Perspective: Infant Feeding Policies among Women Living with HIV in Latin America and the Caribbean: Should They Be Updated?

Among women living with HIV (WLHIV), adherence to highly active antiretroviral treatment (HAART) combined with undetectable maternal viral loads and exclusive breastfeeding during the first 6 mo of life dramatically reduces the risk of mother-to-child transmission of HIV. This knowledge has led to updated World Health Organization infant feeding guidelines for WLHIV, calling for governments to support safe breastfeeding practices among WLHIV who want to breastfeed their infants by providing universal access to HAART, viral load tracking, and high-quality breastfeeding counseling and other needed support across settings. These guidelines eventually led several high-income countries, including the United States and Canada, to revise their infant feeding guidelines that previously contraindicated breastfeeding among WLHIV to incorporate safe, evidence-based breastfeeding recommendations for WLHIV. However, in the rest of the Americas, breastfeeding contraindication remains in place. We strongly recommend that all countries in Latin America and the Caribbean consider updating their breastfeeding guidance for WLHIV to allow for safe breastfeeding. Implementing the new evidence-based recommendations poses major implementation challenges as there is no room for error. Systems-driven implementation science research will be needed to understand how best to codesign, implement, scale up, and sustain intersectoral and equitable person and family-centered policies and programs to empower WLHIV to breastfeed safely if they have the choice to do so.