11.6  Feeding recommendations when a mother is HIV-positive

As you read earlier, breastfeeding has unsurpassed advantages over any other form of infant feeding. In resource-limited countries such as Ethiopia, breastfeeding is a key component of child survival interventions. Infant mortality is higher in settings where infants are not breastfed or breastfeed for a short time only (that is, less than six months).

Exclusive breastfeeding is the safest option for infants born to mothers who are HIV positive.

Although breastfeeding by an HIV-positive mother can transmit the virus to the infant, replacement feeding, if not instituted properly, is actually associated with increased risk of morbidity and mortality at a young age in low resource settings like Ethiopia. Exclusive breastfeeding (EBF) during the first six months of life is associated with decreased transmission of HIV and improved child survival compared with non-exclusive breastfeeding. Because of high infant mortality rates in Ethiopia, EBF for as long as possible up to six months is recommended as the only feasible and the safest option for infant feeding amongst HIV-infected women. At six months, complementary foods should be introduced in order to sustain normal growth. Most Ethiopian children will continue to benefit from breastfeeding until 12‒18 months of age. Universal access to antenatal and postnatal prevention of mother-to-child HIV transmission (PMTCT) services and prioritising antiretroviral therapy for eligible pregnant and lactating women is an important part of decreasing perinatal transmission of HIV.

The primary goals of infant feeding counselling and support are:

  • Improve child survival by actively supporting exclusive breastfeeding for the first six months of life.
  • Decrease HIV transmission via breastfeeding by treating pregnant and lactating HIV-infected women with low CD4 and advanced HIV disease.
  • Provide antiretroviral prophylaxis to the mother or the infant to decrease HIV transmission.

CD4 refers to the type of white blood cells destroyed by HIV.

When the infant reaches six months, you should advise the mother to add complementary feeding in addition to the breastfeeding until the child reaches 12‒18 months. For examples of complementary foods, you can look back at the feeding recommendation in Section 11.3. Breastfeeding should stop only when a nutritionally adequate diet without breastmilk can be provided. This is usually around 12‒18 months of age. Infants who are known to be HIV-infected should continue to breastfeed according to recommendations for the general population.

  • What feeding advice will you give for an infant born from an HIV-positive mother if the infant is under six months old?

  • For infants under six months old you would advise the mother that she should breastfeed exclusively (only breastfeeding, not even water). If she or someone else in the family adds other foods or fluids this is known as mixed feeding, which will increase the chance of HIV transmission. For infants who are six months and above you would talk to the mother about complementary feeding and advise her that she should also continue breastfeeding.

11.5  Recommendations for children aged two years and older

11.7  Assess the child’s feeding