Nutrition and HIV/AIDS: A Training Manual - Linkages Project

• Providing skin-to-skin contact and use of massage and other means to comfortthe baby in place of offering the breast• Teaching the infant to sleep through the night• Monitoring the infant’s urine output to detect and prevent dehydration• Switching from breastmilk to replacement foods• Supporting and caring for the mother• For additional information, refer to Piwoz et al. (2001) Issues, Risks, andChallenges of Early Breastfeeding Cessation to Reduce Postnatal Transmission ofHIV in Africa. Washington, DC: SARA Project, Academy for EducationalDevelopment.Methods for treating expressed breastmilk are currently being tested. Suchmethods include pasteurizing the milk (heating to 62.5 degrees Celsius for 30minutes) or boiling it briefly and cooling it immediately in the refrigerator or byplacing the container in cool water. Although these methods destroy HIV, they maybe difficult to sustain. Heat-treated milk retains nutritional benefits but loses someanti-infective factors. Ideally, an infant should be given the treated breastmilk froma cup. This option is most likely feasible in a hospital setting for sick and low birthweight infants. Several studies have shown that expressing breastmilk and letting itstand for a half-hour inactivates HIV (Orloff et al 1993; Isaacs and Thormar 1990;Newburg et al 1992). During this time the naturally occurring anti-HIV factors inbreastmilk are allowed to take effect.Again, the feasibility and sustainability of this option must be considered. Does themother have time (or well-being) to express and heat treat her milk, and then feedher child? With an electric pump in the optimal setting, expressing and storing takeson average 20-30 minutes, and the infant is fed this expressed breastmilk 8-10 timesa day. Can the mother afford the fuel to heat the breastmilk?201