Breast/Chestfeeding and HIV: Shared Decision-Making and the Needs of Women [ID: 1372281

Abstract

INTRODUCTION: Breast/chestfeeding is considered both the healthiest infant-feeding option for the general population and the standard of care for birthing parents living with human immunodeficiency virus (HIV) in resource-limited settings. Inadequate research on breastfeeding and HIV in high-resource settings has resulted in a lack of clinical guidance for providers to support informed decision-making among women living with HIV in these areas. METHODS: The Well Project, a nonprofit working to change the course of the HIV pandemic through a unique and comprehensive focus on women, conducted a survey in 2021 that included questions about breastfeeding experiences. Among 200 self-identified women living with HIV surveyed via Survey Monkey, 33 women reported experiences around breastfeeding. RESULTS: Forty-nine percent of women reported discussing breastfeeding with their provider—60% with ID providers and 57% with obstetrician–gynecologists. Half of respondents reported their provider initiated the discussion. Sixty-nine percent said their provider told them they could not breastfeed; 19% said they received incomplete/inaccurate breastfeeding information; and 13% reported their provider supported them in making the best decision for their families. CONCLUSION: These numbers, although small, supplement anecdotal evidence suggesting that most U.S. women living with HIV are not counseled according to the Perinatal HIV Guidelines, which recommend people living with HIV who are interested in breastfeeding receive patient-centered, evidence-based counseling on their options and those who choose to breastfeed be supported in order to minimize transmission risk. Education is greatly needed to ensure providers support their patients through this decision-making process.