As a Certified Breastfeeding Counselor, it’s important to stay informed on breastfeeding practices, including for people living with HIV. A policy change in May 2024 by the American Academy of Pediatrics (AAP) updated recommendations for parents with HIV. Parents with HIV can safely breastfeed their babies if they are consistently taking antiretroviral medications that effectively suppress the virus.

This marks a significant shift from previous guidelines, which had discouraged breastfeeding by parents with HIV in the U.S. since the 1980s.

HIV and Breastfeeding

According to Dr. Lisa Abuogi, a pediatric HIV expert and lead author of the new AAP report, modern antiretroviral therapy has advanced to the point where it can reduce the risk of HIV transmission through breast milk to less than 1%. This low risk, combined with the many health benefits breastfeeding provides to both mother and baby, supports an approach of shared decision-making between healthcare providers and parents with HIV.

Dr. Abuogi emphasized that while exclusive breastfeeding for the first six months is recommended to maintain this low risk, it’s important to counsel parents that only complete avoidance of breastfeeding entirely eliminates the possibility of transmission. However, switching between breastfeeding and formula feeding can increase transmission risk due to the impact on an infant’s gut microbiome.

Essentially, parents deserve accurate information to make informed decisions about breastfeeding.

HIV and Pregnancy, Birth, and Breastfeeding

Currently, around 5,000 people with HIV give birth in the U.S. each year, most of whom maintain low viral levels with medication. Without treatment, rates of mother-to-child transmission of HIV through breastfeeding were as high as 30% before antiretrovirals were widely accessible.

Thanks to these advances, the number of annual cases of HIV transmission to infants in the U.S. has dropped significantly.

The AAP’s updated policy is aligned with recent shifts in guidance from the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC). These agencies also support providing information and options for parents with consistent viral suppression and discourage involving child protective services in cases where parents with HIV choose to breastfeed.

Globally, the World Health Organization has recommended since 2010 that women with HIV breastfeed in regions without access to safe water, formula, or donor milk, as these babies face significant risks from malnutrition and infections. However, in resource-rich areas, the availability of safe alternatives led experts to recommend formula instead, causing frustration for some parents with HIV who wanted the option to breastfeed.

Parent Frustrations With Breastfeeding and HIV

Ci Ci Covin, a parent from Philadelphia who lives with HIV, shared her experience of being denied the option to breastfeed her first child due to older guidelines, leading to postpartum depression. With updated guidance and support from her healthcare team, she was able to breastfeed her second child safely while on medication, finding it a rewarding and empowering experience.

Dr. Abuogi notes that this policy update will be crucial for healthcare providers, including pediatricians, nurses, and lactation specialists, as they support parents in making informed decisions. The shift is also driven by the voices of parents with HIV who have long advocated for the ability to make this choice.

This expanded approach allows counselors and healthcare teams to support families more fully and compassionately, honoring each parent’s right to make the best decision for themselves and their child.