Wednesday, September 27, 2006

While we are tweaking AFASS...

One poster at the World AIDS conference in Toronto noted that reports such as Mashi and the diarrhoea outbreak in Botswana secondary to provision of free formula for HIV+ mothers provide evidence “that the [AFASS] guidelines may actually increase risk to the mother/baby dyad as well as other infants in the community.” (Liles and Tompson 2006)."

More than a decade ago, when the spectre of passage via breastfeeding was just starting, I wrote a policy while at USAID, noting that unless we were going to provide premixed small bottles of sterilized formula, we were at risk of not only depriving infatns of the many protective componenets of breastfeeding, but we were also putting them at risk of exactly what happened in Botswana.

Since we did not succeed in creating recognition of the dangers of the current path, at this juncture, I think we need to unite around the concept that supporting exclusive breastfeeding for all children, with special counsling for those tested HIV-positve, is the only logical approach to decreasing transmission and increasing child survival among the untested, while offering specialized counseling.

Exclusive breastfeeding support among those not tested should result in more savings of lives than tweaking AFASS for those who are tested. The numbers are clear on this.

Some real training, or a good job aid, is always helpful, but the use of that training or job-aid is essential.
While I wish you good luck with the job aid, I wonder if there could not be some dedicated action to saving the lives of the children whose mothers are either HIV-negative or untested? They remain the majority worldwide.

Best,
M

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