HIV and infant feeding : a chronology of research and policy advances and their implications for programs

The studies do not, however, lead directly to clear policy and program guidance for mothers living in resource- poor settings where HIV is prevalent, because many critical questions about HIV and infant feeding remain unanswered. These unanswered questions exist because of limitations in HIV test technology, which make it impossible to determine the precise timing or mode of transmission to newborns at the time of delivery and during the first 2 months of life, and because of issues related to the design, analysis, and interpretation of studies on this subject. Also, the mortality and other risks associated with artificial feeding in different environments are largely unknown. In mid-1998, UNAIDS, UNICEF, and WHO released guidelines on HIV and infant feeding for decisionmakers, and for health care managers and supervisors. For the first time, the recommendation to provide HIV-seropositive mothers who decide not to breastfeed with replacement feeds was formally put forward by these organizations. However, the unanswered questions mentioned above leave major gaps in our knowledge and pose major challenges to the adaptation of these guidelines to specific settings and specific mothers, and to the timely, appropriate, and widespread application of these guidelines in countries and communities where HIV exists. This paper: (1) reviews the major advances in the study of HIV and infant feeding and the policy responses to these findings; (2) describes several design and interpretation issues to take into consideration when reading and comparing research studies on this issue; (3) reports the findings of several studies and mathematical models that have been developed to guide program and policy recommendations on HIV and infant feeding; (4) summarizes what existing studies do and do not reveal about this issue; and (5) recommend areas requiring further research to facilitate adaptation and application of the UNAIDS/UNICEF/WHO guidelines on HIV and infant feeding. Includes references. (Author abstract, modified.)