By Dr Solome Jebessa
I was opening my office in one of the hospitals in Ethiopia when the nurse who I worked with for years approached me with a sad and surprised look. I wasn’t expecting this in a beautiful Monday in the summer of 2009.
“You see, doctor, this baby’s mother has no HIV, but we tested the baby and found her to be HIV positive”.
I wasn’t surprised. Sometimes we see false positive results. I advised her to retest the baby.
I should have guessed. She was such a meticulous nurse. She had repeated the test more than once but each time it turned up to be positive for HIV.
So we tried to investigate the route of infection.
Did she have blood transfusion?
Did she have manipulation by a local healer?
Was she exposed to unsafe injection?
Did she have circumcision?
I bombarded the nurse with questions.
The answer was NO!
Then what happened?
After scratching our heads we finally found that the baby was breast fed by a lady from the neighborhood.
I wanted to see the baby and the two mothers.
Two women in their early thirties each carried a child, a boy and a girl.
They were twins, we found out later.
The story goes back to the immediate puerperal period of the biological mother who had been unwell andweak, and gave one of the twins to be breast fed by her best friend, who lived only a block away.
The friend who was entrusted volunteered and took the baby girl to breast feed.
The baby girl would cling to her suckling the virus along with the milk.
Other than wet nursing, I have seen kids whose parents have been negative and acquired HIV through these unusual ways of transmission:
Manipulation by local healer:
- Uvula cutting
- Milk teeth extraction
- Unsafe injections
- Female genital mutilations/ circumcises.
Sharing needle for chiggers extraction
Feeding infants with chewed food especially ‘Kolo’ and meat
Shaving infant’s head using shared blades
Dr Jebessa is a pediatrician who is a senior technical advisor overseeing the pediatrics HIV program at Primary Health Care level in Ethiopia and she is currently stationed at ANECCA headquarters in Uganda. She went to medical school in Jimma University. She later specialized in pediatrics at Addis Ababa University and did her MPH at Addis Continental School of Public Health /University of Gondar, in Ethiopia.
Dear Reader (IW) thank you for your comment and question.
Please note that this story is a true story of a child who acquired HIV through wet-nursing from another lady whose HIV status was not known . Wet-nursing is practiced in Ethiopia sporadically.
It is a good point that you raised the issue of breast feeding in the context of HIV .
The current recommendation for preventing mother to child transmission of HIV ,in most countries is called Option B+ which consists of treating the pregnant mother with triple ART drugs(life long) as soon as she is diagnosed and providing daily NVP or AZT to the baby from birth through age 4-6 weeks regardless of infant feeding methods . Hence as far as the mother and the baby are put on the ART drugs , the viral load is decreased , the potential risk of transmitting the virus to the child is minimal .
secondly , breast feeding is essential way of infant feeding especially in low-income countries with all its enumerated nutritional ,immunological , social and economical benefit . Studies showed that infants not breast fed have mortality rate of 5X greater than those breast fed , due to diarrhea , malnutrition etc.
Hence the current recommendation for breast feeding for low income countries , is advising the mother to exclusively breast feed the baby for the first six month of life and then continue BF with supplemental feeding until at least 12 month of age.
for more information go to : http://www.unicef.org/nutrition/index_24827.html
Have a great day!
Thank you Dr Solomie, very educational. So what is the current recommendation in breast feeding for those with the virus in situations where alternative feeding is not an easy option? What about those on successful treatment regimen who happen to have a new born?
I didn’t even know people let others breast feed their babies. Its just sad though. The best friend meant so well helping the mother out but ended up giving the baby an HIV. That’s just heart breaking.