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  • Writer's pictureNozibele Qamngana

HIV and Breastfeeding: Is it safe?

HIV is a virus that attacks the body’s immune system and is spread through certain body fluids, including breast milk. Mother-to-child transmission can occur during pregnancy, birth, or breastfeeding. Treatment for HIV (antiretroviral therapy, or ART) reduces the risk of transmission from a mother to her infant.

Is it safe for a mother infected with HIV to breastfeed her infant?

There’s been interesting debates regarding this topic. While others advocate for the HIV positive mothers to breastfeeding, there’s been a resistance from others. In the United States, where mothers have access to clean water and affordable replacement feeding (infant formula), CDC and the American Academy of Pediatric recommend that HIV-infected mothers completely avoid breastfeeding their infants, regardless of ART and maternal viral load. Healthcare providers should be aware that some mothers with HIV may experience social or cultural pressure to breastfeed. These mothers may need ongoing feeding guidance and/or emotional support.

However, in resource-limited settings, such as some parts of Africa, the World Health Organization (WHO) recommends that HIV-infected mothers breastfeed exclusively for the first 6 months of life and continue breastfeeding for at least 12 months, with the addition of complementary foods. These mothers should be given ART to reduce the risk of transmission through breastfeeding.

Here are 5 things you need to know about breastfeeding and HIV:

Breastfeeding is the safest, most nutritious option for babies.

Breastmilk is always the right temperature, requires no preparation and is readily available even in settings with limited access to clean water and adequate hygiene. Breastfeeding promotes cognitive development and acts as a child’s first vaccine, giving babies everywhere a critical boost.

Breastfeeding is a life-saving intervention.

Breastmilk contains antibodies and other components that protect children against deadly infections. In some contexts, when there may be limited or no access to clean water and hygienic conditions, breastfeeding can drastically reduce the risk of diarrhea and other deadly diseases.

Breastfeeding mothers need (even more!) support when following an HIV treatment regimen alongside breastfeeding safely.

With adequate support from their families, communities, health workers and society, almost all mothers can breastfeed, even in the harshest contexts. Support for breastfeeding must be free from commercial influences and must include counseling provided within health facilities and at the community level to guide mothers through breastfeeding with HIV safely.

HIV testing, treatment and support should be provided as part of the care women receive before, during and after pregnancy.

This support should be provided confidentially and without judgement. It should also be affordable and accessible for all families.

Preventing mother-to-child transmission of HIV is a public health priority.

Adequate services and support can help women protect themselves from being infected with HIV before and during pregnancy and throughout the breastfeeding period.

Ten safer breastfeeding rules for women living with HIV

  • Tell your HIV team if you want to breastfeed –they will help you make it as safe as possible for your baby.

  • The baby is given Nevirapine (NVP), an HIV drug, as soon as possible after birth. This is to be prescribed for the first 6 months of the child’s life.

  • The mother needs to be 100% adherence to HIV drugs.

  • Only breastfeed when you have an undetectable viral load.

  • Breast milk only – no other food or drink (apart from vitamins and medications as advised) for the baby.

  • Do not breastfeed if you develop mastitis, cracked bleeding nipples or nipple thrush.

  • Do not return to breastfeeding once the baby starts formula feeding.

  • Prepare for when you might have to stop breastfeeding – consider building up a supply of expressed breast milk and have an emergency set of bottles, formula and prescription for cabergoline (to suppress milk production) for established breastfeeding.

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