Pamela Morrison wrote:

<There is a problem with this statement: 
"Absolutely do not breastfeed your baby if: You are HIV-positive or have AIDS"

The AAP have set out very clear guidance on HIV 
and infant feeding which - while it makes a first 
recommendation for no breastfeeding, then goes on 
to recognize that some HIV+ mothers may wish to 
do so, and when that happens they should be 
supported to breastfeed in as safe a manner as 
possible. >

They also make it clear that they *do not recommend* that a mother does this, even with undetectable viral load, and that there is still a risk of transmission. Your phrasing here does seem a bit disingenous to me, in that (whether intentionally or otherwise) you seem to be implying that the AAP are OK'ing this as an approved second-line option. Read in context, it's clear that what they're actually talking about is how to handle the problem of a mother going ahead with this potentially risky option despite best medical advice, and that supporting them to breastfeed as safely as possible is a matter of damage limitation, lesser-of-two-evils situation. 

Yes, some HIV-positive mothers where formula is AFASS do insist on breastfeeding despite all medical advice to the contrary. In that situation, depending on whether the viral load is undetectable or not and on various other factors, supporting them to do so in as low-risk a way as possible may well be a less potentially harmful option for the child than removing child from mother via CPS (which, AFAICS, is the only other option if mum really is insistent). But that does *not* mean that it is a *recommended* option or that an official advice guide should be saying/implying that if mothers really want to do this then it's OK. 


Dr Sarah Vaughan, GP
GMC no. 4193096

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