I remember when HIV first hit the media more than two decades ago. The sense was that people afflicted with HIV would not survive for very long. The intervening years have proven that not to be the case (Hello, Magic Johnson!).

According to UNAIDS, there were more than 33 million people living with HIV worldwide in 2007, about 1.3 million of them in North America. People with HIV are surviving longer than expected, and they’re not just “surviving,” they are living: working, playing, loving, and yes, even having babies.

This has raised some new questions for both HIV-positive individuals and their health care providers, including this one: Should HIV-positive mothers breastfeed their babies? In many parts of the world, the answer is a resounding yes.

Now, just in time for World AIDS Day, the World Alliance for Breastfeeding Action (WABA) has issued a statement summarizing the relevant recommendations. Here’s what it boils down to:

• In places where replacement (formula) feeding has not been shown to be safe, HIV-positive mothers should exclusively breastfeed their babies for 6 months.
• They should continue breastfeeding into their babies’ 2^nd year of life.
• They should receive antiretroviral therapy (ART) not just during pregnancy and birth, but also while breastfeeding.

While it may seem that formula-feeding would be the better option for all HIV-positive mothers, this is most definitely not the case. Dr. Hoosen Coovadia has estimated the global risk of HIV infection of breastfed babies to be about 300,000 per year. However, he estimates the global risk of death for formula-fed babies to be about 1.5 million per year. In addition, the risk of HIV infection of breastfed babies could be reduced by as much as 75% if their HIV-positive mothers received ART.

The importance of this strategy cannot be overstated, as it improves the mothers’ health at the same time as reducing risks to their babies. And (contrary to what we in the run-down-to-the-corner-store-for-formula world may expect), the cost of ART would be no more than the cost of formula in the developing world.

As WABA notes, formula itself can pose risks. Contamination of powdered formula can occur “intrinsically from raw materials, during manufacture or from extrinsic sources,” such as impure water. Use of formula for babies of HIV-positive mothers has higher risks of malnutrition and infant mortality, and it takes funding away from treating the HIV-positive mothers.

More than twenty-five years after HIV was first diagnosed, it’s time for health care providers to re-think the recommendations they have typically made to the much broader population of HIV-positive people.

also on babygooroo

Amy looked at recent global recommendations.

And Becca considered a recent study about components of human milk that protect breastfed babies from HIV transmission.