The first case of AIDS was reported 25 years ago. Today, nearly 40 million people are living with HIV—half of them women. It is estimated that breastfeeding accounts for up to half of all human immunodeficiency virus (HIV) infections in infants and carries an estimated transmission risk of about 15% when continued into the second year of life.

In countries where replacement feeding is safely available, culturally acceptable, and affordable, HIV-infected women are encouraged not to breastfeed. In many parts of the world, because breastfeeding provides protection against other causes of infant mortality, approaches that sustain breastfeeding but reduce mother-to-child transmission of HIV are being explored.

Strategies to prevent mother-to-child transmission currently being tested in clinical trials include exclusive breastfeeding for the infant’s first few months of life followed by rapid weaning, treatment of expressed milk to inactivate the virus, and antiretroviral prophylaxis taken by the infant and/or mother while breastfeeding. Clinical trials involving passive (antibodies) and active (vaccine) immunoprophylaxis will begin soon.

Until more data is available, UNICEF and other UN agencies continue to recommend the following:

• Exclusive breastfeeding for HIV-infected women for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe before that time. While such conditions are rare in much of the developing world, if they do exist, it is recommended that HIV-infected women avoid breastfeeding.

• If all untreated HIV-positive women breastfeed, most of their children – approximately 80 per cent - will not become infected with HIV through breastmilk. However, 5-20 per cent could become infected with the virus. There is a risk.

• Therefore, the most appropriate infant feeding option for an HIV-infected mother depends on her individual circumstances. She must have the information she needs to make an informed decision and all the services and support to help her implement that decision.

• If formula feeding is still not acceptable, feasible, affordable, sustainable and safe at the age of six months, continuation of breastfeeding with additional complementary foods is recommended along with regular assessment of both mother and baby. Breastfeeding should stop once a nutritionally adequate and safe diet without breastmilk can be provided.

• Breastfeeding mothers of infants and young children who are known to be HIV-infected should be strongly encouraged to continue breastfeeding.

• Whether the child is breastfed or formula-fed, health services should monitor all HIV-exposed infants and offer infant feeding counseling and support, particularly at key moments such as the diagnosis of the HIV status of the infant and at six months of age, when complementary feeding can begin.

• Governments and other stakeholders should promote and support breastfeeding in the wider community. They should offer active support to HIV-infected mothers who choose to exclusively breastfeed and take measures to make formula feeding safer for HIV-infected women who choose that option.

• National programs should provide all HIV-exposed infants and their mothers with a full package of health-related interventions, with strong links to HIV prevention, treatment and care services. Health services should make every effort to protect women who test negative for HIV after delivery from infection, particularly during breastfeeding.

• Governments and donors should greatly increase their commitment and ability to implement the Global Strategy for Infant and Young Child Feeding and the UN HIV and Infant Feeding Framework for Priority Action. Together these strategies seek to prevent post-natal HIV infections, improve overall child survival rates and move the world closer to achieving the health-related Millennium Development Goals.

• Knowing one’s HIV status is crucial to making choices about feeding, so voluntary and confidential testing is a priority. However, the most important means of preventing mother to child transmission is basic HIV education. Efforts to protect young mothers from infection are critical, and UNICEF supports a wide range of education programs at the local level to educate women and girls of the risks.