Friday, June 08, 2007

Bob Geldof on HIV at the G8

The G8 meeting of the world's richest Western nations, plus Russia, broke up today. After the promises of action on climate change and in support of Africa made at the previous G8 meeting two years ago, to applause from veteran campaigner Bob Geldof, we have been brought down to earth with a bump. There has been much back-tracking and weasel words from the G8 to try to cover the fact that action and aid promised will be much less than first suggested.

This time Bob has not been taken in and called the communique issued at the end of the meeting a rude word, which probably was bleeped out by much of the world's media. Thoroughly deserved it was too.

As George Monbiot wrote earlier this week, while the rich-country governments profess to care, they will not take action if it conflicts with their own financial interests. And will take action to promote their financial interests, the example of US pressure on the Philippines government to scrap its new baby food marketing regulations being used to illustrate the point. See:

Bob was asked on BBC television's 'Newsnight' programme what the scaling back in promised aid would mean to Africa in practical terms. He cited children who had been going to school, who would no longer be able to do so.

And then he said this: "A child who picked up aids from its mothers breast. Chances of life, minimal..... No more medicines so you die."

It is a valid point that if the Global Fund for Aids does not receive its promised funding, people who need drugs will suffer. But invoking breastfeeding as the cause of a child picking up Aids is ill informed and ultimately a dangerous message to send.

Yes, there is a risk of transmission through breastfeeding. However, if current UN health guidance is followed by a mother in conditions of poverty the risk of transmission is not only relatively small (at 4% in a new study), her child will be more likely to survive other illnesses than a child given formula, even free formula.

The best people to listen to on this issue are people on the ground in Africa. The International Baby Food Action Network (IBFAN) has had African partners for 25 years and recently the coordinating office has posted an overview of HIV and infant feeding to the IBFAN website:

You will find lots of other valuable information from people who are experts in their fields and at the sharp end of infant feeding issues in their countries.

You can find the specific document from IBFAN Africa on HIV and infant feeding at:

As with everything IBFAN does it is evidence and science based. Here is an extract:

---Quote begins
Recent research by Coovardia H.M[4] (Lancet Vol. 369 March 2007) has made very valuable findings for Africa and the developing world. The researchers from the Africa Centre for Health and Population Studies have found out that there is only a 4% risk of postnatal transmission of HIV to infants who are exclusively breastfed from 6 weeks to 6 months of age. The researchers are now calling for the United Nations Guidelines to be changed to promote exclusive breastfeeding for mothers in developing countries. This study has serious implications for resource poor countries where over 60% of populations live below the poverty line. According to the study, infants who receive supplements such as commercial formula or cow’s milk were two times as likely to be infected as infants who were solely breastfed, while those given solids in addition to breastmilk were 11 times more likely to be infected than those who exclusively breastfed.

The study that involved around 2700 babies born between 2001 and 2005 further found that the death rate by 3 months of age for babies who were exclusively breastfed was less than half that of infants who received formula milk alone. Over 15% of babies whose HIV positive mothers did not breastfeed them died by 3 months compared to only 6% of the babies whose mothers breastfed them exclusively.
---quote ends

So it is critically important that the message of the importance of exclusive breastfeeding is not lost or distorted in sound bites about children becoming infected at their mother's breast. The UN has indeed strengthened its language in a new consensus statement, as we reported in Update 39:

---From UN Consensus Statement
“Exclusive breastfeeding is recommended for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.... Breastfeeding mothers of infants and young children who are known to be HIV-infected should be strongly encouraged to continue breastfeeding.... Governments should ensure that the package of interventions referenced above, as well as the conditions described in current guidance, are available before any distribution of free commercial infant formula is considered.”
---Quote ends

Breastfeeding saves lives in poor conditions, even for those infants whose mothers are infected with HIV.

Even before the reduced risks of exclusive breastfeeding were properly researched and the practice recommended, it was true that more infants were infected with HIV in utero than through breastfeeding (a risk that anti retro viral drugs can reduce).

But lets not let these facts distract from the starkness of the absolute figures cited above.

6% of the babies who were exclusively breastfed in the Coovardia study died by 3 months. 15% of those who were formula-fed had died by 3 months. Every death is a tragedy.

For comparison, in the UK the infant mortality rate is about 5 per 1,000 live births. Or, to put it another way, 0.5% have died by one year of age.

Considering the population as a whole, infant mortality rates in Africa are far higher than in the rich world. I've just turned up a figure of 92 infant deaths per 1,000 live births for Malawi where I used to work, nearly 20 times the UK rate.

The bigger killer is poverty and I believe Bob Geldof is right to blast rich-country leaders for their lack of action, particularly when so many of their citizens and tax payers have called for action. Particularly when so much of the wealth of rich countries comes through abuse of power over poorer countries.

It is great that he is heard by the world's media (beeps aside), but I hope for greater clarity in future when touching on mother-to-child transmission of HIV, please Bob.

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