AFASSAcceptable Feasible Affordable Sustainable and Safe
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The majority of mothers live in conditions where the AFASS criteria cannot be met, and yet a large-scale move away from breastfeeding occurred even among mothers who without knowing their status feared being HIV-infected and refrained from breastfeeding, further eroding breastfeeding practice.
It became evident that even though the AFASS criteria for advising formula feeding were a scientific and medical attempt to discriminate between risk categories, counsellors, nurses and doctors could only promote breastfeeding half-heartedly when there was a real possibility that HIV infection could be transmitted to babies via breastmilk.
Though the 2010 guidelines build on previous guidelines clarifying some concepts such as AFASS, it also introduces new concepts including the following:
The fact that ARV intervention can make breastfeeding safer and reduce the risk of HIV transmission is of significant importance in environments where (AFASS) conditions for safe replacement feeding are difficult to achieve.
It may be the denial of the 'opportunity to have an HIV-uninfected child' that will result if women are denied access to formula despite meeting AFASS criteria.
There is no argument that many HIV-positive women fulfil the AFASS criteria (see Table I) and can appropriately avoid breastfeeding and give replacement feeds to their infants.
Exclusive breastfeeding continues to have a place for the large majority of HIV-positive women in sub-Saharan Africa who cannot replacement feed safely (AFASS) and who wish to breastfeed for cultural reasons, and for the even larger group of HIV-negative women or women of unknown status.
However, provinces, and perhaps even districts, should be allowed the freedom to decide whether they wish to continue to support the provision of replacement feeding for poor women who meet the AFASS criteria, based on their own circumstances.
Yet inadequate training on infant feeding guidelines, AFASS criteria and the new WHO recommendations1 impacts on the quality of counselling they can confidently offer.
All HIV-positive infants should continue breastfeeding for at least 2 years, regardless of whether the mother meets the AFASS criteria.
True (A) or false (B)--click on the correct answer: In conditions where replacement feeding is not AFASS, HIV-free survival is not much different whether or not the baby is bottle-fed or breastfed.
(42) But for the majority of mothers in southern Africa these 'AFASS' criteria cannot be met and the baby will need to be breastfed (see boxes, p.