Q: I want to ask why the recommendations on breast feeding are different in the West for HIV positive mothers and different here? Isn't it hypocrisy that life in the developing world is cheaper?

A:No, it is not a matter of double standards. The recommendations must be the same - an HIV positive mother should not breast feed her child as there is a 10% chance of the baby getting infected. When the mother, however, cannot afford proper artificial feeds, there is no choice. If the baby is not fed it will die, if it is fed with inadequate concentration of artificial feeds, it will develop malnutrition and die, if it gets an infection because of unhygienic feeds it will get diarrhoea and may die. Where a mother is HIV infected and cannot afford artificial feeds, the best remaining option is exclusive breast feeding for 3 or 4 months. It has been found that when nothing else is given by mouth, not even water, HIV infection chances are reduced but not eliminated. The person giving the advice must judge. Where artificial feeds are possible in adequate quantity and without infection, breast feeding must not be given, If this is not possible for any reason, exclusive breast feeding must be recommended. It is not fair I agree, but life is full of such difficult choices.