First decade - PMTCT and paediatric AIDS

Second decade - Preventing HIV infection among adolescents

Across both decades - Protection and care for children affected by AIDS

Children and AIDS Regional Initiative (CARI)


Infant and young child feeding in the HIV context

© UNICEF/NYHQ2009-0714/Nesbitt
A woman who is HIV-positive breastfeeds her six-week-old son in their home in Lusaka, Zambia.


Without intervention, breastfeeding carries a 5 to 20 percent probability of transmission of HIV from an HIV-positive mother to her child. In many countries in Eastern and Southern Africa (ESA), however, infants who are not breastfed are up to six times more likely to die from malnutrition, pneumonia and diarrhoeal illnesses due to contaminated drinking water and other causes.

New evidence suggests that HIV transmission through breastfeeding can be significantly reduced if a mother breastfeeds her child exclusively and if she or the baby receive antiretroviral therapy (ART) at the same time.

The exclusive breastfeeding rate has increased across the region over the last few years but it still remains low at an average of 49 percent in 2010, with wide variations between and within countries ranging from 85 percent in Rwanda to 9 percent in South Africa.

Despite strong evidence that infant feeding practices are one of the most significant determinants of child survival, national and international commitment to improve these in all populations has not been matched by funding and action. Supporting optimal infant feeding practices has also been a challenge for health systems even in countries where HIV is not a problem.


Based on latest scientific findings, the World Health Organization (WHO) in 2010 revised its guidelines on HIV and infant feeding. According to the new guidelines, WHO now recommends that mothers with HIV breastfeed their baby exclusively for the first six months and continue to breastfeed up to 12 months while introducing complementary food in settings where breastfeeding is judged to be the safest infant feeding option.

© UNICEF/NYHQ2010-1499/Noorani
A one-month-old baby is being breastfed by her mother, who is HIV-positive and has been participating in the PMTCT programme at Chelstone Clinic in Lusaka, Zambia.

In that case, breastfeeding must be accompanied by ART for the mother or her baby. Further, it is now up to national authorities to decide whether they promote exclusive breastfeeding or the avoidance of all breastfeeding, based on national epidemiological trends. This is a marked change from other approaches whereby health workers are expected to counsel HIV-infected pregnant women and mothers, and to individually determine which infant feeding method would be most appropriate for their particular situation.

Results for children

UNICEF has been supporting the implementation of the new WHO recommendations on infant feeding in the context of HIV.
The new WHO guidelines are being widely adopted throughout the region. Progress so far includes:

  • In Zambia, the revision of the national training package on PMTCT to reflect the current WHO recommendations was finalised and disseminated. Eight countries in the region have national legislation or regulatory provisions in force to protect breastfeeding. The remaining countries have either drafted or are in the process of  developing national breastfeeding legislations for government approval.
  • In Malawi, infant and young child feeding counselling cards were developed and discussions on infant and young child feeding are being carried out on radio, reaching about 80 percent of the population in their local language.
  • In Kenya, a comprehensive Infant and Young Child Feeding strategy and plan of action, inclusive of recommendations for feeding infants exposed to HIV, has been developed and is being scaled up nationally, helping to increase exclusive breastfeeding rates. UNICEF, in close coordination with WHO, also supported advocacy for the country to adopt the new WHO guidelines.
  • In South Africa, in collaboration with the national Department of Health, Saatchi and Saatchi and other partners, UNICEF supported national PMTCT and infant feeding communication campaigns using TV, radio and print media.



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