Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

The availability of effective short course antiretroviral (ARV) regimens in the peripartum period provides the potential for significant reductions in utero and intrapartum mother-to-child HIV transmission (MTCT)6 (1,2). With the widespread introduction of prevention of mother-to-child transmission (PMTCT) programs containing peripartum ARV prophylaxis, MTCT in the postpartum period through breast-feeding is becoming increasingly important. Exclusive breast-feeding or complete avoidance of breast-feeding through exclusive replacement feeding is currently the main focus of attention, but little is known about how to achieve these practices (3,4).

UNICEF/WHO has recommended that HIV-positive women avoid all breast-feeding when replacement feeding is acceptable, feasible, affordable, sustainable, and safe for their circumstances.

If the available replacement feeding methods do not meet these criteria, exclusive breast-feeding (EBF) is recommended during the first months of life (5). The application of these recommendations in operational settings is a challenge. Both clinical trials and evaluations of PMTCT programs have found that rates of exclusive infant feeding, both breast-feeding and formula-feeding,are suboptimal (69). In South Africa, although the majority of mothers initiate EBF, only 10.4% exclusively breast-feed until their infant is 3 mo of age and the percentage decreases to 1.2% for those who breast-feed their infant until 6 mo of age (10).