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close this bookHIV and Infant Feeding - Review of HIV Transmission Through Breastfeeding Jointly Issued by UNICEF, UNAIDS and WHO Guidelines - Prevention of Mother-to-Child Transmission (UNAIDS, 1998, 26 p.)
View the document(introduction...)
View the documentExplanation of terms
View the documentIntroduction
close this folderMother-to-child transmission
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View the documentHIV infection in women
View the documentRates of mother-to-child transmission
close this folderEvidence for breast-milk transmission
View the document(introduction...)
View the documentMechanisms of breast-milk transmission
View the documentQuantifying the risk of breast-milk transmission
View the documentTiming of HIV transmission during breastfeeding
View the documentColostrum and mature milk
View the documentFactors associated with the risk of mother-to-child transmission
close this folderAnti-infective properties of breast milk in women with HIV
View the documentGeneral infections
View the documentHIV infection
close this folderStrategies to reduce breast-milk transmission
View the documentPrimary prevention
View the documentReplacement feeding
View the documentEarly cessation of breastfeeding
View the documentTreatment of breast milk
View the documentWet-nursing by a tested HIV-negative woman
View the documentAntiretroviral therapy
View the documentSummary and Conclusion
View the documentReferences

Introduction

In the past three decades, strategies to reduce child mortality and to promote family health have resulted in considerable improvements in child health (World Development Report, 1993). Promotion of breastfeeding has played an important role since breastfeeding contributes to reduced mortality by providing optimum nutrition, by protecting against common childhood infections, and by its child-spacing effects (American Academy of Pediatrics, 1997; Golding et al., 1997; Goldman, 1993; De Soyza et al., 1991; Akr1990; Monteiro et al., 1990; Thapa et al., 1989; Habicht et al.,1988; Victora et al., 1987).

However, the emergence of HIV threatens to reverse gains in child health, since children are at risk of acquiring HIV infection through transmission from an HIV-infected mother. It is recognized that breastfeeding by an HIV-infected mother increases the risk of HIV transmission to her infant.

Since the beginning of the HIV pandemic, approximately three million children under 15 years of age worldwide have been infected with HIV and current estimates suggest that 600 000 children are newly infected annually (UNAIDS/WHO, 1998). The majority of these children live in sub-Saharan Africa, where between 25-40% of HIV-infected children die before their fifth birthday, and HIV is already contributing to increased childhood mortality (UNAIDS/WHO, 1998; Ryder et al., 1994; Nesheim et al., 1994). Although HIV transmission through breastfeeding is only partially responsible for this increase, HIV and infant feeding is an important public health issue, particularly in regions where HIV prevalence is high, and infectious diseases and malnutrition are the leading causes of childhood death. Countries need to develop sound policies regarding the prevention of HIV transmission through breastfeeding while continuing to protect, promote and support breastfeeding for infants of HIV-negative women and women of unknown serostatus.

This document reviews current scientific knowledge about breast-milk transmission of HIV, and serves as the foundation for two complementary documents:

HIV and infant feeding: Guidelines for decision-makers1
HIV and infant feeding: A guide for health care managers and supervisors2

1 Guidelines for decision-makers, 1998, 36 pages [E]; WHO/FRH/NUT/CHD 98.1
2 A Guide for Health Care Managers and Supervisors, 1998, 36 pages [E]; WHO/FRH/NUT/CHD 98.2