Nutrition and HIV/AIDS: A Training Manual - Linkages Project

the options. It should be emphasized that none of the following options are easy forthe mother to practice without support, especially is she is HIV infected.Modified exclusive breastfeedingExclusive breastfeeding of infants up to 6 months should be promoted for womenwho are HIV negative or of unknown HIV status. Exclusive breastfeeding should alsobe supported as long as replacement feeding is not a viable option for an HIVinfectedmother. UN guidelines state that breastfeeding should be promoted,protected, and supported for all women who do not know their HIV status and forwomen who are not infected. Note: Address the policies that support exclusivebreastfeeding or breastfeeding in general in your country, for example, the Baby-Friendly Hospital Initiative and International Code of Marketing of BreastmilkSubstitutes.Early cessation of breastfeeding is recommended after a certain period of time(an optimal time has not been determined) for HIV-infected mothers when adequateand hygienic replacement feeds are available. Cessation is especially important if amother develops AIDS symptoms. Research is being carried out in Lusaka, Zambia, toexamine the effectiveness of early breastfeeding cessation at 4 months for HIVinfectedwomen. One study (Victora et al 2000) carried out to facilitate infantfeeding risk assessments in regions of high HIV prevalence did a pooled analysis ofresearch examining the effect of not breastfeeding and death from infectiousdisease. This study showed the declining protection afforded by breastmilk with ageof infant (pooled odds ratio 5.8 for < 2 months; 4.1 for 2-3 months; 2.6 for 4-5months; 1.8 for 6-8 months; and 1.4 for 9-11 months).A number of factors should be considered to support a mother in the early cessationof breastfeeding. As discussed below, acceptable, feasible, sustainable, and safebreastmilk substitutes must be available. Appropriate complementary foods andfeeding practices must also be encouraged, and food security considerations takeninto account. Piwoz et al (2001) recommend a transition period between exclusivebreastfeeding and exclusive replacement feeding with the following actions toaccustom the infant to the new feeding patterns.• Accustoming the infant to cup feeding200