HIV and safer infant feeding

HIV and safer infant feeding

African woman breastfeeding

A number of studies have shown that the protective benefit of drugs is diminished when babies continue to be exposed to HIV through breastfeeding.^{16 17}

Mothers with HIV are advised not to breastfeed whenever the use of breast milk substitutes (formula) is acceptable, feasible, affordable, sustainable and safe. However if they live in a country where safe water is not available then the risk of life-threatening conditions from formula feeding may be higher than the risk from breastfeeding. An HIV positive mother should be counselled on the risks and benefits of different infant feeding options and should be helped to select the most suitable option for her situation.¹⁸

A baby fed on infant formula does not receive the special vitamins, nutrients and protective agents found in breast milk. And the cost of infant formula often puts it beyond the reach of poor families in resource poor countries, even if the product is widely available. Many women also lack access to the knowledge, potable water and fuel needed to prepare replacement feeds safely, or simply have no time to prepare them. If used incorrectly - mixed with unsafe water, for example, or over-diluted - a breast milk substitute can cause infections, malnutrition and even death. Furthermore, if a mother chooses not to breastfeed in settings where breastfeeding is the norm then this may draw attention to her HIV status and invite discrimination, violence or abandonment by her family and community. Another factor worth noting is the contraceptive effect of breastfeeding, which can help to lengthen the interval between pregnancies.

Infant feeding advice for women with regular access to antiretroviral drugs

For HIV positive women who choose, or who are advised to breastfeed, the World Health Organization's (WHO) recommendations are based on whether a women has access to antiretroviral drugs or not. If a woman has support and a regular supply of antiretroviral drugs then she should exclusively breastfeed for the first 6 months of an infant's life and then introduce mix feeding until the infant is able to have a safe diet without breastmilk. Mixed feeding (breastfeeding mixed with bottle feeding of water or formula, or providing other foods) is only safe in this situation because the mother or infant is taking antiretrovirals.