Sunday, November 20, 2011

I’m HIV+ : Can I Breastfeed?

The answer to this may depend more on where you live than how safe it is. 

In a recent podcast with How Positive Are You, Marian Tompson, a co-founder of La Leche League International, talks about her long-time search for answers to questions about breastfeeding and HIV.

Marian remembers back in 1997 when the World Health Organization (WHO) published its recommendation that HIV+ women should not breastfeed. Period.  Marian questioned the science behind these recommendations and began the online chat group, Another Look, to examine current research on HIV and breastfeeding. She invited doctors, nurses, and policy-makers from both sides of the issue to participate in the discussion “because I felt that we really needed to listen to each other.”  

I interviewed Marian while doing research for This Child of Mine in 2000.   Back then, one of her biggest concerns was that the lack of compelling evidence that breastfeeding while HIV+ was dangerous. In fact at least one study showed that among mothers who exclusively breastfed, there was no higher risk of HIV transmission than among mothers who formula fed

Someone must have been listening. In 2010, after a series of new studies that demonstrated strong evidence of positive health outcomes for breastfed HIV-exposed babies, WHO and UNAIDS reversed their earlier recommendations.  Now mothers are advised to exclusively breastfeed for six months in conjunction with antiretroviral treatment (ARV) for themselves and their babies.

The catch is that, in reality, this recommendation only applies to women living in resource-poor countries where formula feeding can be a death sentence because of the lack of access to clean water, and the long-term sustainability and cost of formula feeding. In most countries, while there are no laws prohibiting HIV+ mothers from breastfeeding, choosing to do so can result in a mother losing custody of her child. Marian refers to a recent study of mother-baby AIDS clinics in Chicago where nurses were asked in a questionnaire what to do if an HIV+ mother said she wanted to breastfeed. The unanimous response? Time to call the lawyers. 

In the podcast Marian talks about a few cases where this has happened, including the 1999 case of Kathleen Tyson, one of the mothers in This Child of Mine. In fact, Marian says that for a long time La Leche League counselors were afraid that supporting HIV+ mothers who wanted to breastfeed could land them in jail, and passed all calls of this nature on to Marian.  

She points out that even now, over ten years later, with new research and guidelines,  there are still very few resources for HIV+ moms who want to do something differently than they’re told. Many end up lying to their doctors, their neighbors, their friends -even going underground   to do so.

Tuesday, November 8, 2011

Why am I a better parent when my kids are asleep?

For the past few months I have been leading a fairly erratic double life of substitute teacher by day, dance studio employee by night. (No, I don’t dance. I’m not nearly that cool.)  And lately I miss the days when my husband was at work until 7 or 8 and I was home with the kids, making fish sticks, hearing about handball bullies at school, drawing the lollipop card in Candy Land.

Until the occasional nights when I am actually home doing those things.

I know I should be pleased that the no-homework policy at my son’s school affords us more quality family time. But let’s face it: we don’t play chess, and Jack just got a new IPod Touch for which we can’t seem to hammer out acceptable terms. So family time derails quickly into the familiar:  
“Five more minutes?” 
“No, now."
 “But I’m almost done with this level.” 
“Turn it off now.” 
 We can go for hours on that conversation alone.  So much for quality.

Or there’s my four-year-old daughter whose new favorite game is Neighbor Picnic. Emma spreads a blanket, takes out every pink plastic spoon, fork and dish from her picnic arsenal, and we begin the game on her signal. 

First we double-kiss, Real Housewives style, and she offers me lobster, cookies and miso soup. Sometimes she brings her baby, Sparkle Starfish, for me to rock to sleep while we talk about her job at the pickle factory. I know what you’re thinking. And yes, the first 600 times we played it was super cute. But now, a few rounds of neighbor picnic and I start drumming up excuses to check my computer every 12 seconds, for example, to see if it’s going to rain. You know, in case we’re planning a picnic. She nods knowingly and I feel like a jerk.

