Human Immunodeficiency Virus (HIV)

HIV is spread through direct contact with bodily fluids.1 In North America, those who test positive for any type of HIV are advised not to breastfeed (or donate breastmilk of course) by the CDC.2

However, HIV is easily killed by heating and this effectively mitigates the risk of transmitting HIV through human milk.3 This poses the question as to whether the recommendations of the CDC for those who are HIV-positive to not breastfeed their own baby, without qualifying and allowing for the opportunity to make informed decisions with the guidance of a healthcare provider, is in the best interest of the parent/child in all situations.

Extensive research in the context of HIV in low-resource countries supports the claim that the human immunodeficiency virus is very easily destroyed and that this can be done so at home. Breastfeeding, and especially early breastfeeding, is one of the most critical factors for improving child development, health, and survival. Human milk also has many benefits other than reducing the risk of child mortality. The risks of not breastfeeding are not negligible, even where clean water and sanitation are accessible. 4 5

Donors should avoid high-risk behaviors –i.e. I.V. drug use, unprotected sex with someone of unknown status, etc. that may lead to an HIV infection. Donors should also be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks.

In the US, as well as in many other countries, HIV is part of routine testing during pregnancy or during labor. A copy of the results can be obtained through your healthcare provider. There are 3 methods for HIV testing available depending on which one is appropriate in someone’s circumstances.6

In the US, the risk of HIV transmission by mistakenly feeding a child human milk from another child’s bottle is believed to be low because women who are HIV positive are advised NOT to breastfeed their infants.7 Transmission of HIV from single breastmilk exposure has never been documented.

If there is any doubt regarding the donor’s HIV status or for added protection, it is possible to flash-heat breastmilk at home in order to deactivate HIV.

Please consult with a qualified healthcare provider with any HIV-related issues.

Next section: HIV and the global context of infant

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  1. Los Alamos National Laboratry – HIV and SIV Nomenclature ↩︎
  2. CDC – Human Immunodeficiency Virus (HIV) ↩︎
  3. Word Health Organization. 2008. Module 6. Infant Feeding in the Context of HIV Infection, PMTCT– Generic Training Package Participant Manual ↩︎
  4. Why human milk? ↩︎
  5. HIV has created great confusion among healthcare workers about the relative merits of breastfeeding for the HIV-infected. Tragically this has also resulted in those who are known to be HIV uninfected or whose HIV status is unknown, adopting feeding practices that are inappropriate for their circumstances with detrimental effects on their infants. Infant feeding, even in settings where HIV is not highly prevalent, has been complicated by misguided messaging from the food industry and other groups with the result that parents and caretakers, who have every reason to breastfeed, choose not to do so based on unfounded fears. In these settings, the application of the International Code of Marketing of Breast-milk Substitutes (WHO. 2017. International Code of Marketing of Breast-Milk Substitutes) and subsequent relevant WHO Resolutions have particular importance. (World Health Organization. 2016. Guidelines on HIV and infant feeding) In the context of HIV and Covid-19, it becomes increasingly and urgently needed to support developing advocacy strategies that integrate rights-based, community-led, and inclusive approaches and includes breastfeeding into the universal health coverage (UHC) agenda to achieve health for all. (PITCH – UHC advocacy guide in COVID-19 context for HIV civil society and community partners ↩︎
  6. NIH – HIV Testing ↩︎
  7. In 2010, the CDC also stated that chemicals present in breastmilk act, together with time and cold temperatures, to destroy the HIV present in expressed milk. Wouldn’t it be nice to know the time frame and to see the research on this to see how effective time and temperature really are? Destroy is a strong word, but if this is true, wouldn’t HIV-positive parents deserve to know? The transmission of HIV from an infected parent to their infant through continuous breastfeeding is 5-8%. Combined with ARV treatment and specific handling guidelines, the risks would be practically non-existent. We contacted the CDC back n 2010 about this information so we could refer to the research with no response to date, unfortunately. In fact, this line has since been removed from their list of reasons why the risk of accidental transmission is so low. ↩︎