Illustration: Petra Röhr-Rouendaal, Where there is no artist (second edition)

Breast milk is the perfect food for babies. It provides important nutrients and strengthens their immune system. Breastfeeding helps to protect babies from malnutrition and diseases such as diarrhoea and pneumonia, which can be fatal.

Unfortunately, there is a risk that HIV can be passed from mother to child during breastfeeding. However, with the right actions, that risk can be lowered to less than five per cent.

Should women living with HIV breastfeed?

The decision about whether or not HIV-positive mothers should breastfeed their babies is a complicated one. According to the World Health Organization (WHO), a country’s health authorities should decide whether to advise women living with HIV to breastfeed or not.

The health authorities will make this decision based on the local situation, considering factors such as the main health risks in that region. For example, some areas do not have a good supply of clean water and reliable sanitation, meaning the risk of diarrhoea is high. In these regions, it might be more dangerous for the baby’s health if it is not breastfed by its HIV-positive mother.

There are only two options the authorities should decide between:

Mothers living with HIV should not breastfeed at all, but use other sources of nutrition for the baby (known as ‘replacement feeding’).

Mothers living with HIV should exclusively breastfeed their baby for the first six months (see box). The mothers should receive antiretroviral therapy (ART) and the baby should be given ARV medication.

The option that is never recommended for HIV-positive mothers during the first six months after birth is ‘mixed feeding’. This is using a combination of breastfeeding and other types of food and drink. Other food and drink (such as porridge, cows’ or goats’ milk, or even water) can damage the lining of the baby’s digestive system during this period, making it easier for HIV from breast milk to infect the baby.

You can ask your health worker for more information about whether breastfeeding is advised for women living with HIV in your region.

How to reduce the risks

ART for mothers

All women living with HIV should receive ART during their pregnancy and while they are breastfeeding. This greatly lowers the risk of the mother passing HIV on to her baby. It is very important that the mother takes her ART regularly, exactly as prescribed by the doctor.

Countries have different policies about how long they will continue providing ART for mothers living with HIV.

  • Some countries will provide the mother with ART for the rest of her life.
  • Other countries will supply the mother with ART until one week after she stops breastfeeding. They will then only continue to provide ART if HIV has damaged her health to a certain level.

ARV medication for babies

  • If a mother living with HIV is breastfeeding her HIV-negative baby, the baby should be given ARV medication for the first six weeks.
  • If an HIV-positive mother is not breastfeeding, the baby should still be given ARV medication for four to six weeks after birth. (If at any point, after testing, the baby is found to be HIV-positive, it should start on ART immediately.)  

Breastfeeding advice for women living with HIV

The following advice applies only in countries and regions where the health authorities recommend breastfeeding to women living with HIV.

Exclusive breastfeeding for six months

For the first six months after birth, the baby should only be fed with breast milk. It should not be given any other types of food or drink.

From six months onwards

  • After the first six months, the mother can start giving the baby other food and drink as well as breast milk.
  • The mother should carry on breastfeeding until the baby is 12 months old. She should only stop breastfeeding when the baby can get enough food and nutrition without breast milk. 

This article is based on the World Health Organization’s Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, 2013.

This article is accurate at the time of printing in August 2015. However, advice on breastfeeding can change over time, so please check with your health worker to make sure that the information in this article is still correct.