HIV-infected women in developing countries are faced with a difficult choice. Do they breastfeed their infant and potentially transmit the disease through breastmilk, or do they use supplemental feedings of expensive synthetic formula. Many women that desire to use supplemental feedings lack the financial means or necessary equipment to be able to provide adequate nutrition. There is the distinct risk that even if they are able to use supplemental formula unclean water could expose their child gastrointestinal infections or parasites. The official recommendation of the World Health Organization (WHO) is that if supplemental feeding is feasible and practical by the mother, then the mother should avoid breastfeeding. If supplemental feeding is not feasible, then the child should be exclusively breastfed for at least six months. Neither choice is a one hundred percent satisfactory solution, and ongoing research continues to argue the benefits of one method of feeding versus the other.
Supplemental feedings and replacement milks include commercial formula and animal milks prepared with sugar, water, and other nutrients. Some mothers choose to combine the commercial formula with the milk mixture to stretch their supplies of each. Because HIV is spread through contact with infected body fluids, the child that is fed with supplemental feedings is at a lower risk of becoming infected than a child that comes in contact with the HIV-positive mother’s breastmilk. Common replacement milk recipes that were studied by Papathakis & Rollins in 2004 included 39g of full cream powdered milk (PM), 30g of sugar, and 450ml of water, and 300 ml full cream milk (FM), 30g of sugar, and 150 ml water.
In the findings published by Papathakis & Rollins, they determined that the formula substitutes (replacement milks) were not adequate to meet the nutritional needs of infants 6 months old and younger (2004). After establishing a baseline using commercial infant formula that provided 300 kcal per 450 ml as a baseline to compare the replacement milks to, they found that PM and FM provided less than 50% of the estimated required amounts of Vitamins A and C, folic acid, iodine, and selenium. The zinc and pantothenic acid (Vitamin B5) were even lower, with the replacement milks providing less than 75% of the estimated required amount (Papathakis and Rollins, 2004). PM did provide much more Vitamin D than the commercial formula (and thus reaching the adequate intake), which the researchers attributed to how powdered milk is manufactured.
While Papathakis & Rollins do touch upon the fact that exclusively using commercial formula to feed infants is a financial burden, they still ultimately concluded that it remains the best option for HIV-positive women who do not wish to breastfeed. They briefly acknowledged that for some women, exclusive commercial formula feeding is not feasible and suggested supplementing the commercial formula with replacement milks that had been prepared...