Breastfeeding in Mothers Living with HIV: What Do UN Agencies Say?

One of the many advantages of living in 2026 is advances in medicine. Thanks to the hard work of medical researchers, the risk of HIV transmission from an infected mother to her child has been reduced to almost %0. Of course, the mother should undergo different treatments (like antiretroviral therapy) and make wise decisions about feeding her baby.

It is interesting to know that geographical limitations, access to medical services, economic conditions, and public health policies can affect the decision of HIV mothers and their doctors about the feeding type. For example, in Iran, you will see a totally different approach towards the feeding of exposed children.

In this article by Raadina Health, we explain the challenges of breastfeeding, how to reduce the risk of HIV transmission to infants, what the UN agencies say about breastfeeding in mothers living with HIV, and more.

Can a Baby Get HIV Through Breastfeeding?

Yes, the baby can get HIV through breast milk. The risk of mother-to-child transmission via breastfeeding is around %14, which is a bit higher than the risk of transmission through pregnancy and delivery.

Of course, the exact risk of transmission cannot be calculated because situations vary. Still, researchers and specialists all agree on one thing: antiretroviral therapy (ART) can significantly reduce the risk of transmission. In other words, when the mother’s viral load is controlled by medications, the virus cannot transfer to the baby’s body through breast milk. 

How to Reduce the Risk of HIV Transmission During Breastfeeding?

Here are several strategies that can reduce the risk of transmitting HIV during breastfeeding:

• Using antiretroviral therapy: Antiviral medications suppress the virus and lower its count. When the virus is undetectable in a blood test, it means that it cannot affect the baby.
• Avoiding breastfeeding: If the mother doesn’t receive ART, she should avoid breastfeeding 
• Relying only on the breast milk: The parents can lower the transmission risk by relying only on the breast milk for the first six months. It means they shouldn’t add extra liquids or foods to the baby’s diet. Mixed feeding can increase intestinal inflammation or mucosal damage in the baby, which paves the way for infection.
• Treating breast diseases: When the mother has mastitis (inflammation of breast tissue) or cracked nipples, the virus can easily travel through the milk ducts to the baby’s body. In such cases, doctors recommend bottle feeding to reduce the risk of transmission.

What Do UN Agencies Say about Breastfeeding When Having HIV?

Major international organizations such as the World Health Organization (WHO) and UNICEF recommend that HIV-positive mothers who undergo antiretroviral therapy continue breastfeeding for six months, but after that, add complementary foods up to 12–24 months. Also, UNAIDS suggests that pregnant and breastfeeding women undergo antiretroviral therapy for the rest of their lives to minimize transmission risk in current and future pregnancies.

Safe Feeding Plans for HIV-Exposed Babies

Mothers living with HIV can choose one of the following three alternatives to breastfeeding:

1. Baby Formula

Baby formula has no contact with the mother’s blood or any viruses, so it is totally safe for the infant. In almost all cases, the doctors recommend the baby formula as an alternative to breast milk because it has the necessary vitamins and minerals needed for babies' development.

2. Donor breast milk

Breast milk from healthy lactating women can be a good option when the biological mother has HIV. Donor pasteurized breast milk is also a safe alternative to the mother’s milk. Although the pasteurization process reduces the milk’s protein level, it can inactivate HIV and make it safe for the baby.

3. Home-Made Formula

In underserved areas, mothers can add supplements and healthy fats to standard baby formula to make it more nutritious. Of course, the amount of additives is determined by a specialist. 

Why Are Breastfeeding Recommendations for HIV-Exposed Infants Different in Iran?

Healthcare systems, economic conditions, national policies, and local clinical studies about breastfeeding are different in countries. Each country has its own guidelines for mothers living with HIV who want to breastfeed their baby. For example, in Iran, the duration of breastfeeding in HIV-positive mothers is usually more limited compared to other countries.

Does Antiretroviral Therapy Reduce the Risk of HIV Transmission Through Breast Milk?

Yes, antiretroviral therapy can greatly reduce the risk of HIV transmission through breast milk. The studies have also proved that these medications lower the viral load in the mother’s blood and bodily fluids, including breast milk. From a clinical perspective, mothers who have undergone ART during pregnancy and breastfeeding have a transmission risk lower than %1.

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The Last Note

For mothers living with HIV, choosing between breastfeeding and bottle feeding is a bit hard because they have to weigh up the benefits and risks, and consider their own condition, as well as the health condition of their baby.

According to the World Health Organization, mothers should only rule out breastfeeding if they have access to an alternative option, like standard baby formula or additive vitamins to make home-made formula. Of course, the baby formula should be safe, affordable, accessible, and sustainable for them. If they don’t have these conditions, breastfeeding while undergoing ART is the best option.

FAQs

How long should HIV-positive mothers breastfeed? 

If the mother is taking antiretroviral therapy, she can breastfeed for one or two years. Breastfeeding may be replaced with formula or donor milk under two conditions:

• The mother is not receiving any treatments.
• She has easy access to alternative feeding, such as high-quality baby formula.

Is baby formula safe for infants exposed to HIV?

If the baby formula is standard and is prepared correctly, the risk of HIV transmission becomes %0. Note that it has nothing to do with HIV transmission during pregnancy or delivery.

Why is breastfeeding allowed in some countries but not in Iran?

Choosing bottle feeding depends on whether the parents have access to standard, affordable, and reliable baby formulas or not. In some underserved areas in Iran, people cannot purchase baby formula and its related vitamins easily. In such cases, the parents should choose breastfeeding while undergoing ART because it’s safer for the baby.

If an HIV-positive mother takes antiviral medications, will her baby get the virus?

The antiviral medications reduce the mother’s viral load to an undetectable level, so the risk of transmission to the baby is less than 1%.

Will my baby get HIV if I breastfeed him once?

Since breast milk contains the virus, even breastfeeding your baby once is risky.

Can breastfeeding be stopped and restarted later?

Yes. If the mother needs medical evaluation, breastfeeding can be paused and later resumed under the doctor’s supervision. However, in most cases, it is suggested to continue feeding (whether breastfeeding or formula feeding) without stopping it.

How can I get online counseling about breastfeeding with HIV?

Yes. Many university-related medical centers and health institutions (like Raadina Health) offer online counseling.