:

Partners for Health is a wonderful group that has accomplished near miracles, and Dr. Stulac is clearly an outstanding human being in many ways, willing to sacrifice her time and energies to those in the most vulnerable situations in the world.
However, there is one area,I am afraid, where the organization's approach is perhaps not fully considered: the founder of this group promotes formula use for all children of HIV-positive mothers in settings such as Haiti and Rwanda. This approach can do more harm than good in settings such as this. Dr Stulac started an infant formula program for HIV-positive mothers, and unfortunately, her good works and intentions may be undermined by this approach; today, 3 major studies (Coutsoudis et al in South Africa, Iliff et al in Zimbabwe, Thior et al in Botswana) have shown that exclusive breastfeeding in the early months results in more HIV-free survival in populations such as the one she serves, without the expense, time, and maternal effort to prepare and feed infant formula. In most studies, the mother’s health has not been shown to suffer from breastfeeding, and the money saved might be better used for food for her and her family, and for HIV prevention and treatment.

My warmest regards to Dr. Stulac and all who spend their lives trying to make this a better world.


Success stories inspire [Dr. Sara] Stulac's work in this battered African country. Most people know Rwanda because of the horrific ethnic genocide of 1994, in which as many as 1 million people died. In the aftermath, the economy flat-lined, and many social ills got worse…Now, the nation, still among the poorest in Africa…One of them is Partners in Health, a Boston-based nonprofit that has taken on some of the toughest health woes in the world …"I thought, if I were going to do this with anyone, these people are making a difference," she said. "They're doing it the right way. They have the right philosophy."

In Rwanda, the group is building a new hospital in Rwinkwavu, a hilly corner several miles from the nearest paved road. On a Saturday morning this summer, Stulac's overflowing pediatric ward made clear the medical challenge…. [One major challenge is] the "ATM trio" - AIDS, tuberculosis, malaria - of preventable, treatable in
fections that kill millions of people annually around the world. … Because AIDS can be transmitted through breastfeeding, Stulac helped start an infant formula program for HIV-positive mothers. But the women have no source of clean water, and formula made from local wells can cause life-threatening diarrhea."So, we started this program, myself and the social workers," Stulac said. "All babies born to HIV-positive mothers get a regular supply of infant formula, but they also get a little kerosene stove and a thermos and a bottle we use to boil the water in and a casserole pot so they can prepare clean and safe water for their children."… "It's just a really good community," Stulac said. "The people here are seeing their friends and neighbors and family members getting better. It gives them a lot of hope."