By Diana Namutebi
M iriam is 26 years and she has a accu6months old baby. She got to know that she is infected when she was four months pregnant. She was so scared for her life and her baby’s life.
Luckily she was enrolled in the PMTCT programme at Mulago Hospital and the nurses and counselors kept on consoling her.
The doctors prescribed and asked her to start taking ARVS right away. When she confided in her husband and asked him to go to the hospital with her for testing, he refused and said that he was not infected. Miriam says that she kept on praying that he secretly goes for a test and medication.
As her expected labour date drew close she got more worried. She was not sure that her baby would survive the deadly virus because she thought that she would get re-infected by her husband if he was not on medication.
However, the counselling kept her going. Miriam gave birth to her baby boy and he was immediately put on the Neverapine syrup and multivitamins. She says that the biggest problem she gets with the ARV treatment is that she gets a low appetite and that is why she always tries so hard to keep it up by buying foods she loves and eating a variety of fruits.
Miriam says that she is glad she is attached to a health centre where she goes for routine checkups; she believes that it is because of this that her baby is HIV-negative. She also suspects that her husband is getting treatment much as he will never admit because of his fear and pride.
Kushaba, is in the same queue with Miriam at PMTCT Mulago Hospital, waiting for her routine checkup although shy she manages to tell me briefly what it takes for her to be able to breastfeed her child as an HIV-positive mother.
She says that her baby has got a cold and his appetite has reduced a bit. When asked whether she is worried that he might have got the infection through the breastfeeding. She answers that she is confident that her baby is negative because she has been on medication since she found out and the baby also got his neverapine syrup.
She, however, says that you can never wipe away the doubt that your baby could get infected as an HIV-positive mother who is breastfeeding. She got to know that she was HIV-positive when she was five months pregnant. Her husband too has refused to come for checkups and he insists that she is the only infected party in the relationship.
Kushaba whose baby is seven months old tells me that she has no option but feed well and be strong for her baby.
Annet is the other lady in the queue, her baby is quite a sight, healthy, strong and bubbly, but the mother on the other hand has a worried look.
My comment was that the father must be proud of him and Annet replied that the father has refused to get treatment and that she has always had to ask another man to escort her to the routine spousal counselling sessions. She was scared when she discovered she was HIV-positive at four months pregnant.
Annet says that the fear and anger as a housewife, is inevitable when you get to know that you are infected. Her baby is five months old and HIV negative.
She had refused to breastfeed the baby at first for fear of infecting him but the doctors convinced her that the medication she had been receiving and the syrup for the baby would reduce the risk of infection and death as compared to when the baby did not breastfeed at all.
To date she says that she is very scared when breastfeeding him. Much as she has been counselled Annet says that the norm in society has always been that HIV-positive mothers do not breastfeed and that’s why she cannot discard her fears that her baby might get infected in the process of breastfeeding.
Diet of an HIV+ mother
HIV-positive mothers need a good nutrition plan to have the energy and breast milk for the baby, considering the fact that they are on medication.
Antonio Kiyemba, a nutritionist at Mulago Hospital, says that HIV and malnutrition is a disastrous combination and that is why any HIV-positive mother should know the right diet. The mother should also take two extra meals on top of the traditional meals of breakfast, lunch and supper.
He further explains that, HIV is an immune suppressing syndrome and that is why the mother has to eat foods which will replenish her cells. The mother is expected to eat foods with lots of minerals and vitamins, that is, vegetables and fruits.
Remember there is a lot of tissue degenerating for the mother and she will also need foods with protein.
The mother should also take plenty of fluids like water, juice and porridge.
He also cautions the mothers to stay away from alcohol and cigarettes due the fact they not only lead to cell degeneration but they slow down mineral absorption in the body.
Preventing mother-to-child transmission
The WHO/UNAIDS/UNICEF infant feeding guidelines show that without preventive interventions, about one-third of infants born to HIV-positive mothers contract HIV through mother-to-child transmission either during pregnancy, childbirth or breastfeeding. In 2001, 800,000 children under the age of 15 contracted HIV, over 90% of them through mother-to-child transmission of HIV (MTCT).
Between 15 and 25% of children born to HIV-infected mothers get infected with HIV during pregnancy or delivery, while about 15% of the children get infected through breastfeeding.
However, there are measures that decrease the spread of HIV transmission through breastfeeding;
Shorter duration of breastfeeding, the longer a child is breastfed by an HIV-positive mother the higher the risk of HIV infection.
Exclusive breastfeeding: Some immunological studies are finding that there are factors in human milk, especially the milk of the HIV-infected mother, that will directly combat the cells that contribute to the transmission of the HIV infection.
A study done in Durban, South Africa showed that exclusive breastfeeding during the first three months of life resulted in a lower risk of mother to child transmissions than mixed feeding (breastfeeding combined with other foods, juices or water).
Treatment of breast problems; Mastitis and cracked nipples and other causes of breast inflammation are associated with an increased risk of HIV-transmission.
Prevention of HIV-infection during breastfeeding:
The maternal viral load is higher shortly after a new infection resulting in an increased risk of infection of the child. Early treatment of sores or thrush in the mouth of the infant. Sores in the infant’s mouth make it easier for the virus to enter the infant’s body.
