Despite a slight risk that HIV-positive mothers will transmit the AIDS virus to their infants via their breast milk, the risks of not breastfeeding are far greater for African babies from poor families. So concludes Michael C. Latham, a physician and Cornell University professor of international nutrition, in a preliminary report he co-authored for UNICEF.

"Infants in poor households who are not breastfed are five times more likely to die from infections in the first two months of life and have a much higher risk of getting diseases that are costly to parents. For the mother, not breastfeeding puts her at risk of having another infant at risk of HIV and also destined to be an orphan. Furthermore, the costs related to formula feeding may further impoverish the family," says Latham, who has worked extensively in Africa and studies mother-to-child transmission of HIV. "Recent visits to four African countries convinced me that for almost all poor mothers in Africa, the risks of not breastfeeding are much greater than the risks of HIV infection through breast milk."

In the draft UNICEF report, Latham and co-author Pauline Kisanga, a coordinator at the Swaziland office of the International Baby Food Action Network, point out that efforts to support and promote breastfeeding have declined dramatically in Kenya, Uganda, Namibia and Botswana in recent years and that the waning support threatens the lives of millions of infants.

"The World Health Organization acknowledges that breastfeeding saves as many as 1.5 million lives a year," Latham says. He says WHO's research indicates that the lack of breastfeeding has resulted in a loss of some 15 million children in the past 10 years alone. Infants in Africa who are formula-fed are four to six times more likely to die of disease, Latham points out, because formula is too often prepared with contaminated water; also, breast milk helps build the immune system. The HIV pandemic, however, has led to confusion among women and health workers in Africa, he says.

"We conclude that declining efforts to support and promote breastfeeding in poor African countries is the result of totally unwarranted concerns that efforts to promote breastfeeding might be construed as actions which worsen the HIV/AIDS situation," notes Latham. About 3 to 6 percent of infants are likely to be infected with HIV through breastfeeding. "Yet, in the four countries we studied, there is an exaggerated belief in the risk of viral transmission through breastfeeding and a very much unappreciated knowledge of the high risks in formula feeding in poor families. This lack of knowledge is extremely widespread and includes highly placed officials in ministries of health as well as many other health workers," Latham says.