Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV

Abstract

Background. The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. Methods. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Results. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Conclusion. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany

“…13,14,17,23 Although breastfeeding poses the possible risk of VT, it concurrently offers maternal health benefits, including superior uterus involution, reduced risk of depression, obesity, cancer, or diabetes. 7,13,18,24…”

“…13,14,17,23 Although breastfeeding poses the possible risk of VT, it concurrently offers maternal health benefits, including superior uterus involution, reduced risk of depression, obesity, cancer, or diabetes. 7,13,18,24 Although the results from 30 mother-child pairs are underpowered to assess the VT risk through breastfeeding in high-income countries, the real-life experience is encouraging. According to studies conducted in low-income countries with high HIV prevalence, VT through breastfeeding under regular cART is dependent on nursing period and estimated below 1% 25 : The IMPAACT PROMISE trial assessed VT risk at 0.3%, 0.6%, or 0.7% after 6, 9, or 12 months of breastfeeding with maternal cART.…”

Stakeholder engagement is essential to maximise the impact of research on infant feeding in the context of HIV

“…Moreover, infant feeding decisions are far from a binary choice made at one point in time; rather they are highly contingent and dynamic, with parents revisiting their decision countless times over the course of new babyhood. [13][14][15][16] Addressing the complex, multidimensional landscape within which infant feeding decisions are located involves new ways of researching. We call for the increased adoption of participatory approaches within HIV research, in order to develop evidence that is practicable and grounded in the reality of people's lived experiences.…”

“…Moreover, infant feeding decisions are far from a binary choice made at one point in time; rather they are highly contingent and dynamic, with parents revisiting their decision countless times over the course of new babyhood. 13–16…”

“…These include maintaining discretion about HIV status through maternity and postpartum; managing divergent messaging from HCPs versus family and friends; confusion arising from discrepant local and global guidance; the financial cost of formula feeding; and grief around the loss of breastfeeding experience. 12–16 All of this is experienced within the context of the unrelenting physical and mental pressures that come with growing, birthing and caring for an infant. In the United Kingdom, over 70% of women living with HIV reported to be pregnant are of Black African ethnicity; they may experience additional intersectional disadvantages as a result of racially minoritised status, such as language barriers, cultural expectations, immigration issues and financial insecurity.…”