Can Women with HIV Breastfeed?

Curated by Claudia Shannon / Research Scientist / ishonest

Approximately 23 percent of people living with HIV in the United States are women. And according to a 2018 study, an estimated 5,000 women with HIV were expected to give birth that year.

As any parent can attest, after a baby is born, they’ll need to eat frequently. Because it’s possible to transmit HIV through certain bodily fluids, including breast milk, determining how best to feed their baby may be more complicated for mothers with HIV.

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While individual questions about the safety of breastfeeding should always be discussed with a doctor or other healthcare professional, we’ve gathered information from leading organizations about the general safety considerations of breastfeeding with HIV.

Is it safe to breastfeed with HIV?

Maybe. Recommendations around this issue are complex and differ depending on the organization you consult and your access to resources like clean water, formula, and healthcare.

If a person with HIV wishes to breastfeed, they should speak with their doctor for additional guidance about their personal safety and risks.

Factors to consider when deciding

A few things that may factor into the safety of breastfeeding with HIV include:

  • Antiretroviral therapy (ART). Mothers with HIV should be receiving antiretroviral therapy consistently throughout their pregnancy and while breastfeeding to reduce the possibility of transmission.
  • Maternal virus count. People with HIV who have undetectable viral loads may be able to breastfeed more safely.
  • Other available feeding resources. Access to affordable, clean water, formula, or donor milk will influence whether breastfeeding is the best option for a person living with HIV.

What do health organizations recommend?

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The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) both advise against breastfeeding for mothers with HIV.

This is because people in the United States largely have reliable access to clean water and affordable replacement infant feeding methods.

In countries with limited resources, the CDC recommends that mothers with HIV receive ART and breastfeed their babies exclusively for the first 6 months.

At that point, breastfeeding should continue with the addition of solid food until 12 months.

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La Leche League International, which offers local support groups for breastfeeding people across the globe, encourages those with HIV to seek out the most up-to-date recommendations based on the country in which they live.

In the United States, with consistent ART and monitoring, La Leche League encourages exclusive breastfeeding with support from lactation professionals for the first 6 months.

La Leche League also recommends 4 to 6 weeks of antiretroviral prophylaxis for the baby after birth. Additionally, the baby should be frequently tested for HIV at least 3 months after weaning.

In situations when breastfeeding is recommended, the WHO recommends exclusive breastfeeding for the first 6 months, and then continuing to breastfeed with the addition of solid foods for the remainder of the first year.

What are the alternatives?

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If a person with HIV does not wish to breastfeed their newborn or is advised against doing so, other feeding options may include donor milk and formula.

Lactating women with additional breast milk can donate it for other mothers to use with their infants. Donor milk banks will screen this milk for safety.

Donor milk can be costly, so some people accept extra breast milk from friends or relatives instead. Because this milk is not screened, it’s not generally advised to participate in these exchanges.

Many babies around the world are exclusively formula fed. Parents can choose from a wide range of formulas with varying ingredients. Formula can be fed through bottles, spoons, and syringes.

What are the risks of breastfeeding for infants of mothers with HIV?

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Because it’s possible for breast milk to transmit HIV, there’s a chance that a breastfeeding mother with HIV could transmit HIV to her infant. But receiving consistent ART and having an undetectable viral load helps reduce this risk.

The takeaway

For the approximately 5,000 women with HIV who give birth each year, there are many factors to consider when feeding their newborn.

Because one’s location can impact what style of infant feeding is recommended, it’s important to seek out recommendations and support from local healthcare professionals.

There’s no one clear answer about the safety of breastfeeding with HIV. People living with HIV should always speak with their healthcare team about the pros and cons involved if they wish to breastfeed.

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