Breast feeding must consider HIV transmission in Latin America and the Caribbean

EDITOR—Betrán et al's paper confirms the importance of exclusive breast feeding in reducing infant morbidity and mortality in the Latin American and Caribbean region.1 The authors did not, however, mention other cost effectiveness analyses of the promotion of breast feeding in Latin America that have been carried out.

In particular, through controlled designs Horton et al examined the effectiveness and cost of hospital based promotion of breast feeding in urban areas in three Latin American countries (Mexico, Honduras, and Brazil).2 They concluded that investing in the promotion of exclusive breast feeding and of any breast feeding is highly cost effective and should be part of the basic public health and clinical services packages of countries in the region.

This work highlighted the relevance of breastfeeding peer counsellors, which was confirmed in a subsequent experimental study in Mexico City.3 There, a threefold to fivefold increase in exclusive breastfeeding rates at 3 months post partum was achieved through prenatal and postnatal home visits by trained peer counsellors.

The AIDS pandemic has major implications for the promotion of breast feeding as HIV can be transmitted to children through breast feeding. The seroprevalence of HIV among women of reproductive age is relatively low in Latin America compared with sub-Saharan Africa and Asia but is relatively high in several Caribbean countries and some high risk areas of Latin America. Efforts to promote breast feeding in the region need to take into account the local epidemiology of the AIDS pandemic and available educational and therapeutic strategies for reducing the risk of vertical transmission of HIV from infected mothers to their children.4