Bloodborne HIV: Don't Get Stuck!

Overview of risks and prevention

An HIV-positive baby can infect a breastfeeding woman. And any woman with HIV can infect any child she breastfeeds “in person” or through expressed breastmilk. To protect yourself and your baby: (a) do what you can to ensure healthcare provided to your baby uses sterile instruments; (b) avoid sharing babies around for breastfeeding unless you are confident both the baby and the breastfeeding woman are HIV-negative; (c) don’t use expressed breastmilk from others unless you know they are HIV-negative or the milk has been heat-treated.

HIV transmission from HIV-positive babies to mothers or other breastfeeding women

Many children in Africa are found to be HIV-positive even though their mothers are HIV-negative (for example: >20% of HIV-positive children aged 2-12 years in eSwatini in 2006-7 and >33% of HIV-positive babies aged 6-23 months in  Mozambique in 2015). If a baby gets HIV from healthcare, and if the baby is still breastfeeding, the baby can infect his or her mother through breastfeeding.

Good evidence from investigated outbreaks in Kazakhsan, Libya,[1] and Russia,[2] where hundreds of children got HIV through healthcare, shows HIV goes faster from babies to breastfeeding mothers than from mothers to breastfeeding babies. Experts at the US Centers for Disease Control (CDC) estimate 40%-60% of Russian and Libyan children who breastfed after getting HIV from healthcare infected their mothers.[3] Evidence from Russia suggests child-to-mother transmission was faster when children had mouth sores or mothers had cracked nipples.

HIV transmission from babies to breastfeeding mothers (or to a surrogate breastfeeder) is no doubt common in Africa, but because health experts have generally ignored risks for babies in Africa to get HIV from healthcare, they similarly ignore risks that babies might infect mothers. Without investigations of outbreaks of HIV from healthcare in Africa, there has been little or no chance to see or document child-to-mother transmission.

HIV transmission from breastfeeding women to others’ babies

In August 2012, the Lancet reported a baby girl in South Africa infected by breastfeeding with her HIV-positive aunt.[4] The girl’s mother was HIV-negative. The child, who was 10 weeks old when found to have HIV, had breastfed intermittently with her aunt from age 6 weeks. HIV from the aunt and child were similar and therefore linked; one of them had infected the other. Laboratory records showed the aunt was infected more than a year before she began to breastfeed her niece, making it clear the direction of infection was from aunt to child.[5]

The frequency of surrogate or shared breastfeeding varies from one community to another. In a 2005 national survey in South Africa, 3.5% of women reported breastfeeding another’s baby.[6] On the other hand, 40% of women surveyed in Gabon reported sometimes breastfeeding others’ infants, and 40% of infants breastfed at times with other women.[7]

References

1. Visco-Comandini U, Longo B, Perinelli P, et al. Possible child-to-mother transmission of HIV by breastfeeding. JAMA. 2005; 294: 2301-2. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16278357 (accessed 27 August 2012).

2. Pokrovsky VV. Localisation of nosocomial outbreak of HIV-infection in southern Russia in 1988-89/ Int Conf AIDS. 19-24 July 1992. Abstract no. PoC 4138. Available at: http://www.aegis.org/DisaplayConf/abstList.aspx?Conf=22 (on this link search for PoC 4138; accessed 27 August 2012).

3. Little KM, Kilmarx PH, Taylor AW, et al. A Review of Evidence for Transmission of HIV From Children to Breastfeeding Women and Implications for Prevention. Pediatr Infect Dis J 2012; 31: 938-942. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22668802 (accessed 27 August 2012).

4. Goedhals D, Rossouw I, Hallbauer U, et al. The tainted milk of human kindness. Lancet 2012; 380: 702.

5. Capazorio B. “Tainted milk” from wet nurse HIV risk. Weekend Argus, 26 August 2012. Available at: http://www.iol.co.za/news/south-africa/western-cape/tainted-milk-from-wet-nurse-hiv-risk-1.1369793#.UDtHcNZlRG4 (accessed 27 August 2012).

6. Shisana O, Connoly C, Rehle TM, et al. HIV risk exposure among South African children in public health facilities. AIDS Care 2008; 20: 755-763. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18728983 (accessed 27 August 2012).

7. Ramharter M, Chai SK, Adegnika AA, et al. Shared breastfeeding in central Africa. AIDS 2004; 18: 1847-1849. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15316347 (accessed 29 August 2012).