A baby girl who contracted HIV after being breast-fed by a well-meaning aunt has become the first proven case in SA to have contracted HIV from a surrogate feeder or “wet nurse”.
The case, contained in new research released last week, highlights the importance of HIV testing of mothers and surrogate feeders at a time when the government is phasing out free infant formula in its clinics.
The Bloemfontein baby, born to an HIV-negative mother, was admitted to hospital with pneumonia in 2009. Research entitled “The Tainted Milk of Human Kindness”, conducted by researchers from the University of the Free State, University of KwaZulu-Natal and the National Health Laboratory Services, published in respected medical journal The Lancet last week, uses the baby girl as a case study. It casts light on the issue of wet nursing in HIV transmission, which has received little attention in SA.
Senior researcher Dr Tulio de Oliveira of the Africa Centre for Health and Population Studies at UKZN said the findings were important because the government was halting the provision of free formula in its clinics.
Research has shown that HIV-positive women can breast-feed, but their babies need to be given antiretroviral treatment, and breast-feeding needs to be done exclusively for six months.
In April 2009, the 10-week-old baby was admitted to the paediatric intensive care unit of a Bloemfontein hospital.
She was weak, lethargic, coughing and breathing at a rate of 75 breaths a minute.
Her mother was HIV-tested during pregnancy, and another test confirmed her negative status.
At first, in-hospital infection was suspected, but it later emerged that the baby’s aunt had been breast-feeding her intermittently after the mother returned to work. DNA sequencing supported this scenario. The baby also had a high CD4 count which indicated a recent infection.
De Oliveira said lab records indicated the aunt had tested positive for HIV in 2008. Her baby was also HIV positive. “It cannot be confirmed whether the aunt was counselled regarding this result, but she claimed that she was not aware of her HIV status,” he said. “This was a devastating case for a family in South Africa. I cannot imagine the pain suffered by them. The aunt breast-fed the baby out of great kindness so the mother could go back to work.”
The researchers say that information on the practice of breast-feeding by a surrogate in SA is “scarce”. A small study conducted in the Free State by the Human Sciences Research Council found that 1.7 percent of children surveyed had been breast-fed by a woman other than their mother. HIV-positive babies were 17 times more likely to have been breast-fed by someone not their mother than HIV-negative ones. The HSRC study states that in instances where the mother is HIV negative, with an infected baby, breast-feeding by a non-biological caregiver was the “single most important risk factor”.
In a UKZN study, focus groups were asked to discuss the acceptability of donated breast milk. Participants said wet nursing was no longer practised or no longer “right” because of associated risks.
A study into infant feeding in Nigeria found that it was rarely practised, but when it was, it was done by relatives, neighbours or “co-wives” in polygamous relationships.
The health department discourages wet nursing. Where used, the woman must agree to an HIV test before commencing, and another after six to eight weeks.