March 10th is the national observance of National Women and Girls HIV/AIDS Awareness Day, an annual campaign that brings together organizations at every level to highlight pathways to prevention, long-term management, and support for women and girls in the United States. This year marks the 18th annual observance NWGHAAD, and the theme for 2023 is Prevention and Testing at Every Age, Care and Treatment at Every Stage.

While the world has made immense public health progress towards eliminating HIV and AIDS, the risk of contracting HIV and AIDS still requires the attention of community to reduce stigma, remove barriers to care, and encourage regular testing and supportive conversation. In support of this national observance, the National Association of County and City Health Officials (NACCHO)’s Maternal, Child, and Adolescent Health (MCAH) Team and the HIV, STI, Viral Hepatitis, and Harm Reduction (HSHH) Team are partnering to share more information about infant feeding practices for those living with HIV/AIDS.

Chest/breastfeeding is one of the most effective ways to nourish the body and health of infants; and several studies document positive health benefits for both the infant and the parent. Benefits for the chest/breastfeeding parent include lowering the risk for chronic diseases, including breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, Type 2 Diabetes, and more. For the infant, human milk has a unique combination of minerals, vitamins, antioxidants, fats, and sugars that offer optimal nutrition tailored to the infant. Even more, chest/breastfeeding reduces an infant’s risk of respiratory infections, eczema, obesity, orthodontic problems, and other chronic diseases and illnesses into childhood and adulthood.

For those living with HIV/AIDS, there is an opportunity to participate in chest/breastfeeding a child without HIV transmission via breastmilk. Chest/breastfeeding parents who are on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy have a breastfeeding transmission risk of less than 1%.

The Centers for Disease Control and Prevention (CDC) has published updated recommendations and information on infant feeding for people living with HIV on the CDC Human Immunodeficiency Virus (HIV) and Contraindications web pages. These recommendations are based on the Department of Health and Human Services’ (HHS) Infant Feeding for Individuals with HIV in the United States, as a part of the Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. Some important highlights from the CDC’s updated guidance are below:

• Chest/breastfeeding parents who choose to breastfeed should receive patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making.
• Counseling should begin prior to conception or as early in the pregnancy as possible, and chest/breastfeeding options should be evaluated throughout the pregnancy and after delivery.
• Providers should counsel chest/breastfeeding parents on the importance of adherence to ART and sustained viral suppression. Providers should address challenges to ART adherence during the postpartum period.
• Replacement feeding with properly prepared formula and/or pasteurized donor human milk from a human bank eliminates the risk of postnatal HIV transmission to an infant.

References

1. Building brains. 1,000 Days. (2022). Retrieved from https://thousanddays.org/why-1...
2. U.S. Department of Agriculture (USDA), Dietary Guidelines for Americans 2020-20251–164 (2020). Retrieved from Dietary Guidelines for Americans, 2020-2025
3. “Breastfeeding Benefits Both Baby and Mom.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 July 2021, https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html.