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Questionable Value of Data on HIV-transmission Risk
- George Kent, Honolulu, Hawai'i 96822 (5 February 2008)
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George Kent, Professor of Political Science Department of Political Science, University of Hawai'i, Honolulu, Hawai'i 96822
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Bulteel and Henderson’s article was entitled “Evidence Behind the WHO Guidelines: Hospital Care for Children: What are the Risks of HIV Transmission?” The WHO recommendations for infant feeding when the mother has been diagnosed as HIV-positive are not specific to hospital care, and their analysis did not focus on the hospital context. Thus, the middle part of their title is not relevant. If one is interested in evidence behind the WHO guidelines related to the choice of infant feeding methods when the mother has been diagnosed as HIV-positive, what exactly is the relevance of the risk of HIV transmission? As the paper’s concluding summary says, “WHO advises that unless replacement feeding is acceptable, feasible, affordable, sustainable, and safe for infant and mother, EBF [exclusive breastfeeding] should be practiced.” This recommendation refers to the question of what feeding method should be chosen based on consideration for the likely impact on the infant’s health. That needs to be said. How would data on HIV transmission provide evidence for or against this recommendation? HIV transmission certainly has an impact on infant’s health, but it is not a simple relationship. For a time many people assumed that HIV infection was virtually a death sentence, but the evidence shows that that is far from true. Apparently breastfeeding is capable of transmitting HIV. But breastfeeding also transmits a broad variety of protective factors. Whether the positive or negative factors prevail is an empirical question, one whose answer is likely to vary under different conditions. Drug treatments of the mother or child are likely to have a substantial impact on the relationship. The second paragraph of Bulteel and Henderson’s study says, “This review addresses the question: What are the risks of HIV transmission through breastfeeding?’ It focuses on the impact of various factors on the likelihood of transmission of HIV to the infant, rather than on the impact of those factors on infant health. If the objective were simply to minimize the risk of transmission, the recommendation would be to not breastfeed. However, the objective of concern should be to protect the infant’s health. A study that claims to relate data on HIV transmission to the WHO guidelines needs to be explicit about its understanding regarding the relationship between HIV transmission and infant health. That understanding may be evidence based or, as in much of the literature, it may be based on assumptions. Either way, that understanding should be laid out explicitly so that it can be subjected to examination and possibly to challenge. Aloha, George Kent Conflict of Interest:None declared |
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