Infant Feeding in the Era of HIV: Challenges and Opportunities

Abstract

Child health specialists and health care workers in many resource-limited settings are challenged by the infant feeding dilemma posed by HIV. Whereas previously breastfeeding, especially exclusive breastfeeding, was a key child survival strategy, the finding that HIV is present in breast milk has led to a re-assessment of the benefits of breastfeeding. This has resulted in reduced efforts globally to promote exclusive breastfeeding, a key child survival intervention. Although the World Health Organisation, UNICEF and Inter-agency Task Team (WHO/UNICEF/IATT) have been at the forefront of developing simple consistent approaches and tools for infant feeding in the context of HIV, challenges of implementation remain. For HIV-positive women, the transmission of HIV through breast milk has created a dilemma; the benefits of breastfeeding, and the risks of not breastfeeding, have to be weighed against the risk of HIV transmission through breastfeeding. Whilst intrauterine and intrapartum transmission can be substantially reduced through improved drug regimens, modifying infant feeding practices in order to reduce postnatal transmission is complex and difficult to achieve. This chapter reviews the evidence with regard to infant feeding and HIV with a particular focus on the experiences of HIV-positive women and challenges of implementing recommended feeding methods. It will also present interventions and strategies for supporting women in their feeding choices and opportunities to strengthen infant nutrition in the general population.