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I want to breastfeed
Oct 20, 2003

It's my first time asking a question but I've been enjoying your educative seasons. I use the knowledge I get from here to educate members of our support group and also members of ther public during sensitisation meetings. I,ve heard of the risk involved in breasfeeding for positive mothers. Am intending to be a mother and I'll love to breastfeed. my VL is below 200 copies, could you tell me how to do this and the risk involved. Julie.

Response from Dr. Wohl

Dear Julie,

If you live in a part of our world where you have ready access to clean water and good nutrition, where your baby will not have to fend off dysentery, malaria and other parasites, then it becomes increasingly hard to defend breastfeeding.

Believe me, I understand the value of breastfeeding for both mother and child but that is under normal circumstances. Your being HIV+ and your baby being potentially infected by you is not normal. In general, breastfeeding accounts for about 15%-20% of HIV transmission from mother to child in areas where breastfeeding is practiced.

While it is likely that with lower viral loads the risk may be reduced, the threshold below which the viral load must fall for transmission to be impossible is not known. In the studies of prevention of mother to child transmission, there have been cases of perinatal infection even when the mom's viral load was low.

In addition, some HIV meds find their way to breast milk and the effect this has on babies is not completely clear.

As difficult as it is, I would recommend celebrating your baby being HIV negative and not breastfeed her in order to give her the best chance to stay that way. DW



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