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Issued by the Education Labour Relations Council
SATELLITE SESSION
Tuesday 5 April 2005, 13:00 – 14:00
INTERNATIONAL CONFERENCE ON BIO-PSYCHOSOCIAL ASPECTS OF HIV INFECTION, 4-7 APRIL 2005,
CAPE TOWN CONVENTION CENTRE
WATERFRONT
CAPE TOWN
SHARED BREASTFEEDING CONTRIBUTES TO HIV-TRANSMISSION, NEW STUDY SHOWS Breastfeeding of babies by a non-biological caregiver with HIV is the single most important factor associated with HIV infection in children besides the most obvious route of mother-to-child transmission of HIV. This emerged from an investigation into possible causes of HIV infection among a very small proportion of children in the 2-9 age group, who had HIV negative mothers. The new study, HIV risk exposure among young children aged 2-9 years served by Public Health Facilities in the Free State, South Africa, South Africa, was conducted by the Human Sciences Research Council (HSRC), the University of Stellenbosch, the Medical Research Council (MRC) and the Centre for AIDS Development Research and Evaluation (CADRE). The Nelson Mandela Foundation commissioned the study, with additional support from the Free State Department of Health and the Nelson Mandela Children's Fund. Prolonged breastfeeding of children by HIV positive mothers also increases exposure to risk of HIV infection in children. The study found that 92.3% of HIV positive mothers breastfed their children, 60% longer than one year. "This suggests that even if children are born HIV negative, they are likely to contract HIV due to breastfeeding,” said Dr. Olive Shisana, Executive Director of the Social Aspects of HIV/AIDS and Health at the HSRC and co-principal investigator. The study also found that there is a potential for health-care acquired transmission of HIV in the maternity, paediatric and dental facilities in the Free State health facilities. Poor infection control practices were found in some labour and maternity areas and in dental facilities, in particular through poor cleaning techniques and traces of visible and invisible blood found in these areas and on dental instruments. The study found that 24.6% of dental instruments ready to be used on patient’s mouths and gums and 24% of instruments destined to be used for maternity and paediatric patients were contaminated with invisible blood and 17.5% had visible blood. According to Professor Shaheen Mehtar, University of Stellenbosch and co-Principal Investigator this suggests that there has been a breakdown in infection control processes over an extended period. Management and control of access to expressed milk was also a problem. "We found that babies could be exposed to HIV contaminated milk; 29.7% of the sample of breast milk destined for feeding babies tested positive for HIV, and six milk samples contained high viral load," she said. Breast milk samples were randomly selected. Only 13 of the 25 public hospitals had dedicated milk preparation areas. In the rest, milk preparation was carried out in the ward with few infection prevention methods. "A major problem was that bottles were labelled by cot numbers rather than the name of the baby and rarely checked, allowing milk to be fed to the wrong baby if the cot was moved", Mehtar said. "The evidence generated from this study suggests there is a need to reduce the potential for HIV transmission in dental, maternity and paediatric facilities. Health care-acquired infections are completely avoidable", said John Samuel, CEO, Nelson Mandela Foundation. "The solutions lie not only with policymakers, to ensure that there are policies and guidelines for infection control, and that these guidelines are rigorously implemented, but that patients are educated to demand that health workers wash their hands, wear and change gloves and use sterile equipment. Well-informed patients are best placed to monitor weaknesses in infection control", Samuel said. The purpose of the study was to identity all possible other sources of HIV transmission, besides that of mother to child, among children 2-9 in the Free State public health sector. It investigated breaks in infection control practices that could lead to HIV transmission within the health services, and on traditional practices, birth attendants, and HIV prevention and treatment techniques that could contribute to viral infection. The investigation was conducted from April to July 2004 among 4 000 mother and child pairs in 25 public hospitals, three community health centres and 54 primary health care clinics in the Free State. Mothers and children were tested for HIV, and mothers and caregivers answered questionnaires. DNA testing was done on the biological mothers to confirm maternity of the children who participated. Children were also examined for signs of scars inflicted by traditional practices such as circumcision, incisions, birth procedures and scarification. Findings indicate that the overall HIV prevalence among children in public health facilities in the Free State is 14.3%; among hospitalised children, this figure rose to 21.5% - a heavy burden on public hospitals. "Although this is a high rate of HIV prevalence for children, the prevalence rate of children in the general community is likely to be somewhat lower", said Shisana. "This is because HIV infection is linked to possible illness, which is in turn linked to needing health care." The major findings of the study are: -
Just over 29% of mothers in the study were HIV positive. -
Children in the 2-5 year age group and in the 6-9 year age group have the same HIV prevalence, namely 14.9%. The prevalence rate was similar for children throughout the age range. -
Children using health care facilities and living in urban areas have the highest HIV prevalence, namely 22.9%, compared to 19.1% of children living on farms and 12.5% of children living in villages. Major recommendations emanating from the study are: -
The National Department of Health are urged to conduct a national public health campaign to inform the public that shared breastfeeding is a potential risk factor for HIV in children and to discourage this practice, unless the serostatus of the surrogate mother is established to be HIV negative. The Free State Department of Health could do the same on a provincial level. -
Prolonged breastfeeding of children by HIV-positive mothers should be discouraged. There is a need for a policy review on breastfeeding where the mother is HIV positive, taking into account the socio-economic conditions of the mother. -
The Free State government is urged to ensure that the HIV-positive children whose mother is HIV negative children are given access to ARV treatment, if so indicated. -
Urgent steps should be taken to ensure that there is better control of the labelling of expressed breast milk. If breast milk is going to be "pooled" it must be pasteurised before use. -
It is important to improve infection control practices in all health care facilities. To enforce the infection control policies, the Department of Health is urged to conduct a campaign to encourage the public to insist that health workers must practice universal precautions whenever they treat patients, and to have regular inspection and control visits at these facilities. Such universal precautions should include simple measures as washing hands and wearing gloves and changing them between patients, the sterilising instruments and equipment, and the disposing of waste in a proper manner in the treatment of patients. Click here to view the full report, HIV risk exposure among young children aged 2-9 years served by Public Health Facilities in the Free State, South Africa
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