VOLUME 6, NUMBER 9 REAPPRAISING AIDS                   SEPTEMBER 1998

HIV Hysteria Leads UN to Launch Anti-Breastfeeding Campaign

Proponents Recognize That Initiative Will Cause Even HIV-negative Impoverished Women to Stop Breastfeeding

Nations with millions of people lacking adequate nutrition and sanitation need money to purchase and administer HIV tests and anti-HIV drugs, and to discourage mothers from breastfeeding their children, officials and others asserted at the 12th World AIDS Conference in Geneva.

"The United Nations... is seeking donations from governments and foundations to... expand HIV testing and counseling to introduce replacement feeding, [and] short course AZT therapy," reported New York Times staff writer Lawrence K. Altman, MD, on July 26 from Geneva.

While the UN has always wanted money for HIV testing and AZT in the impoverished regions that it says account for 90% of the world's AIDS cases, the anti-breast milk campaign "represents a significant change in policy... countering decades of promoting 'breast is best' for infant nutrition."

According to Altman "in 1985, when HIV was first detected in mother's milk, US Public Health Service officials issued recommendations applicable only to the US that infected mothers not breastfeed." Unlike babies in underdeveloped regions, US babies raised on formula rarely die as a result. Meanwhile, the UN "first confirmed that mother's milk could transmit the AIDS virus" in 1992. But, until now, the WHO "recommended that, in most developing countries, where malnutrition and infectious diseases remain the paramount threat to infants, 'breastfeeding should remain the standard advice to [HIV-positive] pregnant women... because their baby's risk of becoming infected through breast milk is likely to be lower than its risk of dying from other causes if deprived of breastfeeding.'"

In poor regions, formula feeding can be deadly. Already nutritionally inferior to breast milk, poor mothers stretch the powder by over-diluting, often with unpotable water. WHO officials have changed their policy because they believe that suckling transmission of HIV is rising so fast in those areas that the populations would fare better with the problems caused by formula feeding.

Against the breast?

Altman's dispatch focused on the new stricture against breast feeding. Titled, "AIDS Brings Shift on breastfeeding; To Combat AIDS, the UN Now Cautions on breastfeeding," the article states that, "The very same babies spared HIV infection during pregnancy and delivery could, just a few months later, become infected through breastfeeding. The United Nations is issuing recommendations intended to discourage women infected with the AIDS virus from breastfeeding. It is advising governments to consider bulk purchases of formula and other milk substitutes and dispense them."

According to Altman, "Dr. Peter Piot, executive director of UNAIDS, the agency that has pushed hardest to discourage mothers from breastfeeding," warns HIV-positive moms that "breastfeeding could kill their babies."

And he quotes Bernhard Schwartlander, MD, UNAIDS' chief epidemiologist, claiming: "Last year, breastfeeding accounted for up to a third of the 600,000 children in the world who became HIV infected," and that "from 1992 through last month, up to one million babies in the world had become HIV-infected through breastfeeding."

The article included a sole dissident voice. "Dr. Felicity Savage, a WHO official, expressed extreme caution about the new guidelines, citing the risk of contamination of breast milk alternatives in areas that lack clean water and loss of nutrients if a woman mixes water and formula inaccurately," Altman writes. "Such hazards could 'endanger a lot of lives that would otherwise not have been at risk at all,' and could produce more deaths among those receiving replacement feedings than AIDS among those breastfed by infected women."

Reappraising the UN Initiative

RA Board member Roberto Giraldo, a physician who attended the Geneva conference, objects to the UN initiative, particularly its emphasis on discouraging breastfeeding in underdeveloped areas. He has extensive experience treating infectious and tropical diseases in the impoverished Colombian countryside.

"I was shocked to learn of this new push to discourage millions of mostly impoverished women around the world from breastfeeding their infants simply because they test HIV-positive," he said in an interview with RA . "The people at the conference promoting this initiative provided no evidence -- new or old -- to support their assumption that suckling can transmit HIV, or that HIV even exists in the milk of HIV-positive mothers."

The UN initiative is completely wrong-headed within the context of Giraldo's view, shared by many scientists and physicians around the world, that HIV is entirely harmless, and that poverty itself -- malnourishment and poor sanitation -- and AZT are two of the causes of AIDS. According to this view, money to reduce AIDS in underdeveloped areas would be best spent on fighting poverty, by building modern economic and sanitation infrastructures. Money spent on HIV testing would be a total waste, while money spent on anti-HIV drugs and anti-suckling campaigns would make things worse.

Altman reports that the UN initiative will target "countries in Africa and Asia where women have high [HIV] infection rates." Giraldo points out that where HIV rates are high, so are rates for all germs, and where HIV rates have increased, so have the rates of all germs, indicating sanitation problems, which in turn indicates abject poverty, rather than HIV running amok.

Indeed, a recent series of NYT articles about AIDS in Africa confirms that the populations with the highest HIV incidences are the ones with the most desperate economic and sanitary crises, as well as the highest rates of other germs. The articles also show that where HIV incidences have increased, so have the incidences of other germs, and that these increases reflect worsening economic situations.

