Moving Closer to What Women Want?

A Review of Breastfeeding and Women Living With HIV in the UK and High-Income Countries

N Freeman-Romilly; F Nyatsanza; A Namiba; H Lyall


HIV Medicine. 2020;21(1):1-8. 

In This Article

Abstract and Introduction


HIV is transmissible through breastmilk.[1] If a woman living with HIV has an undetectable viral load, the risk of HIV infection for the breastfed child is much reduced but not eliminated.[2,3] Until recently, guidelines in high-income countries (HICs)[4] advised women living with HIV not to breastfeed, and only use formula milk or other infant feeding alternatives.[5,6] Despite this, a significant minority continued to breastfeed.[7–9] Recent evidence showed that the risk of HIV transmission through breastmilk is lower than previously thought.[10] This has facilitated a change in UK and US guidelines on postnatal feeding.[11,12] Now, certain women living with HIV in the UK and USA in certain circumstances, who wish to breastfeed, can be supported to do so by their clinicians.[11,12]

In this review, we will demonstrate reasons why the UK has moved to consider breastfeeding for some women living with HIV in the context of assessing current guidelines on the issue. We will outline, however, the persisting challenges to supporting breastfeeding when done by women living with HIV in the UK. We acknowledge the lack of research data on HIV transmission through breastmilk in HICs and suggest areas of future work. Despite this imperfect evidence base, however, HIV policy makers acknowledge that there is a need to provide realistic guidance now on how to support new mothers living with HIV and help protect infants from perinatal HIV transmission. Supporting women living with HIV to breastfeed goes beyond accounting only for what is clinically safest with respect to HIV transmission and incorporates the psychological and social needs of the mother and her child too. We will provide examples of patient information on 'safer breastfeeding' that can be used as part of this. Finally, we conclude that the updated guidelines and conditional support for women living with HIV in HICs who wish to breastfeed are an appropriate response to emerging data and an important step towards the normalization of HIV infection.