An Overview of Infant Feeding Options for Parents
Living with HIV
Last updated: August 18, 2025
Together, we can change the course of the HIV epidemic…one woman at a time.
Breastfeeding while taking HIV drugs:
• Standard of care for women and other parents living with HIV in resource -limited areas globally
• Shown to increase survival and well- being of their babies
• Likelihood of HIV transmission is low
• High-resource settings – Until recently, guidelines have discouraged breastfeeding among women living with HIV
• Information on breast/chestfeeding confusing – Nursing, body feeding, chestfeeding: more inclusive terms than breastfeeding
Chestfeeding, and HIV
2023: Significant change to US Perinatal HIV Clinical
Guidelines:
• Reflect current knowledge about low likelihood of HIV transmission through breast milk
• Discuss benefits of breast/chestfeeding
• Encourage informed, shared infant-feeding decisionmaking between provider and patient
Previous guidelines had started to acknowledge breast/chestfeeding desire among some parents living with HIV in high- resource countries
Informed Infant Feeding Decision-Making
• Emotional, cultural, family, and health reasons for considering breast/chestfeeding
• Many reasons why parents may choose a method other than breast/chestfeeding
• Having information about a range of options can prepare you for conversations with your provider; support you in making an informed decision
Breastfeeding as Safely as Possible
• Take your HIV drugs exactly as prescribed (adherence)
– Keeps amount of virus in your blood low
• Makes it far less likely that your baby will acquire HIV
– Additional viral load tests may be run while breastfeeding
• Make sure your infant gets their HIV drug doses
– Additional drugs and testing may be prescribed for the baby
• Do your best to breastfeed exclusively for 6 months
• Take good care of your breasts
– Regular feedings to prevent mastitis
– Warm washcloth on breast to prevent engorged breasts
– Try different positions for proper latching to prevent cracked nipples
Breastfeeding as Safely as Possible
• Find people who will help you manage stressors
– Taking care of an infant, healing your own body after birth, breastfeeding, dealing with your HIV
• Seek help if you feel very sad after having a baby
– “Postpartum blues”
– Postpartum depression (if sadness is severe)
• Ask knowledgeable people or professionals for advice on any breastfeeding challenges
– Cracked or sore nipples
– Baby has difficulty nursing
• Take good care of your own health
– Enough healthy food, clean water to drink, rest
Other Options for Infant Feeding
Infant Formula
• Cow's (or goat or soy) milk modified to be similar to human milk
• Has no antibodies or protective effects of breast milk
• Available as a powder or liquid
– Must be mixed with clean water (not available everywhere)
– Liquid must be refrigerated
• Usually not free
– Formula shortages possible even in US
• Guarantees zero risk of HIV transmission
Milk Bank
Other Options for Infant Feeding
• Women who produce more breast milk than they need may donate extra
– Potential donors are screened and take blood tests before donating their milk
– Milk bank gives that milk (often for a cost) to babies who cannot be breastfed
• Milk banks may not always have enough to give away
• Antibodies may differ among donors
– Baby may not get as much of a specific antibody as they would if always fed by the same woman
Other Options for Infant Feeding
Wet Nurse or Cross-Feeding
• Arranging for another woman to breastfeed your baby (paid or informal via a friend)
• Wet nurses were once common
• Depends on a woman producing more breast milk than she needs
• Woman providing milk must be near your baby and available whenever baby must be fed
• Woman would need to be screened for HIV, other health conditions that affect breastfeeding
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Other Options for Infant Feeding
Flash Heating
• Express your own breast milk, then quickly heat to destroy germs or viruses
• Process also destroys some other components of milk that are healthy for baby
• Developed for people in resource-limited countries who do not have access to any other options listed
• Extremely time-consuming process
What Choice Should I Make?
You are the only person who should decide how your baby will be fed
• If you choose to breastfeed, it is important to:
– Keep up with healthcare exactly as prescribed and recommended by your provider
– Find a support network and a provider whom you trust, who can be good sources of information without judgment
• Making this decision can be challenging
• You may feel fear, stress, or even some sadness over any choice you are considering
What Choice Should I Make?
Take care of yourself during this process
May be helpful to:
• Connect with groups of women or others who can offer support
• Write about your thoughts and concerns
• Engage in some other activity that helps you feel supported
• To learn more, and for links to articles featuring more details, please read the full fact sheet: – Overview of Infant Feeding Options for Parents Living with HIV • For more fact sheets and to connect to our community of women living with HIV, visit: ‒ www.thewellproject.org ‒ @thewellprojecthiv.bsky.social ‒ www.facebook.com/thewellproject ‒ www.instagram.com/thewellprojecthiv/ ‒ www.threads.net/@thewellprojecthiv ‒ www.youtube.com/thewellprojecthiv www.thewellproject.org