The risk of HIV-infection has to be compared with the risk of morbidity and mortality due to not breastfeeding. Breastfeeding is protective against death from diarrhoea, respiratory and other infections, particularly in the first months of life.
Breastfeeding also provides the necessary nutritional and related ingredients, as well as the stimulation necessary for good psychosocial and neurological development.
A mother living with HIV/AIDS, therefore ,faces many grave difficulties: worries about her own health and survival, the risk of infecting her baby through breast milk, and the danger that her baby will develop other health problems if she does not breastfeed as per the guidelines.
HIV+ mums can nurse for a year
According to prevention of mother to child transmission (PMTCT) coordinator, Makerere University and John Hopkins University Research collaboration (MUJHU), Joyce Matovu, the 2010 infant feeding guidelines for Uganda, require that all mothers must exclusively breastfeed their babies for the first six months regardless of their HIV status. At six months the mothers can give the baby other foods.
In the past HIV-positive mothers were not to breastfeed their babies. Joyce Matovu explains that today HIV-positive mothers can breastfeed because of the Option B+ programme for HIV+ mothers and their infants.
The mothers, when discovered to be HIV-positive are started on a triple antiretroviral regimen immediately, regardless of their CD4 count. The mothers are required to continue with that regimen throughout pregnancy.
At the same time babies born to HIV-positive mothers also receive a course of medication as per the PMTCT guidelines. Under Option B+ the infant should receive daily Nevirapine or Zidovudine from birth until age six weeks.
However, HIV-positive mothers can only breastfeed for one year. When it is time to wean the baby, the mothers are usually assessed according to the AFASS acronym.
Here mothers are evaluated to see whether they A - afford the complementary foods; F - whether the feeding is feasible; A - acceptable by both mother and society; S- safety of the food, S- sustainable, can the mother sustain the foods that have been introduced to the baby.
HIV expert’s counsel:Joyce Matovu
10 easy tips to help you cope
1One day at a time
Focus on the day at hand instead of the six months ahead. This will give you confidence to face the future. This will re-assure the mother that she can sustain breastfeeding.
2Create a bank
Expressing milk is a feasible option for feeding the baby when the mother is away. A working mother needs to find a way to pre-pump and vacuum seal her milk to be given to the baby periodically.
Exposure to oxygen will break down the critical enzymes within about 20 minutes rendering them useless. Vacuum sealing minimizes oxidation.
Vacuum sealed breast milk can stay safe at room temperature for eight hours, in a fridge for 48 hours and in a freezer for up to six months. Note: Use the first-in-first-out principle when selecting breast milk for a particular feed. Use an open cup to feed the baby; bottle feeding creates nipple confusion and may make the baby reject the breast.
3 Let the scientific facts motivate you!
Breastfeeding provides unequalled nutrition for the baby. Breast milk is the best food for the baby in its first six months of life.
The mother’s milk has all of the enzymes, hormones, growth factors a developing baby needs to grow. In fact, the mother’s immunity to disease is passed to the baby through breast milk.
Breastfed babies are healthier and require less healthcare costs. A healthy baby means enough time channeled to productive ventures that benefit the family.
4 Seek support
Mother-to-mother interfaces are at the heart of successful breastfeeding. The more mothers share with colleagues, the more their decision to breastfeed is enhanced.
Once accurate information is given, mothers will be more breastfeeding-oriented. Mothers who have breastfed provide proof that it is possible.
6 Breast sag a myth
Breasts sag comes with age, not breastfeeding. In addition, there are different breast types. Correct breastfeeding positioning and attachment does not make breasts to sag.
7 Weight control measure
Want to lose excess weight gained during pregnancy? Breastfeed frequently for a minimum of 30 minutes and the weight will go away naturally.
The hormonal effect of oxytocin will cause the uterus to contract and before you know it, the tummy will be flat and you will be in shape.
Even the excess weight and fat in other parts of the body will be used up in the breastfeeding process and the baby will gain it. It is a win-win scenario. Breastfeeding is a healthy slimming way.
8 Take warm water and fluids
Breast milk is 95% water so you need a lot of water to have enough milk. Warm water taken frequently coupled with a balanced diet is a winner for mothers who want to get enough breast milk.
Stay away from caffeinated drinks. Keep your body in a state of equilibrium by taking a warm drink before breastfeeding and taking a cold or drink at room temperature after breastfeeding. This practice will help you balance your water levels.
9 Breastfeed in totality
Breastfeed for a reasonable duration so that the baby can get the milk in totality. Getting milk in totality means that the baby is able to get the first watery milk that quenches thirst; the middle milk and the hind milk which is very thick and fatty.
Just the way one puts juice in a glass and it forms layers, is how breast milk is. Thus a mother needs to completely empty one breast before feeding the baby another breast.
This is critical in avoiding milk imbalance. This calls for uninterrupted time for breastfeeding. Putting a baby on one breast for two minutes and changing to another for another minute denies babies an opportunity to get to the deeper inner fatty milk.
10 Correct position
It is important to attach the baby correctly making sure that the black part around the nipple is in its mouth. Proper attachment ensures that you are breastfeeding as opposed to “nipple” feeding.
This prevents sore nipples and helps the baby to get enough milk. Similarly, the mother needs to be in a comfortable position, with a straight back so she is not under strain. Breastfeeding is not meant to cause pain to any party.
Compiled by Christine Namatovu, Breastfeeding Consultant