Question
I feel judged for wanting to breastfeed in Germany?
3 January 2018. Related: All topics, Children, HIV transmission, Pregnancy.
Hi to all hiv positive moms out there! I am 36 years old and hiv +. Im 36 weeks pregnant and I really want to breastfeed my son. Ive done alot of counselling on this but when my doctor in Germany says “yes you can breastfeed if you stick to your treatment and come with the baby for monthly control and know you are the champion and will bare the consequences that may follow” I have mixed feelings to be doing the wrong choice or being judged.
I am taking Kaletra and Truvada. Viral load undetectable and my CD4 count about 450 though it fluctuates. I need to know about other personal experiences and the final status of your kids. Are there breastfed kids who are negative? I want to learn from your stories please. I have a planned C-section later this month.
Answer
Hi
This is in many ways a simple issue. Breastfeeding has a risk of transmission, even when viral load is undetectable. UK guidelines are clear that women in the UK should use formula milk to prevent any risk to the baby.
In countries where access to clean water is difficult, and viral load is undetectable, breastfeeding is better for the baby. This is because the risk of early infant deaths from from other infections is much higher.
Living in Germany, you are lucky to have access to formula feed and clean water, and the baby isn’t at risk of other infection. This gives you an option of making the risk to your baby zero. Your doctor can’t say breastfeeding has a zero risk because studies still show there is a small risk.
If your baby becomes positive – and the risk might be 1% (1 in 100), they will have HIV for life and need treatment for life, including all though their childhood.
These are facts and most HIV positive women – in the UK or in other countries – do not understand how having the choice to have zero risk, a privileged person would do anything other than use formula milk.
A very recent talk on the subject at a UK HIV medical conference clearly concluded that evidence still supports using formula feed if you want the risk to your baby to be zero. The webcast of this talk by Dr Hermione Lyall goes through the evidence and uses case studies to explain the UK recommendations.
http://www.bhiva.org/171117HermioneLyall.aspx
This includes data from the PROMISE study reporting risks of 0.3% and 0.6% from 6 and 12 months exclusive breastfeeding, respectively.
This is not a judgemental lecture – it looks at the evidence to define risk. It also stresses that breastfeeding in a high-income country will require month viral load monitoring for the baby because of the urgency for starting early ART if transmission occurs.
It also makes the point that if your baby becomes HIV positive from breastfeeding, the mother will have to explain during teenage years or earlier, why they are HIV positive and have been taking medicine for life.
So perhaps rather than asking for the experiences of women who breastfeed with negative babies, it might be just as important to hear from women whose babies became HIV positive.
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