Abstract

PIP: The finding that HIV-1 is transmissible through breastfeeding has complicated advice for infant feeding in some settings in many countries. Breastmilk, however, is the main source of nutrition for most infants worldwide, and it should continue to be promoted due to its many advantages for both infants and mothers in all environments. In developing countries, breastfeeding promotes child survival and maternal health through child spacing and the prevention of infant mortality from gastrointestinal and respiratory infections. Modeling suggests that a shift to artificial feeding in response to HIV infection in poorer countries would increase child mortality. It is less clear what course should be recommended in intermediate developing countries where the prevalence of HIV-1 is on the rise. Policy based upon local information needs to be developed as soon as possible. It should be understood in the interim that selective advice not to breastfeed should only be given where artificial feeding is affordable, its associated risks can be minimized, and within the context of strong national feeding programs which promote and protect breastfeeding. The authors describe the contribution of breastfeeding to child and maternal health, requirements for minimizing the risks associated with artificial feeding, and recent knowledge relating to the trends and determinants of feeding practices. Evidence for breastfeeding transmission is discussed together with the impact of feeding practices and HIV-1 infection through breastfeeding on child mortality. Current policy on antenatal HIV testing and counseling is considered along with future policy options for feeding and testing. Finally, research needs for public health purposes are suggested.