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SAO TOME AND PRINCIPE: HIV-positive mothers reject formula feeding

Photo: UNICEF
A cultural preference for breastfeeding
SAO TOME, 31 October 2006 (PlusNews) - Poverty and a cultural preference for breastfeeding are driving the spread of HIV from mothers to their babies in Sao Tome and Principe.

The HIV rate among pregnant women on the tiny West African islands tripled from 0.5 percent to 1.5 percent between 2001 and 2005.

"The number of cases is growing every year," said Luis Bonfim, the UN children’s fund health project officer. "We were hoping that with increased support, the rate would either stagnate or reduce. So it's clear that something isn't working."

HIV testing in Sao Tome and Principe is free and health workers say they have no problem persuading pregnant women to test for the virus, adding that most of them who discover they are HIV positive agree to take antiretroviral drugs to prevent transmission of the virus to their unborn child. Others, however, prefer to visit traditional doctors or avoid treatment altogether.

Health workers point out that at present, many women risk post-natal transmission by opting to breastfeed because they cannot afford formula milk. "We recommend that HIV positive mothers feed their babies formula milk, but in most cases this doesn't happen because of the financial difficulties they face," said Antonio Amado Vaz, medical doctor and executive director of the Sao Tome Association for Family Promotion (ASPF).

"A small tin of formula milk costs around 80,000 dobras (US$ 6) and it doesn't even last two weeks. There is no aid programme to help HIV-positive women pay for the milk and they can't afford it. This is a big problem, it is not sustainable," he said.

Sao Tome is currently trying to access financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria to help support HIV-positive mothers.

Next to the financial constraints, many HIV-positive mothers decide not to feed their babies formula milk because they fear it will attract suspicion from family and friends.

"When the baby comes it is hard to convince people to use formula milk, even if they have been doing the [antiretroviral] prevention during pregnancy," said Alzira do Rosario, a medical doctor and coordinator of Sao Tome's national AIDS programme.

"The grandmother will put pressure on the mother to feed the baby breast milk and the mother doesn't want to explain why she is using formula milk," she added.

Filomena (not her real name) knows the risks of breastfeeding only too well. She believes her son contracted HIV from her breast milk, which she fed him from birth.

"I don't think he was born HIV positive. He was a fat baby; he weighed four kilos when he was born. At that time I didn't know I had HIV and so I breastfed him. Here in Sao Tome we are taught that this is the best thing you can do for your child. It was only after about six months that he stopped putting on weight and I realised something was wrong," she said.

Filomena's son is one of only a few Sao Tomean children who are known to be living with HIV, but health workers fear these figures are likely to continue rising. They say that the stigma attached to HIV/AIDS in Sao Tome is promoting behaviour that is likely to increase the incidence of mother-to-child transmission.

While most of the 170,000 people living in the twin-island nation are poor there are high hopes that crude oil exploration may lead to a brighter economic future. Sao Tome and Principe currently relies on small agricultural exports and substantial donor funding. Its external debt stands at around US$300 million.

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[This report does not necessarily reflect the views of the United Nations]

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