Q.52 If ARVs are not available immediately should health workers still recommend breastfeeding?
If there is a national decision to provide ARVs and promote and support breastfeeding for HIV-infected mothers, then the health worker should still recommend exclusive breastfeeding while waiting for ARVs to become available.
However, the health worker should discuss with the mother the risks of breastfeeding without ARVs, as well as the risks of not breastfeeding. If a mother states that she would prefer to formula feed in the absence of ARVs, then the health worker should discuss her circumstances to help her assess if the conditions for replacement feeding (formerly AFASS, see new Recommendation 5) are in place and that it is safe for her to do so. If the mother decides to formula feed, then she should be supported to practise this option.
Health authorities should avoid giving different infant feeding messages in different parts of a health province or district depending on whether ARVs are currently available. Conflicting messages may confuse both mothers and health staff and compromise the quality of support mothers receive.