Shared breastfeeding and poor medical hygiene fuels HIV/AIDS

New research by South Africa's Human Sciences Research Council (HSRC) suggests that negligent breastfeeding at public hospitals in the Free State province is placing infants at risk of HIV infection. Besides the obvious route of mother-to-child transmission, shared breastfeeding emerged as the single most important factor associated with child HIV infection in the study commissioned by the Nelson Mandela Foundation and released at the current Seventh International AIDS Impact Conference in Cape Town. Dr Olive Shisana, executive director of Social Aspects of HIV/AIDS and Health at the HSRC, told IRIN that although there was no doubt of the capabilities of public healthcare staff at the hospitals where the study was conducted, gaps still remained. "A major problem was that bottles were labelled by cot numbers - rather than by the name of the baby - and rarely checked, allowing milk to be fed to the wrong baby if the cot was moved. This suggests that even if children are born free of HIV, they are likely to contract the virus through breastfeeding," Shisana explained. Of the 4,000 mother-and-child pairs studied at 25 hospitals, close to 30 percent of mothers were HIV positive, while children in the two to nine age group had an HIV prevalence of 14.9 percent. Only 13 of the 25 sites had dedicated milk-preparation areas; at the remaining sites milk was prepared in maternity wards with few infection prevention methods. "It is important that expressed breast milk is pasteurised before being fed to infants, and yet we found few suitable preparation areas, as well as an evident lack of programmes to train staff accordingly," Shisana noted. Another concern was that the low safety standards not only put babies at risk of contracting HIV, but also left them vulnerable to other infectious diseases like Hepatitis. The national department of health has been urged to conduct a nationwide public health campaign informing the public of the risks posed by shared breastfeeding. "The practice should be discouraged, unless the serostatus of the surrogate mother is established to be HIV-negative," Shisana stressed. Poor cleaning techniques and traces of visible and invisible blood found on surgical instruments at dental, maternity and paediatric facilities were also listed as catalysts for spreading HIV. Almost 25 percent of dental instruments ready to be used on patient's mouths and gums, and 24 percent of instruments to be used for maternity and paediatric patients, were contaminated with invisible blood, while more than 17 percent had visible blood, the research showed. "The evidence generated from this study suggests there is a need to reduce the potential for HIV transmission in dental, maternity and paediatric facilities. Healthcare-acquired infections are completely avoidable", John Samuel, CEO of the Nelson Mandela Foundation said in a statement. Samuel pointed out that solutions lay not only with policy-makers in ensuring that safety guidelines were implemented, but with patients as well. "Well-informed patients are best placed to monitor weaknesses in infection control," he said. The full report, 'HIV risk exposure in children aged 2-9 years served by Public Health Facilities in the Free State', South Africa, can be accessed at: www.hsrc.ac.za