This post is cross-posted from GetSFcba.
Perinatal HIV transmissions have dramatically declined in the U.S. and a framework for the elimination of perinatal HIV has been proposed by the Centers for Disease Control and Prevention (CDC). This public health success and the subsequent ambitious goal of further decreasing the number of infants born with HIV, is made possible through advances in science followed by rapid implementation by perinatal HIV stakeholders. Key interventions in the perinatal HIV prevention cascade include:
- Routine prenatal HIV testing
- Antiretroviral treatment for pregnant women living with HIV
- Antiretroviral post-exposure prophylaxis (PEP) for infants exposed to HIV
- Infant replacement feeding
For many women living with HIV, learning about the recommendation against breastfeeding is a challenging part of adjusting to her HIV diagnosis and/or her pregnancy. Some women describe a grieving process around letting go of a dream or a family tradition of breastfeeding. As women living with HIV seek information online regarding HIV and breastfeeding, the websites and articles become confusing given the differing recommendations on infant feeding based on the availability of clean water and formula. With the WHO recommendation to exclusively breastfeed in the resource-limited setting, some women question why this is not a possibility for those in the U.S.
It is not uncommon for a pregnant woman living with HIV to have disclosed her HIV status to one or a few individuals but not all of her family members or community. In many cultures, not breastfeeding is essentially a HIV disclosure. Fear and stigma around her HIV disclosure can be a key factor in a woman’s consideration of breastfeeding. A woman’s fear of stigma from her provider for considering breastfeeding or for not disclosing can keep her from discussing this often paralyzing situation in advance.
Following discussions amongst women’s health experts and perinatal HIV providers, we explored a harm reduction model for broaching this difficult conversation with a goal to optimally engage women in care, particularly following delivery. A thoughtful reply from Canadian perinatal providers broadened the conversation and dialogue. We developed patient materials supporting women in bonding with their infant without breastfeeding as well as a review of their infant feeding options.
We’ll talk more in length about what the harm-reduction model entails and the options women living with HIV in the U.S. and Canada have when it comes to infant feeding. Join us on July 9, 2015 for a webinar during which perinatal and women’s health experts from the U.S. and Canada delve deeper into this topic.