7.3.2  Replacement feeding and the AFASS criteria

Exclusive breastfeeding is NOT recommended for the babies of HIV-positive women, since the only way to protect the baby completely from HIV transmission from its mother is to feed it on formula milk. This is known as replacement feeding. However, many families cannot afford to buy milk formula to feed the baby, and bottle feeding may be socially unacceptable in some communities. With all these issues in mind the World Health Organisation (WHO) has set the following criteria (known as the AFASS criteria), which need to be met before counselling an HIV-positive mother to use formula milk:

  • Acceptable: Replacement feeding for breast milk is acceptable by the mother, the family and others who are close to the family.
  • Feasible: The mother has access to clean and safe water for cleaning the feeding bottles, teats, measuring cup and spoon, and diluting the formula milk if it comes as a powder.
  • Affordable: The family can afford to buy enough formula milk or animal milk to feed the baby adequately.
  • Sustainable: The mother is able to prepare feeds for the child as frequently as recommended and as the baby demands.
  • Safe: The formula milk should be safe and nutritious for the health of the baby.

The AFASS criteria are illustrated in Figure 7.4. When replacement feeding fulfils the AFASS criteria, avoidance of all breastfeeding by HIV-positive mothers is recommended.

A flowchart for determining AFASS.
Figure 7.4  The AFASS criteria help you to counsel HIV-positive mothers about feeding options for their newborns. (Source: Ethiopian Federal Ministry of Health, based on WHO, 2010, Guidelines on HIV and Infant Feeding)

7.3.1  Breast milk or formula?

7.3.3  Reducing the HIV risk from breastfeeding