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FACT SHEET 8. HIV and Breastfeeding
Risk of mother-to-child transmission
• Without treatment, about a third of HIV-positive mothers
pass the virus to their newborns during pregnancy,
delivery, and breastfeeding.
• In the absence of any interventions, approximately
16 percent of infants born to HIV-positive women will
be infected through breastfeeding.
• HIV transmission may continue for as long as a child is
breastfed.
• The risk of HIV transmission through breastfeeding is
nearly twice as high among women who have been
recently infected with HIV.
Women with HIV face the dilemma of trying to prevent HIV transmission to their infants
during feeding while reducing the risk of malnutrition and other illnesses if they do not
breastfeed.
Health risks for non-breastfed infants
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Not breastfeeding, compared with any breastfeeding, has been shown to expose
children to an increased risk of malnutrition and life-threatening infectious diseases
other than HIV, especially in the first year of life.
Exclusive breastfeeding appears to offer greater protection against disease than any
breastfeeding.
In developing countries, as many as 54 percent of all deaths among children under the
age of five are associated with malnutrition.
In developing countries, not breastfeeding during the first two months of life is
associated with a six-fold increase in mortality due to infectious diseases. This increased
risk drops to two-and-a-half-fold at six months, and continues to decrease with time.
Types of infant feeding
Exclusive breastfeeding
Means the infant receives only breast milk from the mother or a wet nurse, or expressed
breast milk and no other liquids or solids (with the exception of drops or syrups consisting
of vitamins, mineral supplements, or medicines). A child may be exclusively breastfed with
expressed human milk from the mother, a breast-milk donor, or a milk bank.
Replacement feeding
Means the process of feeding a child who is not receiving any breast milk with a diet that
provides all the nutrients the child needs. During the first six months, this should be with a
suitable breast-milk substitute – commercial formula or home-prepared formula with
micronutrient supplements. After six months, the diet should consist of a suitable breastmilk substitute and complementary foods made from appropriately prepared and nutrientenriched family foods, given two to three times per day. If suitable breast-milk substitutes
are not available, appropriately prepared family foods should be further enriched and given
five times a day.
Partial breastfeeding or mixed feeding
Means giving a baby some breastfeeds and some artificial feeds, either milk, cereal, or
other food.
Increasing Access to Contraception for Clients with HIV: A Toolkit
Fact Sheet 8
Breastfeeding options for women with HIV
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The most appropriate infant-feeding option for an HIV-positive mother should
continue to depend on her individual circumstances, including her health status and the
local situation, but should take greater consideration of the health services available
and the counseling and support she is likely to receive.
Exclusive breastfeeding is recommended for HIV-positive women for the first six
months of the infant’s life unless replacement feeding is acceptable, feasible,
affordable, sustainable, and safe for them and their infants before that time.
When replacement feeding is acceptable, feasible, affordable, sustainable, and safe,
avoidance of all breastfeeding by HIV-positive women is recommended.
At six months, if replacement feeding is still not acceptable, feasible, affordable,
sustainable, and safe, continuation of breastfeeding with additional complementary
foods is recommended, and the mother and baby should continue to be regularly
assessed. All breastfeeding should stop once a nutritionally adequate and safe diet
without breast milk can be provided.
Mixed feeding with both breast milk and other feeds has been associated with a higher
risk of HIV infection for the infant than exclusive breastfeeding and should be avoided
because it increases the risks of both HIV infection and the risks of diarrhea and other
infectious diseases.
In cases where an infant or young child is known to be HIV-positive, the mother
should be strongly encouraged to continue breastfeeding because it has been shown to
improve child survival.
To make the best choice, HIV-positive women should
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Receive counseling that includes information about both the risks and benefits of
various infant-feeding options.
Receive guidance in selecting the most suitable option for their situation.
Have access to follow-up care and support, including family planning and nutritional
support, particularly at key points when feeding decisions may be reconsidered, such
as the time of early infant diagnosis and at six months of age.
Source:
UNICEF, UNAIDS, WHO, UNFPA. HIV and Infant Feeding: Guidelines for decision-makers.
Geneva: WHO, 2003.
World Health Organization (WHO). Consensus Statement – WHO HIV and Infant Feeding Technical
Consultation. Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV Infections in
Pregnant Women, Mothers and their Infants, October 25-27, 2006. Geneva: WHO, 2006.
Increasing Access to Contraception for Clients with HIV: A Toolkit
Fact Sheet 8