Infant feeding options for people with HIV

A new ASHM resource for healthcare providers

The Optimal Scenario & Context of Care guidance for health care providers regarding infant feeding options for people living with HIV provides guidance about a shared decision-making process between women with HIV and healthcare providers to ensure genuinely informed decisions are made about infant feeding. Although formula feeding is the safest way to feed infants in resource-rich countries, there has been growing recognition that breastfeeding can be a viable option for women with HIV within an optimal context of care.

The optimal context of care needs to include:

  • Informed decision making – evidence for and against breastfeeding should be presented in an understandable and culturally appropriate way
  • Supporting choice which is free of judgement
  • Encouraging early discussions: infant feeding options should be part of discussions when potential parents with HIV are thinking about or are in the early stages of pregnancy
  • Supporting healthcare providers: healthcare providers need to be able to access professional peer support and advice
  • Social support for women with HIV

The ASHM document takes a harm minimisation approach and provides clear strategies to reduce the risk of HIV transmission when breastfeeding. These include:

  • Maintaining an undetectable viral load (suppression of viral load to <50 RNA copies/ml throughout pregnancy and breastfeeding
  • Regular engagement with healthcare providers
  • Maintaining mother and child gut and breast health
  • Breastfeeding exclusively for as short a period as possible and for no longer than 6 months
  • Weaning at 6 months or earlier by transitioning to formula feed only and then introducing solids over a period of a few weeks.

The ASHM document was developed in parallel with a resource developed by Positive Women Victoria and the National Association of People with HIV Australia (NAPWHA) Breastfeeding for women living with HIV in Australia. This resource is for people with HIV who may be or are thinking about being pregnant. Anyone working with women and men with HIV should be aware of these documents.

It is recognised in both documents that people who feed infants with human milk are diverse in terms of gender and sexuality. The language in these documents will not be appropriate for everyone. ASHM reminds health workers to be respectful and responsive to language preferences by providing individualised patient centered care.

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