Feeding Your Baby When HIV Positive
What moms living with HIV need to know
In the past, HIV positive moms were advised not to breastfeed. With further research into HIV/AIDS and the availability of antiretroviral therapy (ARTs), a medication that helps to protect the immune system and keep HIV in control, moms living with HIV now have the power to choose breastmilk or formula for their babies.
If you are taking ARTs, you now have the option to choose a feeding method that suits you and your baby . It can be an overwhelming and stressful choice, but with the right facts on hand, you can make an informed decision.
HIV and Breastfeeding
Let’s take a closer look at two important facts.
- Breastmilk is best for babies
Breastfeeding provides your baby with a healthy start. Breastmilk is nature’s perfect food, the best source of nutrition for a baby, and it’s available right on tap and at the right temperature. The nutritional composition of breastmilk provides exactly what your baby needs to grow and thrive. Breastmilk satisfies your baby’s thirst and hunger and the make-up of milk changes through the day and over time as your baby grows. It also contains antibodies that boost your baby’s developing immune system. Your antibodies, for the bacteria and viruses that have caused the diseases you had in the past or been vaccinated against, are passed to your baby.
- ARTs lower the risk of transmission
HIV is carried in four bodily fluids – blood, semen, vaginal fluids and breastmilk. This means that the virus can pass from your body to your baby during breastfeeding. If a person living with HIV has an undetected viral load (the amount of the virus in a person’s blood cannot be detected by tests), they cannot pass HIV on to a partner during sex (zero transmission rate). This is called ‘undetectable equals untransmissible’ or U=U. Researchers are still studying how much HIV is found in breastmilk as opposed to the bloodstream. As yet, researchers are hesitant to declare breastfeeding as zero risk with an undetectable viral load. However, they do know is that if a mother takes ARTs as prescribed while breastfeeding, the rate of transmission to her baby is very low.
Breastfeeding Advice
The World Health Organization (WHO) supports breastfeeding for mothers living with HIV and on ARTs. Their recommendation is exclusive breastfeeding for the first six months of the baby’s life. Solid foods (complementary feeding) can be introduced at six months and along with these foods, breastfeeding should continue until baby is at least 12 months of age. Exclusive breastfeeding means that no other foods or liquids are fed to the baby. Mixed feeding (combinations of breast and formula milk, other liquids and solid foods) can increase the risk of HIV transmission to the baby.
Here are some important guidelines to follow while breastfeeding.
- You must take your HIV treatment exactly as your doctor has prescribed. Do not stop taking your medication or skip doses.
- Don’t feed your baby any other liquids or foods other than breastmilk until six months of age.
- If your healthcare provider gives your baby HIV medication to take after the birth, remember to give the medication as prescribed.
- When nursing, ensure that your baby gets a good latch– how he or she takes the nipple into their mouth. This will help to prevent your nipples from becoming sore and cracked.
Some mothers living with HIV choose to flash-heat their breastmilk to kill bacteria and viruses in the milk. The method inactivates HIV while still retaining the milk’s nutritional value. Breastmilk is expressed and then heated in a glass jar to a high temperature and then cooled. If you choose this option, you will need to learn how to express your milk and the correct way to flash heat the breastmilk and cool it before feeding it to your baby in a bottle.
Formula Feeding
There is zero risk of HIV transmission if you choose to formula feed your baby. As part of the Prevention of Mother-to-Child Transmission of HIV (PMTCT), you qualify for 1.8kg of formula for your baby every month, until they are six months of age. If you haven’t yet had your baby and want to learn more about how to protect your baby during pregnancy, read our article, HIV and Protecting Your Unborn Baby, in this month’s e-newsletter.
Tips for Safe Bottle Feeding
- Purchase several bottles, teats and sterilising equipment, so you will always have a clean bottle on hand.
- Carefully prepare your baby’s bottle using cooled boiled water. To prepare your baby’s bottle, carefully follow the instructions on the back of the formula tin.
- Always test the temperature of the bottle by sprinkling a few droplets on the inside of your wrist. Cool the bottle down in a jug of cold water if it feels too hot on your skin.
- Keeping bottles clean and sterilised is essential to keeping your baby from getting sick. Pathogens like bacteria and viruses can cause your baby to start vomiting and develop diarrhoea. Sterilising feeding equipment can prevent this.
- Before sterilising the bottles and teats, you need to clean them in warm, soapy water to remove a build-up of residue milk on the inside of the bottle. Even bottles cleaned in a dishwasher must be sterilised after the cycle.
- Sterilise equipment in bottle sterilising liquid (Milton) in cold water. You can also use a microwave or stovetop. To sterilise feeding equipment without a sterilising liquid, bring a pot of water to the boil on a stove plate and place the washed bottles into the water. Keep at a running boil (bubbling) for five minutes. Remove and allow to dry.
With the right support and advice, you can make the best choice for yourself and your baby. If you are still unsure, contact your midwife or healthcare provider for more information and counselling.
Your healthcare provider is there to support you. Contact them should you have any further questions or concerns.
Resources: https://www.who.int/; https://www.llli.org/; https://childrenandaids.org/; https://www.childrenandaids.org/; https://www.thewellproject.org/; https://www.avert.org/ https://milkmatters.org/; https://www.cdc.gov/; https://www.aidsmap.com/; https://www.eatsonfeetsresources.org/; https://www.bhiva.org/
