The Evolution of the Intersection of HIV and Breastfeeding in Global Policy

Increasing breastfeeding rates and reducing HIV/AIDS are two important global health priorities, and their intersection has led to policies that meet mutual goals of supporting, protecting and promoting breastfeeding and reducing the risk of HIV/AIDS. The World Health Organization has developed and released recommendations, policies, and guidance on infant feeding and the risk of transmission through breastfeeding. This analysis provides a historical, chronological perspective on the global policies for infant feeding in the case of an HIV-positive mother, an analysis of changes, and recommendations for the future. The policies evaluated demonstrate the evolution in knowledge and recommendations for infant feeding practices in the setting of HIV. Over time, significant changes can be found in the policies regarding breastfeeding, mixed feeding, antiretroviral use, and the inclusion of evidence. In the beginning, women with HIV were advised not to breastfeed their infants, mixed feeding was not discussed, antiretrovirals had not been developed, and citations of evidence were not included. With the latest policies, breastfeeding was encouraged, mixed feeding was not advised due to evidence of an increased risk of harm to the infant, and research was both cited and discussed in terms of quality and strength. This evaluation of previous policies has demonstrated the need for continually clarifying terminology, descriptive criteria and practices, and increasing the evidence-base in order to create effective and accurate recommendations in the future