CAPGAN's response to Para 55

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" CAPGAN recommends that breastfeeding should continue to be promoted, especially in Commonwealth regions where infant mortality remains high.

However ...

Acknowledging resource disparities, wherever possible mothers should be given access to voluntary free HIV testing and informed choice of adequate, acceptable, safe alternatives to breastfeeding "

Promotion of breastfeeding remains one of the single most effective strategies to reduce infant mortality through avoidance of infection and undernutrition

However it is recognised that breast feeding approximately doubles the risk of maternal to child transmission of HIV. The issue of breastfeeding in relation to HIV/AIDS in developing countries represents a major social, nutritional and medical dilemma.

All effort must be aimed at reducing the catastrophic impact of this epidemic. This should occur in the context of a "best affordable package" approach of caring for maternal health for infant survival. This includes access to free voluntary counselling, antenatal testing, high quality antenatal care, provision of antiretroviral therapy and free informed choice of feeding method. Where breastfeeding is chosen, this should be fully supported. For mothers choosing replacement feeds, adequate affordable formula must be available.

"Commonwealth Health Ministers must recognise the failure of "free market forces" to reliably develop and distribute essential drugs and vaccines, especially those required by the poorest in developing countries. Governments should develop strategic partnerships with industry and enact legislation to remedy this situation."

CAPGAN supports the efforts of the "International Aids Vaccine Initiative" to make available as soon as possible an HIV vaccine which would be marketed simultaneously at affordable prices in both developed & developing countries

"Commonwealth Health Ministers should support local authoritative ethics committees in their ability to decide what research is or/and is not appropriate in their own countries. Industry should be encouraged through tax incentives and other support to fund such activities."

In an unjust world it is difficult to apply the ethical principle of justice. It is increasingly recognised that absolutist ethical guidelines may unreasonably prevent appropriate research into essential drugs and vaccines from taking place in developing countries, thereby also preventing studies of great relevance to developing world practice. Research ethics should be applied in a relativistic rather than absolutist approach and controlled by credible ethics committees in the countries concerned.

FOR MORE INFORMATION ABOUT PARA 55

www.para55.org

Questions or comments to info@capgan.org or Fax: +852 26360020 or Tel: +852 26322861

Last modified: December 10, 2001