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Mothers, Babies and AIDS

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Summer 1999
Mothers, Babies and AIDS
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But her answer to my next question, "Have you ever had a blood transfusion?" changed the face of AIDS in this country. "Yes," Elizabeth said. "Twelve times, right after Ariel's birth." Ariel had been born by emergency cesarean section because the placenta was attached over the opening of the womb, and afterward Elizabeth developed severe bleeding and needed l2 pints of blood. "But I recovered completely," Elizabeth added, "and was able to start breast-feeding in just a few days." Upon hearing that, I suspected that both mother and child had contracted AIDS, Elizabeth from the blood transfusions and Ariel from her mother's milk.

There had only been one other reported instance of HIV transmission via breast milk, in 1985 in an Australian child under circumstances similar to Elizabeth's and Ariel's. Blood tests confirmed that Ariel, Elizabeth and the Glasers' son, Jacob, 2, all were infected. Ariel died from AIDS in 1988; Elizabeth died in l994. Jacob, now l5, is doing well on antiviral medicines. Shortly after her diagnosis, Elizabeth Glaser and two friends, Susan Zeegan and Susan De Laurentis, founded the Pediatric AIDS Foundation, now known as the Elizabeth Glaser Pediatric AIDS Foundation. Throughout the remainder of her life, Elizabeth was a tireless advocate for pediatric AIDS, raising research money, lobbying Congress, sponsoring conferences and agitating for the development of AIDS drugs for children.

Breast-milk transmission of AIDS in developed countries is a rare event; indeed, most HIV transmission from mother to infant occurs through the womb or at the time of birth. But because of the slight risk, U.S. mothers with HIV infection do not breast-feed their infants. Breast was not best for Ariel Glaser.

Nairobi, Kenya, 1999 Fast-forward. The scene is again a small, two-story hospital in Africa near downtown, but the city is Nairobi. This modest building, no larger than the emergency ward of a typical hospital in the U.S., is Pamwani Maternity Hospital. After years of work and travel in sub-Saharan Africa, I thought nothing in the medical realm could shock me. I had seen lepers die of smallpox in Ethiopia, toddlers blinded and swollen by kwashiorkor in Ghana and infants horribly burned from convulsions triggered by a brain parasite as they slept next to a fire in their Masai village hut in Tanzania. But Pamwani was an unforgettable experience. It houses the world's largest maternity service. Each day 100 women come to have their babies 36,000 a year. Most have received no prenatal care and come by bus from small villages a few days before the expected delivery.

When labor starts they are admitted and put to bed, not infrequently with another woman. Just before delivery, the mother-to-be moves to another bed. The births are natural, in the bed, and largely unassisted; the doctor or the midwife attends only those deliveries with an obstetrical difficulty. Cesarean section is rarely performed, even after prolonged labor. Following delivery the infant and mother are examined, the infant's eyes and cord are attended to and the baby is left with the mother to start breast-feeding. After several hours, the new mother and her baby move to the waiting room and are discharged, sometimes just six hours after admission.

In 1976, just a few years before the start of the AIDS epidemic, our team came here to study the effect of maternal malnutrition on the newborn immune system. We collected many blood samples from mother and baby and, as we suspected, learned that maternal malnutrition also depressed the baby's immune system, making the infants more susceptible to infections during the first year of life. That

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