Mothers with HIV Go Hungry in order to Purchase Breast Milk Substitutes

If a mother is living with HIV, breastfeeding her child increases the risk of infecting the infant. Therefore mothers on the brink of poverty go hungry in order to buy formula milk.
 
Over there
 
HIV positive mothers with low income go hungry in order to purchase breast milk substitutes (BMS) and to avoid infecting their children through breastfeeding. This is touched upon in Policy Briefing: Access to formula milk for mothers living with HIV in the UK, prepared by the charities National AIDS Trust and Body & Soul.
 
According to a mother of three from London, she regularly gives up food so that she may purchase BMS. “I have to skip eating lunch to save for food in the evening,” she said. “I try to have at least one meal a day … at the time when I need to take the [HIV] medication, because you have to take it with food.” She said she knows many others in a similar or worse situation.
 
The public believes that England’s national health system must develop and implement a state strategy to provide HIV positive mothers with formula milk.
 
At the same time, Great Britain can be proud of its low transmission rate from mother to child (0.27 % in 1,100 births). This was attainable thanks to testing women for HIV during pregnancy and administering chemoprophylaxis in cases where HIV is detected. In the case that the mother’s viral load can not be suppressed, a cesarean section is performed.
 
According to the World Health Organization, from 30 to 60 % of HIV positive children around the world acquired the virus through the milk of their mother. In Great Britain 8 such cases have been confirmed in the last few years, as BuzzFeed reports.
 
In Britain there are a number of governmental schemes that are intended to reduce the financial burden of purchasing formula milk. For example, the Healthy Start program is devoted towards providing assistance to young low-income families. These families are given a voucher for fruits, vegetables, milk, and formula milk. However, according to the Access to Formula Milk For Mothers With HIV in Great Britain report, this scheme does not work well enough.
 
Why? The specialists who were asked indicated that women do not always know about the opportunity and some of those who do know face delays in receiving the vouchers. Even when women have access to this program, these vouchers are insufficient to cover the costs of purchasing formula milk considering that these families also need to purchase other food.
 
According to the research on the economic efficacy of using formula milk, the cost of formula and the equipment to prepare it costs 475 pounds maximum per year for one child. For comparison, the average cost of lifelong treatment for a person living with HIV (in the case they were infected from birth) costs approximately 622 800 pounds per year.
 
And over here?
 
In 2014 as part of the “Give a Child a Chance” project, the Russian community organization, Child’s Rights, conducted multidimensional study in the subjects of the Russian Federation as part of the implementation of the National Strategy in the Interest of Children to Prevent Vertical Transmission of HIV.
 
Two systematic monitorings were organized independent from each other (a survey among specialists and a survey among government officials) in the majority of the subjects of the RF on the topic of vertical HIV transmission.
 
1. The survey for specialists: Monitoring the provision of formula milk adapted for children born to HIV positive women in various regions of the RF. A special questionnaire was developed for the survey and the responses were processed and analyzed by Centers for the Prevention of and Fight Against AIDS in 78 subjects of the Russian Federation. The survey was created collaboratively by specialists from the Federal Scientific-Methodological Center for the Prevention of and Fight Against AIDS.
 
2. Inquiries were sent to the heads of the subjects of the Russian Federation. Responses were received from the health departments of 67 regions.
 
The monitoring showed that:
 
— Programs for provision of BMS to children born to women with HIV reach 90.2% of those who need it, however the logistics are often unsatisfactory to ensure enough BMS.
 
— In 2013 there were regions in the RF where there were no programs to provide formula milk for children born to women with HIV.
 
— The lack of centralized BMS purchasing creates unequal conditions for children born to HIV positive mothers.
 
— In 14% of regions, a monthly allowance benefit is provided to acquire formula milk adapted for children born to HIV positive mothers. However, in the majority of cases, the amount of money is insufficient to provide the full quantity needed for feeding.
 
— BMS is provided to a specific category of women (low income, single mothers, etc.) in a third of all regions and an allowance is provided in 7 of 11 regions.
 
— One of the main reasons women with HIV breastfeed their children is due to late diagnosis of HIV in the mother. Along with this it was found to be widespread that the woman chose to breastfeed due to the lack of access to BMS. This was all combined with the lack of government control and monitoring for the access of BMS for children born to women with HIV.
 
From June 2015 to 2016, E.V.A. implemented the Healthy Mother, Healthy Child Project. The project included research on barriers for HIV positive women and women with children to receiving services in medical and social facilities. The research was conducted in Astrakhan, Ivanova, Leningrad, Novosibirsk and Tyumen oblasts as well as Krasnodar and Khabarovsk krais, the republics of Tatarstan and Bashkortostan, and Saint Petersburg. The total number of respondents was 988.
 
One of the questions touched upon access to formula milk. Here are the results:
 
89.5 % were aware of the possibility to receive BMS, 56.7 % received BMS, and 20.3 % received the full quantity of BMS. Therefore only 25 % of the HIV positive women surveyed in 10 regions of the Russian Federation received breastmilk substitutes as part of the program to prevent HIV transmission from mothers to children. The other three fourths of the total purchased expensive milk formula on their own – at an average monthly cost of 4,900 rubles.
 
What can be done? NP E.V.A.’s recommendations from 2014 are still relevant today:
 
Many women are unaware of the possibility to receive BMS. Additionally, families in difficult financial situations often find it hard to speak about the inability to acquire the required amount of formula milk on their own to medical personnel or social workers. NP “E.V.A.” recommends that informational material be developed which will list all the subsidies and other opportunities granted by the subjects of the RF for pregnant women with HIV and women with HIV who have recently given birth. Informational material can be distributed in AIDS centers, infectious disease hospitals, regional gynecological offices, and social service centers.
 
Having information about possibilities of receiving formula milk for HIV positive mothers does not always mean that she can. NP “E.V.A.” recommends that a national system be created for low threshold access to milk formula for HIV positive mothers. For example: distribute formula at the maternity ward for the first several months of the infant’s life and then allow mothers to receive the formula at regional pediatric offices. NP “E.V.A.” is prepared to participate in the creation of the necessary normative documents. In numerous regions such systems are already in place. A partial solution to this problem could be centralization of formula milk purchase.
 
Half of women who receive BMS remark that the quantity provided was not enough to feed their child. NP E.V.A. recommends that upon purchase of formula, the average amount needed to feed a child for at least 6 months must be taken into consideration. According to the study, conducted by NP “E.V.A.” among HIV positive mothers in 2014, for the first 6 months of a child’s life, at least fifty six 350 gram packages of formula milk are needed.
 
P.S. In October 2016, the chair of the RF, D.A. Medvedev, signed a state strategy to prevent the spread of HIV infection in the Russian Federation for the period until 2020 and further perspectives. One of the strategy’s tasks is to reduce the risk of transmitting HIV infection from mother to child. This includes “expanding the measures for the medical support of persons infected with HIV, as well as providing these individuals and their families with social support measures.” We believe that providing HIV positive mothers with formula milk could fall under this point in the strategy.