Written by Dietician: Azza Motara
Every mother seeks to provide the best for their child in every aspect of their lives. Mothers infected with HIV are faced with the important decision of how they will feed their new-born babies. It is generally known that breast milk is the best milk for every infant. Whilst this holds true, it poses a challenge to HIV-infected mothers because their breast milk, which contains the HI virus, is capable of infecting their babies. Guidelines in the past have therefore discouraged these mothers from breastfeeding and encouraged them to only formula feed (exclusive formula feeding). This is still an option for mothers provided that they are able to afford the resources to prepare formula safely and in a manner that is suitable.
Unfortunately for many mothers in South Africa, poverty and compromised living conditions mean that they have little or no access to clean, running water. Coupled with this they are also unable to afford formula, making formula feeding a dangerous choice if they are forced to do so. Formula prepared incorrectly or in an unhygienic manner is the cause of numerous infant deaths annually.
For the majority of these mothers breastfeeding their babies exclusively i.e. providing only breast milk and nothing else, for the first 6 months proves the healthiest option. Exclusive breastfeeding is proven to reduce the incidence of diarrhoea and many other illnesses in all infants. Furthermore, when an HIV positive mother gives her baby only breast milk, it maintains the gut integrity and therefore greatly reduces any chance of the virus entering the infant’s body (through feeding). If an HIV positive mother provides breast milk and formula milk or other foods in the first 6 months (mixed feeding) the non-breast milk substances reduces the gut integrity and makes it possible for the virus to gain passage into the infant’s body. Mixed feeding is therefore strongly discouraged.
When an HIV positive mother opts to exclusively breastfeed, the mother and/or infant is provided with treatment (ARVs) for the duration of breastfeeding, which further reduce the infant’s risk of becoming HIV infected. It is encouraged that these infants continue to be breastfed after 6 months, at which stage foods are introduced and only stopped when the mother can provide a nutritionally safe substitute such as cow’s milk (suitable from 1-year).
Mothers that are HIV infected face the challenge, in an often discriminatory society, of caring not only for themselves but also for their infants. An important goal is ensuring that babies born to HIV positive mothers stay not only HIV negative but are also healthy and thriving. A mother should seek appropriate treatment sooner rather than later and counselled on the infant feeding choices available to her. Counselling and support for these mothers during their pregnancies and after the birth of their babies is crucial in ensuring that both mothers and their babies stay healthy and happy.