JOHANNESBURG & DURBAN
With nearly 3.5 million residents, Durban is the largest city in the KwaZulu-Natal province of South Africa. It boasts some of the most beautiful beaches and busiest ports in the country, yet the region is also known for its staggering HIV rate among women and children.
[Continue reading the video transcript, or watch the video above.]
In March of 2009, I traveled to Johannesburg and Durban, South Africa to report on the innovative ways that researchers and public health experts are helping HIV positive mothers breastfeed their babies without transmitting the virus during the crucial first six months of life, when babies are most susceptible to contracting the disease. This video examines the pros and cons of a PMTCT (prevention of mother-to-child transmission) method called ‘flash heating,’ as told by experts and a 34-year-old HIV-positive mother of one, Nosipho Hilda-Dludla.
Forty percent of pregnant women in KwaZulu-Natal are infected, often passing the virus to their infants before, during or after labor, or through breastfeeding.
Thanks to the increasing availability of anti-transmission methods, mother-to-child transmission has fallen in recent years. Yet, researchers are scrambling to find newer, and more effective methods that can be applied widely by HIV-positive mothers across the continent.
And that’s where a new, low-tech method called flash-heating enters the picture. Using common household utensils, some HIV-positive mothers can kill the virus in their breastmilk while preserving most of the vital nutrients that babies rely on for disease immunity.
In March 2009, I met with researchers and healthcare professionals at the University of KwaZulu-Natal in Durban and the University of California at Berkeley to find out -where the promising technology- stands today.
[Clip 1: “In sub-Saharan Africa, and other places, where women have no other options, this is a really, really important idea.”]
Dr. Barbara Abrams is a professor of epidemiology at UC Berkeley’s School of Public Health. She joined the flash-heating study in 2001, after one of her students returned from Zimbabwe with data suggesting that women there were willing to try the method. With a growing team of researchers, Abrams helped to prove that flash-heating is nutritious, affordable, and immunologically safe.
[Clip 2: “Heat-treated breastmilk can be such a helpful thing. It’s an option for women to bridge the time from exclusive breastfeeding to the time when babies can receive only food, and reduce their HIV transmission.”]
Babies are most at risk of contracting the virus when their mothers combine breastfeeding with other food sources, such as infant formula or cow’s milk. This is known as mixed-feeding. It’s dangerous because every food source except breastmilk can destroy the protective mucous membranes lining a baby’s stomach. Without that lining, the baby is more exposed to infections, including HIV.
Furthermore, without a dependable source of clean water to mix with infant formula, formula feeding—used successfully by women in developed countries—is not a viable option for most women in sub-Saharan Africa.
[Clip 3: “The time I was pregnant, I decided I’m gonna feed the babies the formula because my CD4 count was low, and the doctor and the counselor, they told me the formula is not good for the baby.”]
Meet Nosipho Hilda-Dludla. A year and a half ago, the 34-year-old HIV-positive mother gave birth to triplets—two girls, one boy, all HIV-negative. Her girls perished soon after they were born, fueling Nosipho to protect her one surviving child from contracting the virus that causes AIDS.
But first, she needed to learn which options were available to her. Formula feeding was not one of them. And while it is true that exclusive formula feeding may protect babies from HIV, the spoiler is that it often exposes them to fatal diarrheal disease.
But avoiding the pitfalls of the flash-heating method is only one of many issues.
[Clip 4: “Not only do we want to protect the baby while the mom is breastfeeding, but we want to protect that mom. I mean, can you imagine anything sadder than having the mom and baby be HIV-positive and faced with illness and death, than having the baby saved and the mom die?”]
Mothers without access to antiretrovirals, which can turn HIV into a manageable chronic illness, succumb to the disease everyday. There are already 1.5 million motherless children in sub-Saharan Africa who are fending for themselves in resource poor townships, or being sent to orphanages.
Deep-rooted community taboos pose yet another obstacle to the wide implementation of flash-heating.
[Clip 5: “People talked about devils and jackals and various animals that could come out of the bush if a woman touched breastmilk. What’s even more important is that right now in many places in sub-Saharan Africa, if you don’t breastfeed, that’s a mark that you’re HIV-positive. That stigma can cause a woman to lose her family, to lose her home, to lose everything.”]
But Nosipho insists she has the full support of her family, and of the staff at the university hospital, where she has been working as a flash-heat counselor since November of 2008.
[Clip 6: “I like to help the other hospitals to flash-heat the milk, if I can.”]
The longer a mother breastfeeds, the greater the chance of transmitting the virus to her baby. Most researchers agree that HIV-positive mothers should exclusively breastfeed for the first three to six months. Later, flash-heated breastmilk can be fed to the baby for the continued health benefits, along with new solid foods. Returning to feeding at the breast, however, after the flash-heated milk and solid foods have been introduced, puts the baby at even greater risk of infection.
It’s a precarious balancing act for all involved.
Nosipho had to learn how to follow these precautions. As the first HIV-positive mother to exclusively flash-heat her breastmilk for six months, Nosipho now teaches other HIV-positive mothers the skills they’ll need to do the same.
She showed me how the flash-heating method works during my visit to the hospital at the University of KwaZulu-Natal.
[Clip 7: Nosipho demonstrates method]
[Clip 8: When we started learning about HIV, we just knew that the breastmilk also has got some virus, and also that the mothers are not allowed to give it to their babies. But seeing that research has advanced so much, now we know that flash-heating is the best.”]
In fact, cost-free breastmilk is six times more effective in saving the life of a baby than the expensive combination of formula and ARVs.
[Clip 9: “All over the world there are developed countries that are pouring money into studies in developing countries…Making drugs is a moneymaking venture. Selling formula is a moneymaking venture. Heat-treating breast milk? There’s no constituency who’s going to benefit from this except, really, the moms.”]
Penny Reimers is the coordinator of the Breastmilk Bank at the iThemba Lethu Orphanage in Durban. She agreed that breastmilk is grossly undervalued in South Africa, where it’s needed most.
[Clip 10: “One of the things we need in this country is to do a massive promotion campaign for breastfeeding, just so moms realize how important it is for these babies. Unfortunately the formula companies have these millions of dollars for marketing and promoting their product and breastfeeding is never really promoted as it should be.”]
[Clip 11: “I think if this had been something that someone could make a lot of money off of, it would have had more resources poured into it.”]
Nosipho offered some words of wisdom to other HIV-positive mothers.
[Clip 12: “She mustn’t say, ‘I am HIV-positive. I can’t feed the baby the breastmilk because my CD4 count is low.’ No, it’s not like that. She must be brave and strong…She can breastfeed the baby because of flash-heating.”]