3.4 HIV and Infant Feeding

The finding that HIV is transmitted through breast-milk has complicated infant feeding recommendations.³⁰ Recognizing breastfeeding as a significant and preventable mode of HIV transmission, the Joint United Nations Programme on HIV/AIDS (UNAIDS), together with WHO and UNICEF, issued new guidelines on HIV and infant feeding in 1998.³¹ These guidelines call for urgent action to educate, counsel, and support HIV-positive women in making decisions about how to nourish their infants safely. The guidelines stress that in order for a mother to make a decision, she must have access to voluntary and confidential testing and counselling, as well as to information about feeding options and the risks associated with them.

Since these guidelines were published, observational data have shown that three-month-old infants of HIV-positive women who were exclusively breast-fed have the same risk of contracting HIV as infants who were never breastfed. In contrast, infants who were partially breastfed had a significantly higher risk.³² Several biological mechanisms could explain why exclusive breastfeeding might be more protective than partial breastfeeding. These include the mother’s reduced risk of subclinical mastitis, which occurs during breast engorgement,³³ and increased integrity of the infant’s intestinal wall. Research is under way to confirm if these important findings are causal.

Shortened duration of breastfeeding is one infant feeding option suggested in the new UNAIDS/WHO/UNICEF guidelines. Confirmation of the protective effect of exclusive breastfeeding on the risk of mother-to-child transmission of HIV is a necessary first step in developing a policy recommendation that would give infants the benefits of exclusive breastfeeding while avoiding the risk of HIV transmission through partial breastfeeding.