How Breast Milk Can Transmit HIV and Why We Should Inform Women

As one of the last fluids we think about when we think about HIV, I thought it might be helpful for us to learn a little more about the 4th fluid that transmits HIV. Since blood, semen and vaginal secretions have gotten all the attention, why not take a moment and learn a little more about how breast milk can transmit HIV.

What a brief review of the research shows:

  • Infant feeding is estimated to be responsible for anywhere from 5-20% of mother to child transmission. If a child is born HIV-negative to a positive mother who is not on antiretroviral treatment, the risk associated with prolonged breastfeeding is estimated at 10-20%.
  • HIV RNA is found in breast milk and the risk of transmission is directly related to the viral load in the mother’s milk.  Some mothers may have a specific gene (SDF1 3’A allele) that causes increased viral replication in breast milk and therefore increases transmission risk.
  • Although breastfeeding from an HIV-positive mother poses a risk of HIV transmission to the infant, there is also evidence that it provides better health outcomes for the child than formula feeding (protective against other infectious diseases)
  • The World Health Organization promotes alternative (formula feeding) only when it is  “affordable, feasible, acceptable, sustainable and safe.” When ARVs are widely available and breastfeeding is a social norm, they recommend that HIV-positive mothers breastfeed until 12 months of age.
  • Women who are on antiretroviral treatment while breastfeeding have a lower risk of transmitting HIV to their infant. (about 3.5% in one study in Kenya)
  • Exclusive breastfeeding has been associated with a reduced risk of late HIV transmission as compared to mixed feeding. Mixed feeding practices (breast milk plus other liquids or solids) and prolonged breastfeeding (more than 6 months) are associated with increased risk of mother-to-child transmission of HIV.
  • Exclusive breastfeeding is hard. Barriers include low milk production, lack of control over the feeding situation, and both perceived and enacted stigma.
  • Infants can develop resistance to HIV medications independent their mother’s resistance – that is, the mother is not necessarily passing on a resistant virus, but if the infant becomes infected while breastfeeding and the mother is on ARV, the infant is being exposed to small amounts of the drugs through breast milk and may therefore develop resistance to them.

The more we can inform women about the risks and benefits associated with breastfeeding, as well as things that can reduce the risk, the better able they will be to make the best decision for themselves and their infants.

Some of the articles/abstracts, if you want to read more in-depth:

WHO Guidelines:

A systematic review of a number of publications on HIV and breastfeeding:

How genetics may impact transmission rates:

Drug resistance:

Large Breastfeeding study in Kenya:

Difficulties of exclusive breastfeeding:

Viral load:

If anyone is still reading,

To kill HIV in breast milk, flash-heating breast milk can inactivate HIV without destroying too many of the vitamins or immunoglobulin in the milk that make it beneficial to the baby. The WHO recommends it as an option to reduce vertical HIV transmission in resource-poor regions. Of course, to do this the mother has to express the milk first, then heat it, then feed it via bottle – so it’s kind of a compromise between breastfeeding, which could transmit HIV, and bottle feeding formula, which has other nutritional/gastrointestinal risks.

What do you think? How has this changed how you think about HIV? Has it changed any of your thoughts?

Race, Poverty, Gender, OH MY!

I recently started an internship at CAP and get to participate in some interesting dialogues and trainings.  One project that I was happy to be a part of was a teleconference discussing the intersections of race, gender, and poverty.  This is fascinating to me since I’m majoring in Social Work at PSU.  Here is a summary of what I heard.

Throughout the conference, emphasis was put on how gender and race have a huge impact on health and health outcomes.  One example came from a recent study that showed middle class women of color are more likely to isolate themselves than other groups.  Many people would think that is counter intuitive—if these women are middle class, shouldn’t they have the ability to access resources?   Well, these same women are living in a state of nondisclosure.  They work 9-5 (when most agencies are open for business) and have the means to support themselves with a job that , more than likely, would not be so great (many examples of workplace discrimination have been reported) if they found out these women were HIV+. Numerous studies have found that most workplaces treat HIV+ folks negatively.  The PTA and neighborhood associations may not be as understanding—even if they were, this group doesn’t perceive them as such, and that is what matters.  Without support and communication, what happens to this group of women?

For the women who are accessing services, a study found those that are most useful offer housing assistance, job acquisition and skills, and assistance acquiring medical services (Yay, CAP!).  What else are women doing to help in this struggle?  Many are participating in academic studies.  Besides the financial reimbursement offered in many of these studies, women are having their voices heard and creating connections.  This is invaluable to their community and to policy and academic leaders who are making decisions.

Another startling fact was the in-your-face graph of the unequal disbursement of wealth.  This translates to how much money is left over after the bills.  I know, I know: we’ve all heard this—but just look at the graph!  Crazy, no?

“Where are the Latina and African/Black women in this graph?” you ask—Well, Latina women have $120 and African/Black women have $100.  These groups didn’t even make it onto the graph!  I told you it was crazy.

This info is great and there is a lot more available at the Positive Women’s Network website (the lovely ladies sponsored this teleconference).

