A woman infected with HIV can pass HIV to her child during pregnancy, delivery, or breastfeeding. Preventive antiretroviral (ARV) therapy (prophylaxis) given to the mother during pregnancy and labor can greatly reduce the chances that the baby will be infected while developing in the uterus or during delivery. During breastfeeding, ARV therapy for the mother, for the HIV-exposed infant, or for both also can significantly reduce the chances of HIV transmission through breast milk.
How can family planning providers help prevent mother-to-child transmission of HIV?
- Help women avoid HIV infection (see Sexually Transmitted Infections, Including HIV, Preventing Sexually Transmitted Infections, p. 280).
- Prevent unintended pregnancies: Help women who do not want a child to choose a contraceptive method that they can use effectively.
- Offer HIV counseling and testing: Offer counseling and testing to all pregnant women, if possible, or offer to refer them to an HIV testing service, so they can learn their HIV status.
- Refer: Refer women with HIV who are pregnant, or who want to become pregnant, to services for prevention of mother-to-child transmission, if available.
- Encourage appropriate infant feeding: Counsel women with HIV on safer infant feeding practices to reduce the risk of transmission, and help them develop a feeding plan. If possible, refer them to someone trained to counsel on infant feeding.
- For all women, including women with HIV, breastfeeding, and especially early and exclusive breastfeeding, is an important way to promote the child's survival.
- HIV-infected mothers and/or their infants should receive the appropriate ARV therapy, and mothers should exclusively breastfeed their infants for the first 6 months of life, then introduce appropriate complementary foods and continue breastfeeding for the first 12 months of life.
- Breastfeeding should then stop only once a nutritionally adequate and safe diet without breast milk can be provided. When mothers decide to stop breastfeeding, they should stop gradually within one month, and infants should be given safe and adequate replacement feeds to enable normal growth and development. Stopping breastfeeding abruptly is not advised.
- Even when ARV therapy is not available, breastfeeding (exclusive breastfeeding in the first 6 months of life and continued breastfeeding for the first 12 months of life) may still give infants born to mothers infected with HIV a greater chance of survival while still avoiding HIV infection than not breastfeeding at all.
- In some well-resourced countries with low infant and child mortality rates, however, avoiding all breastfeeding will be appropriate. A woman with HIV should be advised of the national recommendation for infant feeding by HIV-infected mothers and counseled and supported in the feeding practice that best suits her situation.
- An HIV-infected mother should consider replacement feeding if–and only if–all the following conditions are met:
- safe water and sanitation are assured in the household and community;
- the mother or caregiver can reliably provide infant formula:
- sufficient for normal growth and development of the infant
- cleanly and frequently, to avoid diarrhea and malnutrition, and
- exclusively in the first 6 months;
- the family is supportive of this practice; and
- the mother or caregiver can obtain health care that offers comprehensive child health services.
- If infants and young children are known to be HIV-infected, mothers should be strongly encouraged to exclusively breastfeed for the first 6 months of life and continue breastfeeding up to 2 years or beyond.
- If a woman is temporarily unable to breastfeed–for example, she or the infant is sick, she is weaning, or her supply of ARVs has run out–she may express and heat-treat breast milk to destroy the HIV before feeding it to the infant. Milk should be heated to the boiling point in a small pot and then cooled by letting the milk stand or by placing the pot in a container of cool water. This should be used only short-term, not throughout breastfeeding.
- Women with HIV who are breastfeeding need advice on keeping their nutrition adequate and their breasts healthy. Infection of the milk ducts in the breast (mastitis), a pocket of pus under the skin (breast abscess), and cracked nipples increase the risk of HIV transmission. If a problem does occur, prompt and appropriate care is important (see Sore or cracked nipples, p. 296).