The five articles include an overview ("Parts of Africa Showing HIV in 1 in 4 Adults," June 24), and ones that focus on Rwanda ("AIDS Prolongs War Devastation in Rural Rwanda," May 28), South Africa ("Post-Apartheid Agony: AIDS on the March," July 23, Uganda ("breastfeeding and HIV: Weighing Health Risks," Aug. 19, and Zimbabwe ("Zimbabwe's Descent Into AIDS Abyss," Aug. 6). All are featured on the website www.nyt.com.

In describing the populations experiencing high HIV rates, the articles inevitably describe extreme squalor and destitution. The Rwandan article shows that the rate of HIV-positivity in the countryside has increased from 1.3% in 1986 to 11% today, the sort of data typically used as evidence that HIV is a new virus. But new germs aren't the only ones that spread; old ones do too, when sanitatary conditions decline. The article acknowledges that, during this time, the Rwandans experiencing an HIV increase have also experienced "a state-organized campaign of terror" involving the murder of 500,000 people, and the exodus of 2 million others who lived two years in refugee camps before marching back to Rwanda in 1996. Might the "spread of HIV" among them reflect not the introduction of a deadly new germ, but rather a collapse of sanitation causing all resident microbes, including harmless ones that initially exist at tiny levels, to infect more people? The article mentioned nothing about other microbes, but the other ones did.

The Zimbabwe article states that "Zimbabwe has suddenly turned into the center of the AIDS epidemic. Recent studies now suggest that it may have the highest infection rate on earth. Twenty-five percent of all adults may now be infected with HIV. In some places... the rate is closer to 40 percent." But the article acknowledges that this presumed increase in HIV incidence (it gives no figure for earlier years) has taken place while, with "increasing poverty and instability, illness has begun to overcome the country. Tuberculosis, hepatitis, malaria, measles and cholera have surged mercilessly. So have infant mortality, still births, and sexually transmitted diseases." Malarial deaths rose from 100 in 1989 to 2,800 in 1997. Tuberculosis cases rose from 5,000 in 1986 to 35,000 in 1997 and "this year it is worse." The reporter acknowledged that these diseases indicate poverty, calling TB "the sentinel illness of poverty and social decline."

The NYT series also illustrates one of the essential criticisms of the HIV-AIDS model: among the sick and dying, clinicians can not distinguish who would test HIV-positive if test kits were available. Giraldo points out that in regions with no funds for HIV testing, AIDS diagnoses there are made presumptively , meaning, people are diagnosed as having AIDS simply by having conditions that HIV is said to cause, such as tuberculosis and the symptoms of malaria (persistent night sweats, fever, and wasting) and cholera (diarrhea, fever, and wasting). But when western scientists show up with their test kits, they find that 70% of these "AIDS" patients are HIV-negative (Lancet 340:971, 1992; Journal of AIDS 7[8]:876, 1994; American Review of Respiratory Disease 147:958, 1993).

Even if HIV did cause AIDS

Does the UN's initiative make sense even within the context of the HIV-AIDS model? No, Giraldo says, for three reasons: (1) There's no scientific support for the contention that suckling transmits HIV; (2) The campaign against breastfeeding will cause even HIV-negative women to stop; and (3) Mass HIV testing misidentifies large fractions of people as HIV-infected.

Breast is best

The supremacy of breast milk is well-documented and well-accepted, especially for its life-preserving role in nourishing impoverished children. So there must be a good reason for recommending against it, Giraldo says.

The availability of powdered infant formula introduced in the 1960s exacerbated the epidemic of AIDS diseases (tuberculosis, malaria, cholera, etc.) among impoverished people, as women over-diluted to save money, and often used unpotable water. The UN responded with a campaign to encourage breast milk over formulas. Giraldo is not alone in stating that, "Breast milk is the best source of nutrition for infants, especially for poor children."

Altman quotes Kevin M. de Cock, MD, an AIDS specialist at the Centers for Disease Control and Prevention in Atlanta, as saying: "For large agencies that have worked hard and long promoting breastfeeding to say that women with HIV should avoid it, if possible, has been a very difficult policy pill to swallow."

Altman writes that the UN, despite its new initiative, maintains an "unwavering belief that breastfeeding is the easiest and best source of nutrition for an infant, promotes bonding between the mother and infant, allows for a newborn's natural reflex to suckle, provides longer spacing between births, and protects against many life-threatening infections in the first few months of life."

"Nobody disputes the supremacy of breast milk," Giraldo says. "But the claims that it can transmit HIV come with no documentation at all. We heard lots of claims in Geneva, but nobody provided any scientific data to show that suckling increases HIV risk, or that milk from HIV-positive mothers even contains HIV. I performed an extensive search of the literature and found no proof for these claims, including Altman's comments about HIV being shown in the milk in 1985, and HIV suckling transmission being demonstrated in 1992, and Schwartlander's claim that a third of HIV-positive children became so from breast milk. I found no validation for the hypothesis that children can get HIV through the breast milk of their mothers. This is simply an unproven hypothesis, and one I believe is probably false, given what has been proven about HIV."

