During the first six months of a child’s life, breastfeeding is considered the most ideal meal for a baby. This is because breast milk contains vital nutrients such as vitamins, proteins, carbohydrates and minerals among others that are necessary for proper growth and development. Besides these nutrients, a breastfeeding baby receives antibodies from the mother as a form of natural immmunity to fend off microorganisms.

Naturally, mothers should breastfeed their infants for as long as two years but in some cases, mothers are given very strict guidelines which must be followed without fail. One such group is breastfeeding mothers living with HIV.

Grace Uwera, a nurse at the Kibagabaga Hospital - HIV Clinic, says mothers living with HIV can breastfeed but there are guidelines to minimise the risk of passing on the virus to the baby through breast milk.

"All mothers living with HIV must continue taking ARVs shortly after giving birth since without breastmilk the child stands a higher risk of malnutrition,” Uwera says.

She explains that much as the risk of infecting the child through breast milk is low, HIV-positive mothers are supposed to continue taking their medication on time and consistently.

"The viral load in breast milk is usually low but this does not mean it is unlikely to cause the baby infection considering that some parents love breastfeeding for long,” Uwera adds.

Although medical experts advise exclusive breastfeeding until the baby attains well developed digestive organs, some parents may choose to supplement breast milk before this period.

But HIV experts maintain that in the event that a mother living with HIV produces an HIV-negative child, exclusive breastfeeding is advisable since solid foods are likely to result into complications.

" When solid foods are introduced at an early stage, they are likely to result into sores or damage the digestive path which increases the chances of penetration by the HIV virus,” Uwera says.

Although it is advisable to breastfeed for as long as possible, it is different for people living with HIV. Health experts say the earlier one stops breastfeeding the child, the lower the risk of infecting the child with the virus.

The burden of HIV in infants

Globally, 3.2 million children below the age of 15 live with HIV and, 91 per cent of these come from sub-saharan Africa whereas 6 per cent live in Asia. The rest of the world contributes 3 per cent to this figure.

Further more, although HIV prevalence in Rwanda reduced from 3 per cent to 2.9 per cent, the latest figures from a joint survey conducted by Rwanda Network of People Living with HIV/AIDS, UNAIDS and Rwanda Biomedical Centre (RBC) reveal that 36 per cent of children with HIV have no access to medical care.

According to Vianney Byiringiro Rusisiro, a senior paediatric officer at RBC, effective treatment of HIV-positive children is hindered by mindsets of parents who do not reveal their children’s status.

That is why experts point out that the problem of children failing to access drugs is rather rooted in the communities.

Last year, 773 children were found to be HIV-positive, but only 559 were on treatment and yet there was no trace of the others.

Health workers now advise that only increased effforts between the communities and the health sector would improve the current situation.

"We are looking into how to strengthen community mobilization and advocacy for treatment services for HIV-positive children. Increased collaboration between the HIV network and community health service providers will help change mindsets of parents and guardians not to fear stepping forward to be tested,” Rusisiro says.

Meanwhile, the troubles of HIV in newborns is adverse and begins right from birth. Research shows that if mothers don’t take any efforts to intervene, the repurcussions may be more dire.Feeding the newborns

Immediately after birth, babies born to HIV-positive mothers are started on Neverapine (after tests).

"The baby is subjected to more tests at one and half month such as serology or P.C.R test to find out whether the virus was transmitted to the baby or not. If results are positive, another confirmatory test is carried out,” Uwera explains.

Additional interventions include giving the baby Bactrim as a prophylaxis measure.

"This treatment is continued until the baby is nine months old but both weight and height are monitored closely”If the second confirmatory test yields positive results, the baby should be started on the ARVs.

Discordant couples

According to Cotilde Mukambayire, a pharmaceutical dispenser at Kibagabaga Hospital, breastfeeding infants from discordant couples follow a certain drug regimen.

"Where it’s only the father living with the virus, both baby and mother are given Nevirapine as a preventative measure,” says Mukambayire.

However, HIV breast feeding mothers have to continue taking ARVS throughout the breastfeeding period to lower the risks of transmission while boosting immunity.

Although breastfeeding predisposes the baby to HIV infections, experts agree that provided individuals infected with the virus follow the right procedures and access proper medical care, they should not deny their young ones the right to good feeding.

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Breastfeeding benefits for mum, baby

1. A healthier baby

"The incidences of pneumonia, colds and viruses are reduced among breastfed babies,” says infant-nutrition expert Ruth A. Lawrence, a professor at the University of Rochester School of Medicine and Dentistry in Rochester. Gastrointestinal infections like diarrhea are also less common.

2. Long-term protection, too

Breastfeed your baby and you reduce his risk of developing chronic conditions, such as type I diabetes, celiac disease and Crohn’s disease.

3. Stronger bones

According to Lawrence, women who breastfeed have a lower risk of postmenopausal osteoporosis. "When a woman is pregnant and lactating, her body absorbs calcium much more efficiently,” she explains. "So while some bones, particularly those in the spine and hips, may be a bit less dense at weaning, six months later, they are more dense than before pregnancy.”

4. Lower SIDS risk

Breastfeeding lowers your baby’s risk of sudden infant death syndrome by about half.

5. Fewer problems with weight

It’s more likely that neither of you will become obese if you breastfeed him.

6. A calorie incinerator

You may have heard that nursing burns up to 500 calories a day. And that’s almost right. "Breast milk contains 20 calories per ounce,” Lawrence explains. "If you feed your baby 20 ounces a day, that’s 400 calories you’ve swept out of your body.”

7. Better healing postdelivery

The oxytocin released when your baby nurses helps your uterus contract, reducing post-delivery blood loss. Plus, breastfeeding will help your uterus return to its normal size more quickly — at about six weeks postpartum, compared with 10 weeks if you don’t breastfeed.

8. Less risk of cancer

Breastfeeding can decrease your baby’s risk of some childhood cancers. And you’ll have a lower risk of premenopausal breast cancer and ovarian cancer, an often deadly disease that’s on the rise.

9. A custom-made supply

Formula isn’t able to change its constitution, but your breast milk morphs to meet your baby’s changing needs. Colostrum — the "premilk” that comes in after you deliver — is chock-full of antibodies to protect your newborn baby. "It’s also higher in protein and lower in sugar than ‘full’ milk, so even a small amount can hold off your baby’s hunger,” says Heather Kelly, a lactation consultant in New York City.

Breastmilk is also higher in both sugar and volume than colostrum — again, just what your baby requires. "He needs a lot of calories and frequent feedings to fuel his rapid growth,” Kelly explains. "Your mature milk is designed to be digested quickly so he’ll eat often.”

10. A great way to learn about your baby. "You have to read your baby’s ‘satiety cues’ a little better, because unlike with a bottle, you can’t see how much he’s eaten,” Kelly says. "You have to rely on your own instincts and your baby’s behaviour to know when your baby is full.”

11. There’s nothing easier

Simply pull up your shirt and nurse. Breast milk is always available and always at the right temperature.

Agencies