HIV Transmission through Pre-Chewed Baby Food?

Pamela Merritt

Could pre-chewed baby food be a vector for HIV transmission? A report in Pediatrics suggests that it may -- but when thinking about this phenomenon, we need to avoid the knee-jerk "Ewwww" reaction that a ScienceNews reporter had.

Could pre-chewed baby food be a vector for HIV transmission?  A report in the August issue of Pediatrics suggests that it may — but when thinking about this phenomenon, we need to avoid the knee-jerk "Ewwww" (literally) reaction that a ScienceNews reporter had.  In reading the ScienceNews
piece I was reminded that not everyone has heard of pre-chewing food and a lot
of people simply can not suspend their ethnocentric response it, which may
explain why this news item was treated more as a curiosity than medical
news. 

I don’t have the disgusted response to the idea
of pre-chewed food being fed to babies because my family has long used the
practice when weaning a baby.  As a
matter of fact, my Grandmother swore by it and freely admitted to feeding
pre-chewed food to all of her children and grandchildren.  And this story is more than a report of odd
behavior – as the
ScienceNews piece
points out, the findings that there is a probable link
between pre-chewed food and HIV transmission from adult to child have important
implications and may prove false a long held belief in the late transmission of
HIV through breastfeeding.

It is important to put the practice of pre-chewing food for
babies into context.  There are many
parts of the world where baby food is not available in charmingly labeled glass
jars sold in conveniently located markets. 
There are still other parts of the world where pre-chewing food for
babies is simply cultural accepted as tradition, including parts of America.  My grandmother was born and raised in rural
Mississippi where both factors applied – people made baby food at home or they
pre-chewed and our family valued pre-chewing baby food as a perfectly tradition
for grandmothers and mothers to participate in. 
Since the practice of pre-chewing food for babies is widespread across
the world the implications of the probably transmission of HIV through the
practice are huge.

That raises the question of how HIV might have been passed
from adult to child through pre-chewing. 
As reported
in the August issue of Pediatrics
, three cases of HIV infection were diagnosed in children ranging in age
from 15 to 39 months after symptoms prompted doctors to perform testing.  In two out of those three cases of positive HIV
infection, the mothers were known to be infected with HIV
and had not breastfed their children.  Perinatal
transmission of HIV had also been ruled out
in those two cases. In the third case, the mother of the child was not HIV positive but a great aunt who
helped care for the child was determined to be infected with HIV.  All three children had been fed pre-chewed food
on multiple occasions by an individual infected with HIV
and in two cases concurrent oral bleeding in that individual was also reported.
The Pediatrics
report
concludes that the children were infected through exposure to
pre-chewed food from an HIV positive individual in two out of the three cases studied.

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The researchers recommend that doctors educate patients
about the new findings linking pre-chewed food with HIV transmission when oral
bleeding is a factor so that parents can make informed decisions and take
appropriate preventive action where warranted. 
This research also highlights the need for everyone to know their HIV
status and for there to be safe, affordable and confidential opportunities for
testing.  In poor communities and
countries, not pre-chewing food is not a viable option but testing and
education should be so that parents and caregivers can have all the information
needed to make the best choice for their child.

This study may also play a key role in the analysis of cases
where breastfeeding was thought to be responsible for late HIV transmission
from mother to child.  Armed with this
new data, researches are reviewing those cases to see if pre-chewing may have
played a role.  Given the important
health benefits of breastfeeding and the debate over whether HIV positive
mothers should nurse
, the outcome of those case reviews could have global
implications. 

It sometimes seems that there is a new study debunking a
previous study announced everyday and it is easy for a body to become numb to news
of yet another one.  This story should
suffer that fate.  Mothers and caregivers
deserve to know the facts about the potential of HIV transmission through
pre-chewed food and what, if any, new light that shines on the potential of HIV
transmission through breastfeeding. 

Culture & Conversation Family

Breastfeeding, Bias, and Men Who Give Birth: Q&A With Trans Activist Trevor MacDonald

Britni de la Cretaz

In his new parenting memoir, Trevor MacDonald talks about pregnancy and breastfeeding as a trans man—and why we must dislodge the idea that bearing children is only women's labor.

Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.

With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.

MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.

By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.

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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?

Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.

Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]

It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.

Rewire: What was the decision to carry a baby like for you?

TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.

Rewire: Did you experience any gender dysphoriathe distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?

TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.

I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.

Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.

But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.

Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?

TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.

At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.

Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.

Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?

TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.

Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?

TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.

But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.

In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.

Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?

TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.

Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?

TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.

I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.

Rewire: What do you wish you had known before giving birth to Jacob?

TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.

Rewire: What do you hope people take away from your book?

TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.

This interview was conducted by email and by phone. It has been lightly edited for length and clarity. 

Commentary Human Rights

Tackling Zika: Have We Learned Our Lesson on Rights?

Luisa Cabal

Local governments and public officials should look to the reproductive rights and HIV and AIDS movements for insights into the ways in which they can more effectively center the needs of those most marginalized while fighting the Zika virus outbreak.

Read more of our articles on the Zika virus here.

The Zika virus outbreak and the increase of babies being born with birth defects seemingly linked to the mosquito-transmitted disease have generated a series of prescriptions from governments of the most affected countries about what people need to do and not do. These include asking women to delay pregnancies—until 2018 in El Salvador, for example.

Sadly, these recommendations do not match what is in the realm of possibility for many women living in or near Latin America, the region from which we hail. We propose instead local governments and public officials look to the reproductive rights and HIV and AIDS movements for insights into the ways in which they can more effectively center the needs of those most marginalized while fighting this crisis.

Calls to delay pregnancy in several countries where the Zika virus has spread have revealed gaps in health systems resulting from unfulfilled demands for sexual and reproductive health-care services. While women in Latin America generally have access to contraception—a real demonstration of decades of activism and leadership—in some Central American countries such as Guatemala, over 26 percent of married young women who do not want to become pregnant have an unmet need for birth control, and therefore are at risk of an unintended pregnancy.

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In the regions that have seen a spike in Zika cases, there are also high rates of sexual violence. The World Health Organization reports that one in three women experience violence in her lifetime. Those rates in Peru, where health officials in late January confirmed the nation’s first case of Zika, appear to be higher: A 2005 report found more than half of women in Lima and Cusco experienced physical or sexual violence by a partner some time in their life.

Without access to contraception, many women, including some young girls, will experience unintended pregnancies. And once pregnant, women and girls do not have control over their own reproduction as the laws provide limited options for termination. In countries that have very restrictive abortion laws, women and girls face an even greater health crisis should they experience an unintended pregnancy, become infected with the Zika virus, and want an abortion.

In light of this situation, how realistic is it to expect the public to delay their pregnancies as they are prescribed to do? Is this top-down approach to tackling a health-care emergency grounded in the realities and needs of women? Are policymakers once again “instrumentalizing” women to solve a threat or a global challenge?

Activists have known for a long time what is needed at a structural level to ensure that women’s health and rights are respected and promoted. Reproductive rights and HIV and AIDS advocates have said it all along.

The response demands long-term commitments to three rights pillars: First, access to information and services. Women need access to information about the virus, including how to prevent transmission. They also have a right, as UN bodies have argued, to access the type of sexual and reproductive health services they need, including a range of contraceptive options. If pregnant, every woman should be able to decide if they will carry to term their pregnancy—and have access to safe abortion or maternal health care and social support services.

Second, governments and stakeholders need to scale up their commitments to protect women’s agency. Women have to be empowered to make choices regarding their own health, and those choices need to be respected. Women living with HIV have shared their painful experiences of being subjected to coercive sterilization or abortion and of having their right to reproductive autonomy erased. Advocates and policymakers need to reinforce the rights and dignity of women and show that respect for their decisions is at the center of any policy and health intervention. As we learned from the AIDS response, this work of fighting a global health crisis must start with the concerns of those most vulnerable and marginalized, and their voices must be heard at all times.

Lastly, in a world where leaders look for magic bullets and advance biomedical approaches as one-size-fits-all solutions to health challenges, governments and different stakeholders need to bolster all efforts aimed at eliminating discrimination and violence against women and girls. These efforts should include removing obstacles to reproductive health services, investing in the empowerment of adolescents, and training health providers to protect and promote women’s sexual and reproductive decision making. These interventions will ensure that when a crisis hits, all persons—whether women or those from other marginalized groups—are enjoying the legal, policy, and cultural conditions that recognize them as full citizens and agents of their health and lives.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of UNAIDS.