Our (Spanish) Hotline: Servicios de Intervención Temprana (telephonica), Apoyo Latino

In honor of National Latino AIDS Awareness Day

Apoyo Latino: 1.800.499.6940

Apoyo Latino is the Oregon Spanish speaking HIV/STD Hotline provided by Cascade AIDS Project.  Apoyo Latino provides culturally relevant HIV/AIDS information, support, and referrals to the Latino and/or Spanish speaking community.  It is a confidential and free service open Monday through Friday from 9:00 a.m. – 5:00 p.m.

Hotline Counselors have quick access to thousands of up-to-date local and national resources and can make appropriate referrals as needed.  Many calls include referrals to HIV/STD testing sites, AIDS services organizations, legal, financial, substance abuse, domestic violence, physical or mental health care, support groups, and GLBTQ services.

Counselors are also able to help HIV+ callers get connected to the support services they need including case management, legal, housing, prescription coverage support, financial, housing, and transportation assistance.

If you or someone you know is infected or affected by HIV/AIDS or STDS and need assistance you can call anytime during our hours to speak with a compassionate and knowledgeable individual.

Servicios de Intervención Temprana, Apoyo Latino

(antiguamente conocido como Care Link y Apoyo Latino)

Cascade AIDS Project

Descripción:

Es un programa de Cascade AIDS Project que ayuda a la gente con VIH/SIDA a conectarse con servicios relacionados con el VIH/SIDA.

Servicios:

  • Ayudarle a encontrar servicios médicos y un trabajador de casos personales
  • Ayudarle a encontrar un seguro médico
  • Hacer sus citas médicas y/o llevarle al médico
  • Ayudarle a llenar las formas necesarias
  • Abogar por usted con los proveedores de servicios
  • Ayudarle a encontrar recursos de transporte
  • Ofrecerle información y referirle a servicios
  • Hablar sobre las barreras que existen por la diferencia del idioma y la cultura

Requisitos:

Todos los servicios son gratuitos y están disponibles para todos, posean o no documentos.

Horario: Se atiende de lunes a viernes de 9am a 5pm.

Contactos:

503-223-5907 Hay personal bilingüe.

1-800-499-6940 Línea en español.

What if we could get celebrities like Mario Lopez , Penelope Cruz, Carlos Mencia or Antonio Banderas  to answer the line…?

From “grumpy teenager” to educated youth a Teen2Teen story

My name is Indica Hanson;  last year I was in the Teen2Teen program .I am going to be in the program this year as well.  I grew up in this program and learned so much from it.

                In early September 2009 my mom convinced me to fill out the paper work and interview for Teen2Teen; my mom was a volunteer for Cascade AIDS Project so she knew Annika, the leader of Teen2Teen. I was not exactly ecstatic about this, as I was a grumpy teenager and didn’t want anything to do with some extracurricular activity. I went in for my interview and loved Annika, she was exciting, happy, and I got along with her very well. Finally, I started to become excited about maybe being a Teen2Teener.

 Then came the retreat. It was 11 teenagers and Annika in a big white van driving to the beach. I automatically became close friends with this girl Jessie, we talked the whole way to the beach and we made sure we got a room together in the house. The retreat was a blast. We played games with Joseph [another CAP staff]  and learned all about sex, STI’s, HIV, gender and sexuality from Annika! I already felt like I was growing. Sadly, it was time to go home. I couldn’t wait for Tuesday as that was the day of our meetings.

                 All of us fellow Teen2Teeners became very close; we were our own little family. Every Tuesday at our meetings we learned something new and exciting, as the weeks went on I became much more comfortable with myself and with others. I started to open up and share my own opinions. Throughout the months I began to grow up and mature very fast. I realized that I cared deeply about teaching and becoming one with the community. I also figured out a lot about myself, I started to realize who I was. I finally let myself become okay with the idea that I was gay. I came out to my family and to my friends, and I started to really care about the gay community. I started to learn about homophobia and stigma; I tried to fix things and teach people on my own time. I was really becoming a strong peer educator and I really started to get my own thoughts and ideas.

                Because of Teen2Teen I felt like I was actually making a difference. I started to teach in more schools, I was teaching high schoolers that were older than me. I was even teaching some middle schoolers and elementary students. The students really listened when a peer was teaching them, you could see them slowly change within the hour that we had with them. We taught them subjects and material that they would not have learned in their basic health class. Being in Teen2Teen was not just to help others learn, but to help you learn as well. It was a life changing experience and I am very glad I joined. This whole thing sounds so cheesy but it is all so very true, I loved it, and so did everyone else. Even if you are not a Teen2Teener there is so much you can do to help the community, you can come to one of our agent trainings or come to CHAT(Room)  and learn about sex ed, HIV, get tested, and see what you can do to help as well!

-Indica Hanson, Teen2Teener 2009-2010

[Teen2Teen is a group of passionate, activated youth ages 15-19 who volunteer for an entire year and are trained as peer educators in HIV/AIDS and Sexuality education. The young people in Teen2Teen dedicate their time to learning and educating about HIV/AIDS, sexuality, gender, sexual orientation, healthy relationships, and so much more!]

[If you would like to learn more about Teen2Teen or apply to be a Teen2Teener, please contact Annika Shore:  Ashore@cascadeaids.org or 503.278.3872 and you can apply by filling out the application for the 2010-2011 year here]