25 May The American Academy of HIV Medicine Unequivocally Supports an Evidence-Based, Patient-Centered Approach to Infant Feeding
As a professional association representing frontline HIV care providers, the American Academy of HIV Medicine strongly supports shared decision making and evidence-based, patient-centered choice on infant feeding options for people with HIV (PWH). This position is in alignment with the latest clinical guidelines issued in January by the U.S. Department of Health and Human Services (HHS) Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission in the U.S.
These guidelines represent an important step forward in supporting pregnant persons with HIV and their options for breast- and chestfeeding, including the use of appropriate and inclusive language for trans and nonbinary pregnant persons. Some key updates from the guidelines underscore the importance of shared decision making and support of patient choice, including:
- Individuals should be counseled on the risk of HIV transmission. For PWH on antiretroviral therapy with sustained undetectable viral load through pregnancy and postpartum, breastfeeding has a less than 1 percent (but not zero) risk of HIV transmission to a breastfeeding infant.
- Individuals with HIV who are on antiretroviral therapy with a sustained undetectable viral load and who choose to breastfeed should be supported in this decision.
- Individuals with HIV who choose to formula feed should be supported in this decision. Providers should ask about potential barriers to formula feeding and explore ways to address them.
- It is inappropriate to engage Child Protective Services or similar authorities in response to infant feeding choices of PWH.
Based on these latest guidelines, the Academy firmly believes that a more patient-centered approach to infant feeding can and should be reached. Providers should prioritize their own knowledge and understanding of these guidelines, as well as that of their team. We believe that any stigmatization of a virally suppressed PWH choosing the option of feeding that works best for themselves and their baby must immediately halt, particularly in its most egregious form of engaging Child Protective Services or another entity that can irreparably harm a family. HIV criminalization laws still exist in many states and interactions with protective authorities could have very different consequences for a PWH than they would for a person who does not have HIV.
We believe that providers should counsel their patients on infant feeding options with accurate, relevant, and evidence-based information and data. As with all medical decisions made between the provider and the patient, the Academy believes in the sanctity of that relationship and in protecting those shared decisions from unreasonable interference by politically motivated policymakers or because of stigma or misinformation.
To access the full guidelines, “Infant Feeding for Individuals with HIV in the United States,” visit: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states