To breastfeed or not breastfeed when you have HIV, what are the choices?

Choosing whether to breastfeed/chestfeed (some people prefer the terms chestfeed and chestfeeding) or bottle feed your new baby can sometimes feel like a complicated decision if you are living with HIV. It’s important to know your choices, as it’s often reported that people living with HIV feel pressured by medical professionals to not breastfeed. You may also feel like you are not ‘a good mother’ if you don’t breastfeed or face questions from friends and family who do not know your status.

This National Breastfeeding Week, we share the latest on what you need to know about your choices around breastfeeding when you are living with HIV.

What does the science say?

If you are living with HIV the usual advice that you will get is to not breastfeed and use formula milk instead to feed your baby. This is because there is a small chance that HIV can be passed on in breast milk, especially if your nipples become cracked and bleed or if you get mastitis. However, if you want to breastfeed your baby you can get help and support by talking with your HIV doctors and paediatric team. They can advise you about the precautions to use like always taking your treatment and checking your nipples for cracks and bleeding. In this way you can lessen and manage the risk of transmission through breastfeeding.

In some other countries, women living with HIV are advised to breastfeed their children as the risk of using contaminated water is greater than that of passing on HIV. While this advice makes sense in those countries, you will probably be getting different advice in the UK.

If you are choosing to breastfeed, then you will be advised to do so for the first six months only and then transition over to formula before weaning your baby onto other foods. For these six months, you and your baby will be asked to come in for monthly check-ups. It’s very likely that you'll be advised to do what is called ‘exclusive breastfeeding’, only feeding the baby breast milk and not adding anything else into their diet like other milks (cow or soy for example) or other foods.

There is new guidance that says that in certain situations, breastfeeding alongside some use of water-based drinks like formula can be done.

These situations are:

• When you are starting to breastfeed, when the most important benefits for the baby are in the first few weeks of life. If the baby needs an occasional formula feed to help them start breastfeeding, then this is acceptable.

• When you switch from breast milk to formula. It’s advised that you breastfeed for as short a time as possible, usually less than 6 months (although again this is your choice) and the change from breast milk to formula is made as quickly as possible. To help this you can use expressed breast milk from early on to help the baby become used to sucking from a bottle as well as the nipple. This also allows the other parent the chance to feed and bond with the baby.

• If you get mastitis, it is recommended that you express and discard breast milk and use formula milk only until the symptoms of the mastitis are gone. You may be able to start breastfeeding again after the mastitis has fully cleared, but this has to be considered on a case-by-case basis with the advice of a healthcare professional experienced in HIV care.

• If the baby has gastroenteritis (an upset tummy) it’s advised to move to formula feeding and that breastfeeding is not started again when the baby’s symptoms have cleared.

• If you have gastroenteritis the recommendations are the same as mastitis.

What support could I get?

It’s important to know that if you choose to feed your baby with formula, it doesn’t make you a ‘bad mother’ or ‘bad parent’, you have made a choice for yourself and your baby based on what is right for your specific circumstances.

Peer support can be really important to help navigate challenges like this and to help you decide what is the right option for you. 4M Network is a peer support organisation specifically for mothers living with HIV.

Also, the formula should be given to you for free for as long as you are feeding your baby with it, ask your paediatric clinicians or talk with 4M Network if there are problems with this in your area and they will be able to help. Many food banks and organisations like The Food Chain will help supply you with the formula.

You may want to get additional advice and support from:

National Breastfeeding Helpline: 0300 100 0212

National Childbirth Trust: 0300 330 0700

Check out NAM Aidsmap’s ten safer breastfeeding rules.

Can I take PrEP if I’m breastfeeding?

PrEP is a drug taken by HIV-negative people to stop them from getting HIV. If you’re taking PrEP, it is safe to continue to take it whilst breastfeeding. Very small amounts of the drug do pass through the breast milk, but in such small amounts, it is unlikely to cause any side effects for the baby. However, it’s been reported that a very small number of babies have had mild diarrhoea.

I have a sexually transmitted infection (STI). Should I still breastfeed?

Most antibiotics used to treat STIs are safe during breastfeeding. It’s best to let your doctor or nurse who is prescribing your drugs know that you are breastfeeding.

If you have been diagnosed with trichomonas and are breastfeeding, you will be given the antibiotic metronidazole. You may need to wait 12 to 24 hours after taking the drug to resume breastfeeding.

If you have or are being treated for syphilis or herpes, you can breastfeed as long as your baby or any pumping equipment does not touch a sore. If you have sores on your breasts, pump or hand express your milk until the sores heal.

If you have chlamydia, gonorrhoea or HPV (warts) you can breastfeed your baby as these STIs are not passed on in breast milk. It is also safe to breastfeed if you have hepatitis A, B or C.

Hopefully, that answers some of the questions that can be missed when talking about breastfeeding. Happy Breastfeeding Week, and breastfeeding support for all!

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