University of Washington

Infant feeding and HIV

Last updated : 09/09/2026

Welcome

Deciding how to feed your baby is a personal decision. When you are living with HIV, there are some extra things to think about. This guide is meant for you to use with your healthcare provider.

1. You have an undetectable viral load

Undetectable means that the amount of HIV in your blood (viral load) is below the level of measurement. Having an undetectable viral load both at birth and during the time you are breastfeeding dramatically reduces the chances of passing HIV to your baby to less than 1%.

Your provider will recommend regular testing of the viral load while you are breastfeeding to make sure it is still undetectable.

2. You continue HIV medications through pregnancy and breastfeeding

This is the most important thing you can do to decrease the chance of transmission. Continuing medication to suppress your viral load (the amount of HIV in your blood) is the only way to make sure that your viral load remains undetectable.

4. Your baby gets regular blood tests

It is important to test baby for HIV to make sure that they do not develop evidence of HIV during breastfeeding. No matter how you feed your baby, many clinics will recommend testing for HIV at least during the following periods:

• Right after birth
  
• When they are 14 to 21 days old
  
• When they are 1 to 2 months old
  
• When they are 4 to 6 months old
  

If you breastfeed, your provider may recommend that baby is tested more often or for a longer period of time. Every clinic does things a little differently, so talk to your baby's doctor about their schedule. If you were diagnosed with HIV while you were pregnant, or if your viral load was ever "detectable" during your pregnancy, your doctor may recommend even more  tests.

5. Baby is exclusively breastfed

If you are planning to breastfeed, it is recommended that you only give your baby breast milk for at least the first six months. This is called "exclusive breastfeeding." This is the same recommendation for babies of mothers who do not have HIV.

Giving solid food during this time increases the chance of HIV transmission while breastfeeding. 

It is unclear if giving formula also increases the chance of HIV transmission. Because of this, it is best to avoid giving formula if at all possible.

It can be difficult to only breastfeed – talk to your provider or lactation consultant if you think you may need formula.

The research studies that looked at mixed feeding were done before ART (medications for HIV) were available, so individuals in this study had high viral loads. Those research studies showed that mixed feeding of milk and solid foods increased the chance of transmission by increasing inflammation in the baby's gut. There have not been high quality research studies since then looking to see if formula also increases the chance of HIV transmission if you are taking ART and undetectable.

Banked Donor Milk

Banked donor milk is breastmilk donated from other breastfeeding parents. If breastmilk comes from a place that has been accredited by the Human Milk Banking Association of North America, it means that it has been tested for safety very carefully.

If you are struggling with your supply, using donor milk is an alternative instead of giving baby formula. However, it can be very expensive and may not be available in your area. Ask your provider if this is an option for you.

1. You have a detectable viral load

It is important to continue testing for HIV during breastfeeding. Your provider may recommend testing every 1-2 months while you are breastfeeding.

If you have a detectable viral load, or if you are unable to take your medications, you should contact your healthcare provider immediately. They will help you decide if you need to stop breastfeeding.

2. Mastitis or bleeding nipples

There is concern that developing mastitis ( breast inflammation and infection) or having bleeding nipples can increase the risk of HIV transmission to baby.

If you develop mastitis or have bleeding nipples, talk to your healthcare provider. They may recommend that you pump and discard the milk from the affected breast and continue to breastfeed from the unaffected breast.

Social Support

Having a new baby can be very stressful. Having support from a partner, friends, or family can make taking care of your baby much easier.

Take a moment to think about the people around you. Who can you count on for help after you have your baby? How do they feel about the different ways to feed a baby?

• If your friends and family do not know about your HIV status: They might pressure you to breastfeed because they do not know the whole story.
  
• If they do know about your HIV status: They might share their own opinions on what you should do, even if it is different from what you want to do.
  

Self Care

The most important thing you can do to prevent HIV transmission to your baby is to continue your ART or HIV medications.

Do you have the time and energy to take care of yourself and continue your medications?

Also think about your own health – are you on any medications that are unsafe for breastfeeding? Do you have any medical conditions that significantly worsen with lack of sleep? These are good questions to talk about with your healthcare provider.

What does the chance of transmission mean to you?

Everyone looks at risk in a different way.

If you are living with HIV and have an undetectable viral load, breastfeeding has a chance of passing the virus to your baby of less than 1%. While that number is very low, it is not zero.

For some people, a less than 1% chance is still too high.

For other people, a less than 1% chance is small enough, especially when they think about the benefits from breastfeeding.

Confidentiality

Some people have not told their family, friends, or partner that they have a diagnosis of HIV. They may feel that choosing not to breastfeed will potentially reveal their HIV status as they are otherwise strongly expected to breastfeed.  

Other people worry that needing to give medications to baby in front of their family or friends when breastfeeding may also reveal their HIV status.

Giving Your Baby Medicine

Most babies are given medicine after they are born to help prevent HIV. If you breastfeed, you may need to give your baby medicine for a longer period of time. You should talk to your baby's healthcare provider about about whether they recommend a longer period of medication if you breastfeed.

• How it works: This is a liquid medicine that goes in your baby's mouth using a dropper.
  
• How often: You will need to do this at least once a day, and sometimes more, depending on the medicine.
  

For some parents, giving medicine every day can be hard.

Take a moment to think about how you might feel about giving your baby medicine.

Testing

If you plan to breastfeed, your baby will need to have more blood tests, usually for the entire time that you are breastfeeding.

You will need to take your baby to the clinic for a visit. A blood sample will be taken from your baby's arm or leg.

You might feel anxious or stressed when you are watching baby get a blood test.

It also takes extra time to go to more clinic appointments, which might also be hard.

Take a moment to think about how you might feel about taking your baby to the clinic for these extra blood tests.

Time

Breastfeeding can be time-consuming but can be so rewarding. Think about what your life will look like after delivery – how will breastfeeding every few hours look like in your life? Will you need to go back to work? When you go back to work, are you considering pumping when you are not with baby?

Costs of Feeding Your Baby

Both formula and breastfeeding have different costs to think about over time. Formula or breastmilk should be the primary food for baby until they turn 1.

Formula Costs

• Formula can be expensive and add up to a lot of money for your family.
  
• Some babies might have upset stomachs from a certain kind of formula. You might need to try a few different kinds or buy a special kind.
  
• Programs like WIC (Women, Infants, and Children) can help you get formula for free or at a lower cost.
  

Breastfeeding Costs

If you breastfeed and have trouble making enough milk, you might need to buy a pump and extra supplies. This is usually covered by insurance.

Cultural Beliefs

You might come from a community or culture where everyone expects mothers to breastfeed. You may have grown up always planning to breastfeed your own baby. In some communities, choosing not to breastfeed can make people think something is wrong.

Take a moment to think about this:

Is it important for you to follow the feeding traditions of your culture and community?

How do you feel about making a feeding choice that fits—or does not fit—with what your community expects?

Feedback

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This website was funded by the UW CFAR (Center for AIDS Research).

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