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HIVAN/ECI April 2005 HIV/AIDS Public Health Journal Club
Jo-Ann Du Plessis. HIVAN Networking Unit. April 2005.
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The April 2005 HIVAN/ECI HIV/AIDS Public Health Jounral Club featured two presentations. Anna Coutsoudis, Associate Professor at the Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, presented on "Adherence to optimal feeding practices and risk of postnatal transmission of HIV" and Xoliswa Keke, a Researcher with the Centre for HIV and AIDS Networking (HIVAN) presented on "Disclosure and HAART adherence: exploring the dynamics".
Xoliswa reviewed a study by Klitzman et al. which looked at the intricate relationship between disclosure and HAART adherence. A diagram was presented which showed how adherence to and the side effects of HAART can lead to disclosure, and how therapeutic effects can lead to disclosure or non-disclosure. Also, it illustrated how disclosure and non-disclosure can both lead to non-adherence; and that the relationship between medication adherence and disclosure works in both directions. The conclusions of Klitzman et al.?’s research encouraged further investigation into fear of disclosure, and how this may hinder or enhance adherence.
It also suggested further examination into the ways in which HAART may delay disclosure, which could lead to the continuation of risky behaviour and less support for people living with HIV/AIDS. Xoliswa also spoke about the need to disclose and the potential (positive and negative) outcomes of disclosure, and how an anticipated outcome can affect a person?’s intention to disclose their status.
Anna Coutsoudis reviewed two journal articles, the first of which (by Magoni et al.) was limited by a small sample size of 148 participants. This study showed that exclusive breastfeeding, as opposed to mixed breastfeeding, had no significant effect in reducing HIV transmission from mother to child. However, in the study no support was provided to help mothers practice exclusive breastfeeding, and the authors report that participants exhibited poor adherence to their chosen feeding mode: 25% of mothers who practiced exclusive breastfeeding admitted non-compliance. In addition, the authors state that the results of the study ?“may not be valid for the whole population as women included middle- and high-class women who had been trained by health personnel in the use of formula feeding?”.
The second research Anna discussed was by Iliff et al. and showed that early exclusive breastfeeding does reduce the risk of postnatal HIV transmission, and it increases HIV-free survival. The study enrolled 14 110 mother-baby pairs, and results were analysed for 2060 infants who were HIV-negative at 6 weeks and for whom complete feeding data had been obtained. According to Illiff et al.?’s findings, the cumulative risk of HIV-transmission at 6 months was 1.31% and 4.4% for exclusively breastfed babies and babies who received mixed feeding respectively, and 6.94% and 13.92% at 18 months. These were significant differences. The study also showed that exposure to education and counselling was associated with increased adherence to exclusive breastfeeding, which was in turn associated with reduced postnatal HIV transmission. Anna concluded the presentation with an important message:
- HIV-positive mothers who breast feed should do so exclusively
- The better they are able to adhere to exclusive breastfeeding, the lower the risk of mother-to-child-transmission or death of their infant.
- HIV-positive mothers whose babies have escaped HIV infection after 6 months of exclusive breastfeeding should consider early cessation.
- However, safe alternatives (for example, formula made with clean water) must be accessible for the second half of infancy and the mother must have adequate social support to implement these alternatives.
References:
- Klitzman et al. (2004). ?“The intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study.?” AIDS Care, 16(5):628-640.
- Magoni, M., Bassai, L., Okong, P. et al. (2005). ?”Mode of infant feeding and HIV infection in children in a PMTCT program in Uganda.?” AIDS, March:433-7.
- Iliff, P.J., Piwoz, E.G., Tavengwa, N.V., et al. (2005) ?“Early exclusive breastfeeding (EBF) reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival.?” AIDS, April.
Biosketches:
Xoliswa Keke: Xoliswa Keke is a Researcher with HIVAN, based in the MTCT Plus clinic. She has B.A. (Hons) Social Work. She is currently completing her Masters in Child Care and Protection. Xoliswa has extensive experience working with HIV infected and affected children and families. Her ethnographic research investigates issues of disclosure within the family, in the context of ARV treatment.
Anna Coutsoudis: Anna Coutsoudis has a PhD from the University of KwaZulu-Natal and is an Associate Professor in the Department of Paediatrics and Child Health at the Nelson Mandela School of Medicine in Durban, South Africa. During the last eight years, her main research interest has been the Prevention of Mother-to-Child Transmission of HIV. She is a member of the UNAIDS informal working group on Prevention of Mother-to-Child Transmission of HIV, and her research findings have been widely published in international journals. She currently runs a large care and treatment programme for HIV infected mothers and their families in one of the municipal clinics in Durban. Anna recently founded and chairs a non-profit organisation called iThemba Lethu, formed to address the needs of children orphaned by AIDS and to run HIV prevention programmes for young people. Attached to the home for orphans she has set up a breastmilk bank to serve the needs of these orphans and abandoned children ?– this was the first community based breastmilk bank in South Africa and it has been a model for the recent set up of two other breastmilk banks in South Africa. She is involved in training programmes designed for HIV/AIDS counselling, breastfeeding counselling and nutritional advice both for health workers and community members.
Both presentations can be downloaded on the righthand side of this page.
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