Breastfeeding, a practice that is encouraged internationally, is under scrutiny in Africa where little research has been undertaken on this method of nourishing infants in a time of AIDS.
Breast milk carries the AIDS virus. It is widely accepted that an estimated 15 percent of infants who are breastfed by infected mothers contract the virus.
Yet breastfeeding is still widely promoted as the safest option in Africa, where AIDS is rife and where the sanitary conditions needed for the preparation of artificial infant foods do not prevail.
But with a lack of conclusive scientific evidence, doctors, fieldworkers and AIDS lobby groups cannot agree on the best method of nutrition for the offspring of infected mothers.
International agencies like UNICEF appear not to have strayed too far from a long-standing "breast is best" campaign in developing nations, where it has taken decades to reverse the damage done by producers of infant milk formula.
The producers spent much of the 1970s presenting their products as a viable option for "sophisticated" mothers, officials from the agency explain.
Infant mortality rose as mothers the world over turned their backs on natural feeding. In resource-poor settings like Africa, infant formula is still the "very bad idea" it was then, according to the Pretoria-based UNICEF head of health Marinus Gotink.
But as the prevalence of AIDS pushes up mortality figures in countries like South Africa, some scientists are taking another look at artificial milk substitutes as a means of preventing infection in infants that are fortunate enough to escape the virus during the birth process.
Durban-based academic and researcher professor Anna Courtsoudis is adamant that, given the "balance of risk," breast milk is the safest.
Four years ago, she ran a trial that found exclusive breastfeeding for a limited time early in life reduced to about 4 percent the risk of HIV infection in infants.
Exclusive breastfeeding by lactating infected mothers ensures that infants are provided with the necessary antibodies to fight diseases, including AIDS, she said.
"In each case you have to weigh up the balance of risk. In wealthy western society you can formula-feed safely. But if you are from rural Kwazulu-Natal, the chances of your child dying because of this method is far higher," she said.
Cousoudis' position that highlights as dangerous mixed feeding, where breast milk and other foods are given over the same period, appears to dominate in some parts of the country and has informed UNICEF policy.
Some doctors working to prevent mother-to-child transmission of the AIDS virus in South Africa, where one in four pregnant women test positive for the disease, disagree, saying that formula feeding does not necessarily have to lead to pneumonia and diarrhoea that kill infants.
Medecins sans Frontieres' Herman Reuter is the project coordinator of an HIV prevention and treatment program in Lusikisiki, a rural district in the country's Eastern Cape province.
"We give the women the choice to breastfeed or formula-feed. We believe optimal formula feeding can be achieved even in rural areas like Lusikisiki," he said.
A similar program in the impoverished Western Cape township of Khayelitsha has also begun to dispel the view that the question of artificial feeding will cause more infant deaths.
AIDS activists argue that with enough support, formula feeding as the "only sure way to avoid post-birth mother-to-child HIV transmission," can become a reality for many more women regardless of their circumstances.
At many public health centers, formula is provided for infected women who decide against breastfeeding, but AIDS activists say healthcare workers are more likely to advocate breastfeeding in many areas around the country.
South Africa's mother-to-child AIDS prevention strategy is in its early stages, and the focus is still largely on preventing infection during labor and childbirth.
Some scientists and activists consider the introduction of the risk of infection through subsequent breastfeeding as a sure way of undermining the program.
Others go as far as to accuse agencies like UNICEF of "letting old hangups" with formula producers get in the way of logic.
"HIV-positive women should have a choice based on the best available information. However, what one finds is that in areas where doctors support exclusive breastfeeding, nearly all women choose this option, and vice-versa," said Nathan Geffen, a spokesman for the Treatment Action Campaign lobby group.
"We are aware that an important study will soon be published which will bring more clarity to this issue. We hope that once the results are public, scientists will reach consensus on which option is best," he said.
Mark Colvin, the researcher responsible for this study, says an ideal strategy would be that "breast is best" unless you are HIV positive.
"In the first world, of course nobody breastfeeds if they know they are infected," he points out.
More conclusive evidence of both methods of feeding is desperately needed in the developing world as "old studies" have been used to justify the sidelining and virtually exclude formula as an option, he believes.
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