The Well Project commends recent updates made by the American Academy of Pediatrics (AAP) to their guidance on recommended infant feeding practices, Infant Feeding for Persons Living with and at Risk for HIV in the United States: Clinical Report. These updates, which reverse prior guidance, instruct pediatric care providers to offer a "family-centered, nonjudgmental, harm reduction approach" to support people living with HIV who want to breast/chestfeed and are virally suppressed on antiretroviral therapy. AAP guidelines are used by pediatricians, nurses, and lactation specialists who work directly with children and families.
The updates to AAP's guidelines follow 2023 updates to the Infant Feeding for Individuals with HIV in the United States section in the Perinatal HIV Clinical Guidelines, issued by the US Department of Health and Human Services (HHS), which provide information for healthcare providers to engage with women and other birthing parents living with HIV about decisions related to pregnancy and infant feeding. Both these updates reflect the evidence-based understanding that when mothers are virally suppressed, the rate of HIV transmission through breastfeeding is less than 1 percent. Guidance in the US is now consistent with guidelines in many parts of the world that have long supported breast/chestfeeding among women living with HIV who are taking effective HIV treatment.
Collectively, these guideline updates have the potential to dramatically alter the experiences of women and other birthing parents living with HIV in the US, who historically have been told they could not breast/chestfeed and too often have been threatened with legal action (child protective services) for even expressing interest in doing so. Both guidelines discourage engagement with child protective services in response to a parent living with HIV expressing interest in breast/chestfeeding. Both documents also highlight the short- and long-term health benefits of breastfeeding to mother and child.
"For many years, we at The Well Project have collaborated with a wide range of stakeholders to ensure that women living with HIV can make the best infant-feeding choices for their families, and we applaud the pediatric care professionals who made these updated recommendations possible," said Krista Martel, executive director of The Well Project. "These updates, which recognize the complex nature of infant-feeding conversations, have the potential to meaningfully improve the care and decision-making processes of women and other parents living with HIV, as well as the health of their babies."
The Well Project's senior manager of community programming, Ciarra "Ci Ci" Covin, who was featured in an Associated Press (AP) article about updates to the guidelines, has publicly shared her frustration after being told she could not breastfeed her first child and her success nursing her second. "I couldn't understand how come my sister that lives in a place like Kenya, who looks just like me with the same color brown skin, was given the option to breastfeed and how my option was starkly 'no,'" she said. "Breast milk has everything in it that my baby would need. That's a beautiful thing."
Resources
- View the full update, Infant Feeding for Persons Living with and at Risk for HIV in the United States: Clinical Report, in AAP's journal, Pediatrics
- Access the 2023 HHS guidelines update of Infant Feeding for Individuals with HIV in the United States
- Read the AP story "US pediatricians reverse decades-old advice against HIV-positive mothers breastfeeding" about this policy change
- Check out The Well Project's latest educational resources and tools on infant feeding and HIV
- View a compilation of all The Well Project's work on breast/chestfeeding and HIV since 2018
- Email The Well Project's editorial director to join the HIV and Infant Feeding discussion listserv
