t he case of a baby girl who contracted HIV after being breast-fed by a well-meaning aunt has become the first in SA where an infant has been proven to have contracted HIV from a surrogate feeder or “wet nurse”.
The case, cited 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, the University of KwaZuluNatal (UKZN) and the National Health Laboratory Services was published in the medical journal The Lancet last week.
Using the baby girl as a case study, the report casts light on the role of wet nursing in HIV transmission, which has received little attention in SA.
Senior researcher Dr Tulio D’Oliveira from the Africa Centre for Health and Population Studies at UKZN said the findings were important because the government was halting the provision of free milk formula in its clinics. He said more research was needed on wet nursing in the light of the phase-out of formula and the government’s establishment of milk banks.
Research has shown that HIV- positive women can breast-feed but their babies need anti-retroviral treatment, and breast-feeding needed to be done exclusively for a period of six months.
In April 2009, the 10-week-old baby cited in the study was admitted to the paediatric intensive care unit of a Bloemfontein hospital weak, lethargic, coughing and breathing at a rate of 75 breaths per minute. Her mother was HIV tested during pregnancy and another test at the time confirmed her negative status.
It later emerged that the baby’s aunt had been breastfeeding 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.
D’Oliveira said lab records indicated the aunt had tested positive for HIV in 2008. Her baby was also HIV-positive. She had claimed she was not aware of her HIV status.
“This was a devastating case for a family in South Africa… The aunt breast-fed the baby out of great kindness so the mother could go back to work,” D’Oliveira said.
The researchers say that information on the practice of breastfeeding by a surrogate in SA is “scarce”.
One small study conducted in the Free State by the Human Sciences Research Council found 1.7 percent of the children surveyed had been breast-fed at some point by a woman who was not their mother. HIV-positive babies were 17 times more likely to be have been breast-fed by someone who is not their mother than HIV-negative ones.
The HSRC study states that in instances where the mother is HIV negative with an infected baby, breastfeeding by a non-biological caregiver was the “single most important risk factor”.
A Department of Health pamphlet on breastfeeding says wet nursing is “not advisable” and where used, the feeder must agree to an HIV test before commencing and another after six to eight weeks.