Mothering Magazine Examines Debate Over AZT Use in HIV-Positive Pregnant Women, Breastfeeding
In the September/October issue of Mothering, a publication that promotes a "natural family lifestyle," Susan Gerhard, a San Francisco-based writer and editor, looks at a movement among some HIV-positive women to refuse drug treatment during pregnancy and labor, therapy that some studies show could reduce the risk of transmitting the virus to their infants from 25% to 8%. Many women also refuse to let their newborns receive AIDS drugs out of fear that the drugs will harm the children more than they will help. The U.S. Public Health Service recommends "aggressive combinations" of antiretroviral drugs during pregnancy, accompanied by AZT administration during labor. Women are asked to formula feed their infants, who are placed on a six-week course of AZT, regardless of whether or not they test positive for HIV, she writes. AZT "can be extremely damaging," she continues, citing studies that found the drug causes cancer and fetal deformities in lab animals. She also points to one study that found children born to women who received AZT during pregnancy were more likely to get sick and die by age three than children whose mothers did not take AZT. Due to potential side effects and toxicities of antiretroviral drugs and the possibility of drug resistance, the NIH revised in February its treatment guidelines for adults and adolescents, recommending that therapy not be started until immune deficiencies reach a certain level, rather than started as soon as possible after diagnosis. However, NIH did not revise its guidelines for the treatment of pregnant women and infants (Gerhard, Mothering, September/October 2001).
In a separate article, Neville Hodgkinson, author of "AIDS: The Failure of Contemporary Science -- How a Virus That Never Was Deceived the World," argues that researchers cannot even be sure that HIV is the cause of AIDS and that therefore it is wrong for the government or hospitals to mandate that pregnant women receive treatment for themselves and their infants, calling such stipulations "draconian measures." He states that the stress of testing HIV-positive "in itself damages immunity" and that the "bond of love created at the time of a new arrival is destroyed by the trauma" associated with an HIV diagnosis. He adds that there is "no scientific evidence" that antiretroviral drugs can prolong or improve a person's quality of life and that the belief is "entirely a supposition, based on the finding that the drugs cause fewer children to be born testing positive" (Hodgkinson, Mothering, September/October 2001).
The potential toxicity and disputed efficacy of the drugs in pregnant women have prompted many women, who are afraid that doctors or hospital personnel who disagree with their decisions will turn them in to Child Protective Services for not complying with the recommended course of therapy, to go "underground," declining testing and treatment and searching for sympathetic health care workers, Gerhard reports. Christine Maggiore, head of the group Alive & Well AIDS Alternatives and founder of Mothers Opposing Mandatory Medicine, advises HIV-positive women on how to get around state testing requirements and how to avoid being forced into treatment either for themselves or their infants. The group tells women to only inform a few "trusted" individuals about their pregnancy and to find a doctor or midwife who is "sympathetic with your choices and will not perform postnatal HIV testing without your consent." The group also advises women to avoid applying for or accepting public benefits because federal, state and local authorities can "impose the accepted standard of care and create custody battles when recommendations are not followed." MOMM also advises against using emergency rooms except in real cases of emergency because they are more likely to administer HIV tests without securing consent.
The Debate Over Breastfeeding
In another sidebar article, Gerhard examines why health officials continue to lobby for HIV-positive women to forego breastfeeding despite a study released at the 13th International AIDS Conference in Durban, South Africa, that found that children of HIV-positive women who were exclusively breastfed for at least three months had "no more chance" of contracting HIV than children who were bottlefed. The study of 551 mother-child pairs, which also appeared in the Lancet in 1999, also found that children who received a mixed diet of breastmilk and formula had the highest incidence of HIV. The debate over breastfeeding is especially important, she states, because children in developing countries who are not breastfed have a "six-fold greater risk of dying from infectious diseases" than those who were breastfed. Even among middle-class children in the United States, Canada and Europe, there is an increased risk of death among children who are formula fed, she says. For this reason, women in developing countries with diseases such as hepatitis A and B and inactive tuberculosis are told to breastfeed their infants, she states, adding that HIV, active TB and galactosemia, a rare disease, are the only "disease-related contraindications to breastfeeding." According to UNAIDS, the risk of HIV transmission through breastmilk is around 15%. Anna Coutsoudis, the researcher who conducted the Lancet study, concluded that "the lower rate of HIV-1 transmission achieved by avoiding breastfeeding is almost completely negated by the increased mortality among formula-fed infants." However, despite these findings, breastfeeding by HIV-positive mothers "remains taboo" and has been legally challenged in the United States, Gerhard writes (Gerhard, Mothering, September/October 2001).