Then it’s 14 reminders to brush teeth, and, no you can’t wear your toy pumps and angel wings to bed,  who taught you the word idiot, Halloween is O-V-E-R, don’t point the nerf gun at your sister, and my favorite, this apartment is TOO SMALL for Baby Knight (suffice to say that Baby Knight involves hiding, chasing, lunging  squealing, and eventually tears.)  By lights out (although they fall asleep with the lights on) I’m literally giddy. I know, I suck, but I’m giddy. For about five solid minutes.

Don’t know if it’s all that rich lobster or the emotional toll of being outwitted by angry birds at every obstacle, but these kids crash hard and fast. All’s quiet on the western front and in all that silence I miss them. Every night I come back in the room to shut off the light and watch them sleep. Wait on the edge of the bed for one of those tiny sleep sighs to escape in the darkness. Then I think if I had five more minutes I’d happily read one more book. Go over that student council speech one more time. Join forces with Baby Knight, pick up a nerf gun and fire away at invading dragons. Because tomorrow night I’ll be back at the dance studio. Shortly after that, they’ll be off on real picnics. And they won’t invite me to tag along.  

Someday I’ll learn.

Tuesday, November 1, 2011

Teens on Gardasil: What do they think?

I recently posted some articles about Governor Brown’s new law that will allow children as young as 12 to receive the Gardasil vaccine without their parents’ knowledge or consent.

In case you’re just hearing about the newest vaccine debate, here’s some info about Gardasil from the website to get you started:

GARDASIL is the only HPV vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, GARDASIL helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, GARDASIL helps protect against 90% of genital warts cases.
GARDASIL also helps protect girls and young women ages 9 to 26
against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

So why wouldn’t parents want their kids getting this vaccine?

Some parents are concerned about side effects.  Others fear that vaccinating children against STDs will give kids a green light to jump in the sack. Jerry Brown’s law, which takes effect in January, 2012, simply removes parents’ from the equation. Problem solved.

But noticeably missing from all the noise are the voices of those most affected by the whole debate: the kids. If we’re going to plop this responsibility in their laps, it seems fitting that we hear what they have to say about it.

So I asked around.

Let me preface by saying, there is no particular research design here. The 40 or 50 kids I surveyed ranged in age from 14-19 and reside in Los Angeles county.  I explained the law, briefly explained what Gardasil was – a striking number of them had never heard of it – and described the concerns on both sides of the issue.  The quoted answers below represent the most common responses I received. 

Here’s what they said:

What do you think of the law?
“If the child wants to take that risk, I think it’s okay but the child should be informed, given all the information so that they would be smarter on the decision they are going to make.”

“Nobody should be denied vaccines for any reason.”

“Actually [Gardasil] should just be mandated like other vaccines you need for school.”
"It’s wrong because [Governor Brown] should at least talk to the parents or have them vote.”

“This law may expand for other medical uses.”

"This is not okay. It sounds like [the law] was done out of a whim or something.”

Are kids old enough to make this decision?
“As teenagers we know what we are doing.”

“any [kid] can be educated about this if their doctor is willing.”

“When you feel that it’s your responsibility you rise to the occasion”.

“Every kid should have the right [to make the decision]. Because it’s their responsibility and their own body.”

"12 year olds are  are still young and don’t know what they are doing. I mean at least the kids should be a little older, like 15  or 16,  so they can actually think more carefully for themselves."

“[Kids] are more interested in playing and are not going to be able to make a serious decision."

“If kids are able to get their own medicine, they should be responsible to do anything.”

What about the parents?
“Some parents are worried about side effects. But what’s worse, a few side effects or cancer?”

“A lot of parents are uninformed or even ignorant. Look at the whole autism debate.”

“Kids can take this vaccine behind the parents back and if something goes wrong it’s the parents’ responsibility and nobody wins except for the drug company [who]  wins your money.”

"Parents care and they know what’s good and bad for kids.

"If the kids are making decisions like that, what are parents for?”