Giraldo says he can find no data to show that breastfed babies of HIV-positive mothers fare worse than those denied their mothers' milk, or that HIV-negative children denied their mother's milk do better than HIV-positive children fed it. And this, Giraldo says, is precisely the sort of data one ought to require before warning women against breastfeeding.

HIV proponents back the breast

Among physicians who buy the HIV-AIDS model, at least one has also searched vainly for proof that suckling transmits HIV, and others continue to favor breastfeeding even for women who test positive.

S. V. Kennedy IV, a professor of public health at the Allegheny University of the Health Sciences, documented in the July 1998 issue of Medical Hypothesis his search for scientific data supporting the notion that suckling transmits HIV. Like Giraldo, Kennedy found nothing matching the figures tossed out by Altman and Schwartlander.

Reports Kennedy: "a recent analysis of the MEDLINE database of articles compiled by the National Library of Medicine (1985-95) revealed approximately 167 publications with HIV, breast milk and breast feeding as the common denominators. Of the 20 articles representing adequate reviews of the key words," none showed that breastfed babies of HIV-positive mothers had a higher HIV-positive rate than those denied their mothers' milk. Furthermore, he noted that "only a few citations mentioned the presence" in mothers' milk of anything indicating the presence of HIV, and 19 of the 20 papers, or 95% "advocated the value of breast feeding despite the HIV alarm."

"From the database analysis, we know that the relative role of breast feeding in the epidemiology of HIV is still uncertain," that the "epidemiological data do not lend credence to such a theory of the postnatal infectivity (of HIV) by breast milk," and that "the documented level of infectivity has led some researchers to believe that" the "possibility" of suckling transmission might have been "overstated and could therefore not be... the... major public health factor" some have suggested.

Kennedy goes on to acknowledge that "we know of the antiviral activities of breast milk, and possibly an anti-HIV property." Then he concludes; "taking into account the role and value of breast milk in preventing or minimizing childhood diseases like malnutrition, infections, diarrhea, and measles, in enhancing mother-to-child bonding, and in childhood nutrients, breast milk and breastfeeding should continue to be encouraged, especially in the developing countries."

HIV-negative mothers and breastfeeding

Proponents of the new policy against breast milk know that it will cause even HIV-negative mothers to forgo breastfeeding. "The United Nation said it was deeply concerned that advising infected mothers not to breastfeed might lead many mothers who are not infected to stop breastfeeding," Altman writes.

This is because the UN knows that it'll never raise enough money to test most pregnant Third World women. With the same publicity machinery that so effectively sold the HIV-AIDS hypothesis now selling the HIV-suckling hypothesis, many women unable to get tested will simply "play it safe."

The UN's solution? "It is advising governments to consider bulk purchases of formula and other milk substitutes" so that there's enough not just for those who test positive, but for those who don't test at all.

Problems with testing

Even among those who get tested, many people identified as positive will be labeled falsely. This is because the tests are very nonsensitive: most people who test positive have no active HIV infections. The sensitivity of HIV antibody testing -- a battery of ELISAs and Western blots used to define people as "HIV-positive" -- is 41%-76% in people with AIDS conditions, and 0%-10% in people without AIDS conditions (Gallo, Science 224:497, 1984; Piatak, Science 259:1749, 1993; Piatak, Lancet 341:1099, 1993; Daar, NEJM 324[14]:961, 1991; Clark NEJM 324[14]:954, 1991; Cooper, Lancet 340:1257, 1992). This means that among HIV-positive people with AIDS conditions, only 41%-76% have what are regarded as active HIV infections, and among HIV-positive people with no AIDS conditions (the majority of HIV-positive people), only 0%-10% do.

"Viral load," which involves the counting of HIV RNA fragments, is no better. Sensitivity for people with AIDS conditions is about 66%, and for people without AIDS conditions only 9% (Piatak, Science 259:1749, 1993).

One reason for this low sensitivity is that most HIV infections are inactive: the host harbors sleeping HIV DNA that is harmless, even if HIV was a pathogen.

Another reason is that antibodies produced against HIV proteins -- the antibodies that define people as "HIV-positive -- are produced also against many non-HIV proteins, "including those associated with more than 70 different conditions," Giraldo says. "Interestingly, most of these conditions are present in the vast majority of the inhabitants of the underdeveloped world." This means a lot of HIV-positive people have never even encountered HIV, and those don't even have inactive infections.

So, under the UN's directive, HIV testing efforts will result in many people who have no active HIV infections none the less taking toxic anti-HIV drugs and feeding their children diluted, contaminated formula instead of breast milk.

For Giraldo, the proper course of action is clear. "These people need food, modern homes, paved streets, indoor plumbing, and clean water, and the babies need to breastfeed," he says. "Not HIV tests, AZT, or warnings against mother's milk. You get rid of TB, cholera, malnutrition, and the rest, and you will get rid of AIDS." -- Paul Philpott

REAPPRAISING AIDS HOMEPAGE