Infant feeding and HIV in Sub-Saharan Africa: what lies beneath the dilemma?
Infant feeding and HIV in Sub-Saharan Africa: what lies beneath the dilemma?
复制标题
撒哈拉以南非洲地区的婴儿喂养和艾滋病毒：困境背后隐藏着什么？
DOI：
10.1007/s11017-008-9083-z
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发表时间：
2008
影响因子：
1.4
通讯作者：
Kelley,MaureenC
中科院分区：
文献类型：
--
作者：
Fletcher,FaithE;Ndebele,Paul;Kelley,MaureenC
关于如何在资源贫乏的环境中最好地指导感染艾滋病毒的母亲喂养婴儿的争论已经持续了20多年。在全球范围内，母乳喂养每年造成大约30万例艾滋病毒感染，而与此同时，儿童基金会估计，非母乳喂养（用受污染的水喂养配方奶）每年造成150万儿童死亡。这些感染和死亡的最大负担发生在撒哈拉以南非洲。我们以该地区为例，说明在其他资源贫乏的环境中更普遍面临的负担，并将高收入国家感染艾滋病毒的母亲喂养婴儿的临床护理标准的演变与资源贫乏环境中感染艾滋病毒的母亲和婴儿喂养的现行国际临床指南进行了对比。虽然6个月纯母乳喂养的国际准则似乎为减少婴儿期间艾滋病毒母婴传播提供了最不坏的策略，同时通过6个月后的母乳喂养赋予了一些免疫力，但我们认为，该政策对母亲和当地卫生保健工作者的影响尚未得到很好的了解。在卫生政策层面采取减少伤害的做法，对艾滋病毒阳性母亲和向她们提供婴儿喂养指导的人来说，是一种复杂而痛苦的道德困境。我们认为，潜在的社会经济差异继续推动了对婴儿喂养和对妇女和儿童的伤害减少政策的需求：(1)通过改进安全喂养替代数据来解决婴儿喂养困境的更高优先级；(2)支持创新的、社区驱动的解决方案，以解决在这些社区中继续导致艾滋病毒传播给儿童的特定经济和文化挑战。
The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities.