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Guide to HIV, Pregnancy and Women's Health: Feeding Your Baby

By Polly Clayden

March 2013

There is a risk of transmitting HIV from mother-to-baby via breast milk.

HIV positive mothers living in well- resourced countries can easily avoid this by using bottles and infant formula milk.

How does the cost of formula milk for a year compare to the cost of HIV treatment for life?

As an HIV positive mother, I would never put my baby at even the slightest risk of contracting HIV through my breast milk as I live in the UK where I can access clean water and formula milk.

-- Mem, London


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Bottle-Feeding and Free Formula Milk

Avoiding breastfeeding is currently strongly recommended for all HIV positive mothers in the UK, regardless of their CD4, viral load or treatment.

After doing all the right things during pregnancy and delivery, you will not want to risk your baby's health now by breastfeeding.

Mother to child transmission of HIV is now very low in the UK. Alongside using antiretrovirals in pregnancy and a carefully managed delivery, exclusive feeing with infant formula milk has contributed to our excellent low rates.

All HIV positive mothers in the UK should be supported to formula feed their babies. This mean that, if you cannot afford the formula, bottles and sterilising equipment, these should be provided by your hospital so that you do not need to breastfeed. Schemes vary from clinic to clinic.

Your midwife should discuss whether you need this extra support as part of your discharge package when you leave the hospital with your baby.

Medical treatment and provision of formula milk will be in confidence. Please make sure that you take advantage of this if you need to.


Can I Breastfeed Occasionally?

It is very strongly recommended that you do not breastfeed occasionally.

In fact, several studies showed that "mixed feeding" may carry an even
higher transmission risk than if you breastfeed exclusively.


Sometimes People Ask Me Why I Do Not Breastfeed

Sometimes mothers can be worried that being seen to be bottle-feeding will identify them as HIV positive.

It is up to you whether or not you tell anyone that you are HIV positive.

If you do not wish to tell anyone that you are breastfeeding because you are positive, your doctor or midwife can help you with reasons to explain why you are bottle feeding.

For example, you can say you have cracked nipples or that the milk didn't come, both of which are common.

You are NOT a bad mother if you do not breastfeed.


Breastfeeding

The World Health Organisation (WHO) infant feeding guidelines for women in countries were replacement feeding is not safe or available recommend that breastfeeding is safer if the mother or the baby receives antiretrovirals.

BHIVA and the Children's HIV Association (CHIVA) recommend the complete avoidance of breast feeding for HIV positive mothers, regardless of whether the mother is healthy, has an undetectable viral load or on treatment.

The BHIVA/CHIVA position statement on infant feeding in the UK can be accessed here.

Many community groups in the UK (including i-Base, Positively UK and the UKCAB) also recommend complete avoidance of breastfeeding for HIV positive mothers.

Further reading: www.positivelyuk.org/policy.php.


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