Saturday, December 28, 2002


December 14, 2002

By David Crowe

"Breastfeeding by HIV-positive women has been frowned upon for a long time. In fact, in at least one case, it has been declared illegal for an HIV-positive woman. This view is based on inaccurate information, and it seems likely that breastfeeding is the best thing that HIV-positive mothers could possibly do for their babies, just as is the case for all other mothers.

It only took two anecdotal cases for the CDC to warn against HIV-positive mothers breastfeeding, but it was a meta-analysis published by Dunn et al in Lancet in 1992 that was the beginning of the end for choice in feeding practices. This study concluded that breastfeeding posed a 14% excess risk of HIV transmission. Since then, breastfeeding has been difficult for women in poor countries, and a huge amount of effort by WHO, Unicef and others has gone into studying and implementing replacement feeding (i.e. formula) by mothers in poor countries.

Dunn believed that the HIV status of breastfed children was a combination of HIV transmission in the womb (in utero transmission) and through breastmilk. He therefore, searched for data sets that compared the HIV transmission frequency of formula fed and breastfed babies. He found six, from Zaire, Miami, France, Switzerland, Australia as well as a pan-European study. He subtracted the HIV transmission frequency of the formula fed babies (which he believed could only be due to in utero transmission) from the frequency in breastfed babies for each study. His 14% figure was a weighted average of the difference in each study.

This is very clever but, like all meta-analyses (those that use the output of other researchers as their raw material) it is subject to the GIGO principle (Garbage In ? Garbage Out). And, in the case of the studies used by Dunn, there are enough holes to drive trucks full of formula through (and many have been)." [ is well known for its thorough criticism of health care establishment issues, and this essay on breastfeeding and HIV is no exception - JC]