A new position paper on infant feeding for women living with HIV (WLHIV) has been published by the 4M Mentor Mothers Network and the Salamander Trust. The paper was written by WLHIV who are Mentor Mothers, supporting other WLHIV before, during and after pregnancy. It is designed for use by WLHIV in the UK who are considering infant feeding options, their families, and professionals who support them.
The paper summarises UK and WHO guidelines and then gives a thoughtful examination of the complexities of infant feeding for WLHIV from a holistic standpoint, taking into account the many components and pressures involved in infant feeding decisions.
Current UK guidelines recommend formula as the preferred option for babies of WLHIV, but also state that women wishing to breastfeed should be supported to do so. The WHO guidelines recommend breastfeeding because the risk of transmission is outweighed by risks associated with formula feeding in low income countries. This difference is a source of confusion for some WLHIV in the UK, including those from migrant African communities where breastfeeding is the cultural norm.
Covid-19 restrictions mean that the British HIV Association has re-emphasised formula feed as the preferred choice, because of challenges in accessing the monthly viral load testing required during breastfeeding, the paper notes.
Key points in the position paper include:
- U=U: there is some uncertainty among healthcare professionals as to whether U=U applies to breastfeeding.
- Some healthcare professionals have difficulty supporting WLHIV to breastfeed because they are fearful about transmission.
- Some studies have found that guidelines advocating that WLHIV should avoid breastfeeding may not necessarily maximise health outcomes.
- WLHIV need evidence-based, objective and non-judgemental information about the risks and benefits feeding options to allow them to make an informed choice.
