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Informed choice in infant feeding decisions can be supported for HIV-infected women even in industrialized countries

This article argues that even in industrialized countries HIV-infected women should be allowed to choose how to feed their babies rather than being coerced into artificially feeding, as is now the practice nearly everywhere. This is because when they are on anti-retroviral drugs, have no measurable viral load, and exclusively breastfeed, the risk of HIV transmission is likely similar to the risk of death from not breastfeeding. Unlike what most health professionals and policy-makers assume, this risk is not zero. In fact, in the USA, not breastfeeding is the seventh largest cause of infant death. Click here to access the article.

Kenya Infant Feeding Assessment

This reports on two studies done with funding I applied for from USAID Kenya. The purpose was to examine the infant feeding patterns of infants exposed to HIV and to observe the infant feeding counseling the mothers received, as well as doing interviews with a sample of mothers. Click here to open the pdf file.

Postpartum AFASS assessments to support appropriate timing of cessation of breastfeeding

This is a power point presentation I gave in Dubai at the 1st Regional Conference on Human Lactation:
Breastfeeding for Healthier Generations. HIV and infant feeding policy making has come far in the past few years, but as of mid 2008, there is still a lot of confusion about when an HIV+ mother who is breastfeeding should stop. More importantly, how should the decision as to whether it is acceptable, feasible, affordable, sustainable and safe (AFASS) to stop be taken?

Click here to download the presentation.

Structural Violence and Clinical Medicine: Free Infant Formula for HIV-Exposed Infants

This letter to editor in response to an article by Paul Farmer that I wrote with colleagues in PATH and EGPAF, can be read here.

Algorithms to assist in counseling on whether it is AFASS for an HIV+ mother to stop breastfeeding

During 2005-6, with input from Kathy Krasovec, help from Jennifer Marcy, and graphic design work by Jennifer Fox (all of PATH), I created two algorithms to assist counselors in advising HIV-infected mothers when it might be acceptable, feasible, affordable, sustainable and safe to stop breastfeeding. If you click on “more” below, you can see the letter I wrote providing some explanation and references for desiging diets for non-breastfed infants.

I also presented them at the WHO HIV and Infant Feeding Technical Consultation in October 2006 in Geneva. These simplied versions benefitted from feedback from two groups who reviewed them at that meeting.

Click here to see the algorithms (one for infants 6-12 mo and one for older infants) in powerpoint format, each divided in two, making the text larger and easier to read.

Toronto AIDS conference: where were the children?

This is a letter to Lancet. Click here to download the pdf file.

IMAGE: Yemeni children from the village of Udain, 1978

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Effect of the HIV epidemic on infant feeding in South Africa: “When they see me coming with the tins they laugh at me”

This is a qualitative study from Tanya Doherty’s PhD at Uppsala University. It was funded by WHO.

Click here to download the Pdf file.

Concerns regarding a randomized trial of two postexposure prophylaxis regimens

This letter to the editor of the journal AIDS comments on a paper published by Gray et al. Naturally it makes more sense if you have the Gray paper, and I will be happy to send it to anyone who writes and asks for it:

Click here to open the letter in pdf format.