Abstract
While there have been considerable advances in the reduction of mother to child transmission of HIV (MTCT) in sub-Saharan Africa with the advance of anti-retroviral therapies (ART), there remain challenges in the late postpartum period. Structural issues including food insecurity and stigma make better maternal ART adherence and exclusive breastfeeding unreachable for some women. There are no other scientifically researched feeding options as there have been few studies on different types of mixed feeding practices and risk of HIV infection. Additional studies are warranted to assess detailed feeding practices in HIV exposed infants in relation to clinical outcomes.
Highlights
Exclusive breastfeeding is widely understood to have a number of significant benefits for infant and child health, low- and middle-income countries continue to have low prevalence of exclusive breastfeeding rates [1]
Exclusive breastfeeding rates are even lower for Southern Africa; for example, only 7% of infants are exclusively breastfed in Swaziland, along with only 11% and 14% of infants in Zambia and Lesotho, respectively
Human immunodeficiency virus (HIV)-exposed children—who comprise a large group of children overall in Southern Africa—have an increased risk of serious infections and mortality if they are not breastfed, especially in the first three months of life
Summary
Exclusive breastfeeding is widely understood to have a number of significant benefits for infant and child health, low- and middle-income countries continue to have low prevalence of exclusive breastfeeding rates [1]. In spite of huge gains made in pregnancy, labor, delivery and the early postpartum period by widespread ART usage, along with high reductions of mother-to-child transmission (MTCT)—close to 5% in some areas [3]—by 18 months of age, the cumulative incidence of HIV in infants can be between 10%–15% in Swaziland and other areas of the Southern African region [4] This high cumulative incidence of infection by 18 months of age can most likely be explained by low maternal adherence to ART under Prevention of Mother-to-Child Transmission (PMTCT) programs, along with a low percentage of women exclusively breastfeeding until six months of age. Especially in the context of Option B+
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