Transmission and HIV and Infant Feeding
Primary prevention of HIV in girls and women of reproductive age remains the most important component of any strategy or programme to prevent mother-to-child transmission (MTCT).
For women who are HIV negative or of unknown status, breastfeeding should be protected, promoted and supported. (See Chapter Three-Safe Motherhood)
For HIV-infected pregnant women, the only interventions proven to reduce significantly MTCT of HIV are the use of antiretroviral therapy (ARV) and the avoidance of breastfeeding. Women who are known to be HIV positive should be counselled about the possibility of avoiding breastfeeding. They should consider using commercial infant formula, home-prepared formula, or a modified form of breastfeeding, such as expressing and heat treating their own breast milk. They could also breastfeed for a shorter time than usual, or find an HIV-negative wet nurse. However, most of these options are usually impractical. Studies are continuing on the effectiveness and service delivery implications of providing short-course ARV treatment which may represent a feasible intervention in some settings and for some circumstances.
In some settings, consideration could be given to providing HIV-positive mothers with breast milk substitutes and supporting its safe use. The supply of the substitute should be guaranteed for at least six months. The acquisition and distribution of breast-milk substitutes should be in compliance with the International Code of Marketing of Breast-milk Substitutes.
Considerable resources are required to prepare formula, whether commercial or home made. The mother needs water to clean equipment and prepare feeds; she needs adequate fuel to boil water to sterilise equipment and make feeds safe. She must do this six times a day, or prepare six feeds at one time and keep them cool for up to 24 hours to prevent spoilage.
This is not often practical when normal life is disrupted. If feeds cannot be mixed correctly, if equipment cannot be adequately cleaned and sterilised, or if prepared feeds cannot be stored to prevent spoilage, the risks of sickness and death to the infant may be greater than the risk of transmission of HIV through breastfeeding.
Bear in mind these considerations when counselling women. Health care
providers should support women and, when possible, their families, in
making the best decision on how to feed their infant given their particular
circumstances. Breastfeeding may be the most appropriate and safest
For more information on HIV and Infant Feeding refer to the "HIV and
Infant Feeding Packet" produced by UNAIDS, UNICEF and WHO, Geneva, 1998.
Also refer to "Nutrition and HIV/ AIDS", Sub-committee on Nutrition
News, Number 17, WHO, Geneva, 1998.
FIVE ANNEX TWO