Question: I am pregnant and HIV positive. Is is okay for me to breastfeed my baby? This is my second baby and I breastfed my first baby, now I'm confused as I have not told anyone at home about my HIV status and I have heard people say that babies could become infected through breastfeeding if their mothers are HIV positive. I have been counselled at the MOU and heard about the MTCT program, but I'm still confused.

Answer: It is understandable that you feel worried about breastfeeding your baby as you are HIV positive. It is important that you focus on what is best for your baby and to ensure that the chances of your baby being infected are limited. Sharing the fact of your HIV status with others is your choice entirely.

As you were informed by the Counsellor at the MOU concerning the Mother to Child Transmission Programme, it is important that you consider all the feeding options and choose what is best suited to your baby, according to your circumstances. I don't know how much you remember from your first counselling session, but you need to choose to either exclusively breastfeed or to formula feed your baby. Exclusive breastfeeding means only breastmilk and nothing else but breastmilk (except perhaps for prescribed medicine from the clinic). No water, formula, juices, gripe water or even a dummy. All these things together with breastmilk constitutes MIXED FEEDING and this can be harmful to the baby

If you choose to exclusively breastfeed, this should be done for no longer than four months and at the end of the four months you should abruptly stop breastfeeding and change the baby to formula which you may get at your local baby clinic for the next two months until the baby is six months old. Once you have changed from breastfeeding to formula feeding, you should NEVER put the baby back onto the breast. This would be mixed feeding and could cause the baby to become HIV positive.

The important thing about breast milk is the first milk the mother produces, called Colostrum. This lines the baby's stomach and gut, and this protects the baby from infections. Breast milk also contains all the nutrients the baby needs. It is always at the right temperature, is easily available (the more you breastfeed the more milk you produce), and it also saves time. You need to remember the basic hygiene principles of cleaning your nipples before you breastfeed to prevent infections. You have to make sure that baby latches correctly onto the nipple so that you can avoid having cracked nipples, which apart from being painful, could expose the baby to HIV infection. If you develop a cracked nipple stop feeding from that breast. Rather use the other breast and seek medical treatment immediately. For all advice, please contact your MOU or baby clinic immediately.

As far as the baby is concerned, should the baby have an infection (oral thrush, gastro-enteritis etc), you need to take baby to the clinic immediately since the baby is at risk of becoming infected with HIV. From six months of age the baby can be started on certain solid foods as advised by the clinic.

This brings me to the second feeding option, Formula Feeding. If you choose to formula feed your baby, then he/she needs to be exclusively formula fed for 6 months. You will need to connect with your MOU so that it can be arranged for you to leave the MOU after delivery with sufficient formula to last until your first visit to the baby clinic. At the baby clinic you will be supplied regularly with formula for six month.

The most important thing to remember about formula is to prepare it exactly as instructed according to the weight and age of your baby. Any deviation could cause your baby to become ill. If you formula-feed your baby, the recommended way to do this is by cup feeding. At the clinic you will be shown how this is done. Thoroughly cleaning the cup and spoon you use is absolutely necessary in order to prevent infections to the baby. The formula of choice is a milk free product, which will protect your baby from allergies like those that can result in conditions such as asthma, hayfever, etc. If you do not follow the instructions on the tin, you could underfeed or overfeed the baby, which would lead to complications like malnutrition, dehydration, constipation, etc. The baby should start eating solid foods after 6 months, whether you breastfeed or formula feed.

You will need to decide which option is best for you. The risk of HIV transmission will be lessened if you exclusively breastfeed your baby for not longer than four months. Formula feeding means the baby will not be at risk of getting infected with HIV, but could be at risk for other infections like gastro enteritis, pneumonia, etc.