HIV AND BREASTFEEDING

Human immunodeficiency virus (HIV) infection is a chronic condition, like diabetes or high blood pressure. It is very important that all people living with HIV take their antiretroviral medicines (ARVs) daily.  

 

HIV AND PREGNANCY

It is important to:
•    Take your ARVs correctly.
•    Tell your healthcare provider if you struggle to take them.
•    Attend ALL your antenatal clinic visits.
•    Do your regular blood tests to check that your ARVs are keeping your viral load undetectable (<50c/ml).

 

This protects your baby from getting HIV. Your baby will also get ARVs after birth to prevent HIV.[1] 
More than 99% of babies born to HIV positive mothers do not get HIV.[1]

ONCE BABY ARRIVES

Keep your baby in direct skin-to-skin contact for as long as possible. Skin-to-skin contact helps breastfeeding and prevents baby from losing too much weight and getting jaundiced. 

BREASTFEEDING WHILE HIV+

  • Exclusive breastfeeding protects babies from HIV transmission and gives your baby the best chance of good health.[2] Anything else – water, tea, formula, food – increases the risk of getting HIV and other illnesses.  

  • Exclusive breastfeeding for the first 6 months means that baby gets nothing else to eat or drink other than breastmilk. 

  • However, mixed feeding with formula milk is not a reason to stop breastfeeding if you are taking your ARVs every day and have an undetectable viral load.[1][2] 

  • Breastfeeding is recommended for 2 years and longer.

  • Even if you breastfeed for a shorter time, this is better than never breastfeeding at all.[2]

 

WHAT IF I AM SEPARATED FROM BABY?

If you become sick or need to go to hospital, ask to keep baby with you. Or, hand express your milk while separated to keep up your supply and to avoid engorgement. Tell your healthcare provider that you are breastfeeding. 

WHAT IS BABY IS ALSO HIV+

Less than 1% of babies born to HIV positive mothers will get HIV. If your baby tests HIV-positive, there is NO reason not to breastfeed. Breastfeeding for 2 years and longer is better for an HIV-infected baby’s health, nutrition and survival.[2] It is important that you and your baby take your ARVs daily. 

WEANING WHEN HIV+

If you decide to stop breastfeeding, wean gradually over several weeks. Stopping breastfeeding suddenly may increase the risk of your baby being infected.[1]

WHAT IF I CHOOSE NOT TO BREASTFEED?

If you are HIV-positive and choose not to breastfeed, make sure that you understand and get information on: 

  • The risks of not breastfeeding. 

  • Preparation and storage of formula to minimise risks. 

  • Amounts and frequency of feeds. 

  • The cost of formula feeding.  

REFERENCES

[1] PMTCT 2019 Guidelines South Africa - https://sahivsoc.org/Files/PMTCT%20Guideline%20November%20signed%20PRINT%20v7.pdf

[2] WC HIV consolidated guidelines October 2020 - https://www.westerncape.gov.za/assets/departments/health/hiv_guidelines_22012020.pdf

[3] Adult Primary care guidelines 2019 South Africa - https://www.knowledgehub.org.za/elibrary/adult-primary-care-apc-guide-20192020-updated