Breastfeeding in Sub-Saharan Africa: Still the Best Despite the Risk of HIV

Abstract

In the 1980s, the finding that HIV can be transmitted through breast milk resulted in heated controversies over the potential benefits of breastfeeding versus bottle-feeding for HIV-positive mothers in resource-poor settings such as in Africa. The early part of the 1990s was marked by ambiguity, uncertainty and fear about the rising rates of paediatric HIV/AIDS due to mother-to-child transmission. By the late 1990s, the results of various epidemiological studies had shown that, in the absence of antiretroviral therapy (ART), HIV-free survival was similar for breastfed versus bottle-fed infants. By the turn of the century, it was clear that breastfeeding was best practised exclusively as breast milk supplementation before the infant was 6 months old increased the risk of HIV transmission. At the close of this decade, the results of epidemiological research indicate that, compared to replacement feeding, exclusive breastfeeding and antiretroviral therapy (ART) result in similar HIV-free survival. Breastfeeding, in conjunction with ART, is considered the best intervention in resource-poor settings as it reduces the risk of HIV transmission through breast milk and has the added advantage of improving the HIV-positive mother’s health. Looking ahead, the provision of consistent information about the importance of exclusive breastfeeding, coupled with early ART initiation, will be critical in efforts to improve child health and survival in the context of HIV/AIDS.