From the mother’s perspective
Q.60 How does HIV testing at 6 weeks influence a mother’s decision about how to feed her infant, especially if the child is HIV uninfected?
The main reason for testing at 6 weeks is to see whether the infant is HIV-infected, and therefore needs ART. Testing at 6 weeks for infant feeding counselling is not recommended. If the test is negative, the mother should be encouraged that she has been able to protect her baby.
If the HIV test at 6 weeks is positive, the baby will be more likely to survive if breastfeeding is continued, and there is no evidence that continued exposure to HIV in the mother’s milk will cause more severe disease. In this case, the mother should be encouraged to continue breastfeeding as per the recommendation for the general population, up to 2 years of age or beyond. The baby should be referred for treatment according to guidelines for the age group, and should stop taking any ARVs that were given for prophylaxis. If the mother is taking ARVs to prevent breastfeeding transmission (not for her own treatment), she should also stop.
On receiving a negative HIV test for their baby at 6 weeks of age, many mothers may wish to stop breastfeeding in order to end the risk of HIV transmission to their baby. Mothers who are considering stopping should be counselled about the risks to which they may be exposing their baby by switching to another kind of food. In most cases, the baby’s health will be better protected by continuing to breastfeed until126 months of age while either the mother or infant receives ARVs.