A multi-site study conducted in the US and Canada brings groundbreaking findings, showing no instances of HIV transmission among individuals living with HIV who breastfed their infants between 2014 and 2022. This study not only provides reassurance to breastfeeding individuals with HIV and their families but also highlights the need for improved guidance and support from healthcare providers.
Breastfeeding and HIV – From Discouragement to Support
Historical discouragement and emerging guidelines historically- that’s how clinical guidelines in high-income countries discouraged breastfeeding for individuals living with HIV, citing the risk of transmission. Safer alternatives like formula or donor breastmilk were recommended. However, this approach led to challenges and potential harm to families, resulting in reports to child protection services. In contrast, WHO guidelines for low and middle-income countries have supported exclusive breastfeeding, considering limited access to safe drinking water or formula.
New Guidelines and Reassurances Recognizing the benefits of breastfeeding and the increasing number of individuals with HIV opting for breastfeeding, new guidelines were issued in the US and Canada in 2023. These guidelines emphasize shared decision-making and support for virally suppressed individuals who choose to breastfeed. Research from low and middle-income countries has shown that with proper antiretroviral therapy, the risk of HIV transmission through breastfeeding is less than one percent.
Examining breastfeeding practices and experiences- a comprehensive multi-site study led by Dr. Judy Levison from the Baylor College of Medicine in Houston aimed to address the lack of data on breastfeeding among individuals living with HIV in North America. The study analyzed factors such as reasons for choosing breastfeeding, experiences during breastfeeding, and institutional practices and policies. Among the 72 mother-baby pairs included, no cases of HIV transmission were observed. Participants cited various reasons for choosing breastfeeding, while also highlighting challenges such as low milk supply and pain.
Challenges and the Way Forward
Supporting healthcare providers while the study provides promising insights, healthcare providers now face the challenge of supporting breastfeeding individuals with HIV without clear guidance. Concerns have been raised regarding the lack of consistency in guidelines, leaving providers uncertain about best practices and protocols. A multidisciplinary approach is needed to develop policies and procedures that support breastfeeding among individuals living with HIV. Comprehensive advice on infant feeding options, including breastfeeding, should be provided to all pregnant individuals with HIV. Access to expert clinical consultation through resources like the National Clinician Consultation Center Perinatal HIV/AIDS Hotline can help address these concerns and provide guidance to healthcare providers.
The groundbreaking study examining breastfeeding individuals with HIV in the US and Canada has provided valuable insights into the absence of HIV transmission in this population. These findings emphasize the significance of establishing consistent guidelines and fostering a supportive environment for individuals who choose to breastfeed despite their HIV status. However, further research, collaboration, and the development of improved guidance are necessary to ensure the overall well-being of breastfeeding individuals with HIV and their infants. By continuing to explore this important area of study, we can enhance support systems and advance the health outcomes of this vulnerable population.