In a May report, the American Academy of Pediatrics announced that HIV-positive people who want to breastfeed can do so with minimal risk of HIV transmission if they are undergoing treatment and their viral load, or the amount of human immunodeficiency virus in their blood, is undetectable.
The updated AAP guidelines concur with the U.S. Department of Health and Human Services, which made similar recommendations in 2023.
Read on to learn more about how HIV is transmitted and treated, what the AAP’s guidelines mean for breastfeeding parents with HIV, and why it’s important to know your status.
What is HIV?
HIV is a virus that infects and destroys cells that are part of the immune system. This makes people with HIV more vulnerable to infections.
This chronic condition occurs in three stages:
- Acute HIV infection: Some people may experience flu-like symptoms within one month after infection as the virus multiplies and spreads throughout the body. The risk of transmitting HIV to others is greatest during this stage because the viral load is very high.
- Chronic HIV infection: After becoming infected, people can live with HIV for many years without feeling sick. People who are infected with HIV can still spread the virus to others, even if they feel healthy.
- AIDS: If a person with HIV does not receive treatment, their illness will progress to acquired immunodeficiency syndrome (AIDS). During this stage, the virus has severely weakened the immune system, which leaves people extremely vulnerable to infections and certain cancers that may lead to severe illness or death. People with HIV who receive early and consistent treatment can avoid developing AIDS and live long, healthy lives.
How is HIV transmitted and treated?
You can get HIV if an infected person’s bodily fluids—including blood, vaginal fluids, semen, and breast milk—enter your body through your mouth, genitals, anus, or broken skin. You cannot get HIV from touching, kissing, or sharing utensils with someone who has the virus.
Having sex without safer sex barriers, including condoms, and sharing needles for drug use are the most common ways HIV spreads. Breastfeeding parents can also pass HIV to their babies through their breast milk.
However, when HIV-positive people consistently take antiretroviral therapy (ART) medication, they can reduce their viral load to an “undetectable” point. This means that the amount of HIV is so low that a test will be unable to detect any significant trace.
When an HIV-positive person achieves an undetectable viral load and maintains it for six months, there is no risk of transmitting the virus to others through sexual contact, and the risk of transmitting HIV through breast milk is extremely low.
The only way to know if your viral load is undetectable is to get regular blood tests from your health care provider—typically every three to four months. Talk to your provider about the right testing schedule for you.
How can HIV-positive breastfeeding parents safely breastfeed their babies?
Avoiding feeding babies breast milk from an HIV-positive parent is the only way to fully eliminate the risk of passing HIV to babies through breast milk. However, according to the AAP, if an HIV-positive breastfeeding parent is undergoing ART and has maintained an undetectable viral load, the risk of transmitting HIV to their baby through their breast milk is estimated to be less than 1 percent.
If an HIV-positive breastfeeding parent is not taking ART, or if the baby is not taking preventative antiretroviral medication, the risk of HIV transmission through their breast milk is between 5 percent and 6 percent when the baby is 4 to 6 weeks old.
If you’re an HIV-positive parent who would like to breastfeed, but your viral load has not yet reached an undetectable level, or if you do not wish to breastfeed, talk to your health care provider about feeding your baby formula or donor breast milk. You can find donor breast milk through the Human Milk Banking Association of North America.
How can I get tested for HIV?
Nearly one in seven people in the U.S. living with HIV don’t know they have the virus, so getting tested for HIV on a regular basis is a critical part of routine health care—especially if you have unprotected sex or use injectable drugs. When you know your status, you can get treatment early and take steps to avoid spreading the virus to others.
You can request an HIV test from your primary care provider, or you can get tested at a health clinic like Planned Parenthood. Visit the CDC’s GetTested resource to find a health center near you that tests for HIV.
You can also purchase an at-home HIV test online or from a drugstore. You do not need a prescription to purchase an at-home HIV test. If you receive a positive at-home test result, follow up with your health care provider for additional testing to confirm the diagnosis.
Where can I find resources for HIV-positive parents?
Learn more about HIV, pregnancy, and breastfeeding from the CDC.
Access financial resources for HIV-positive parents and children from the Ryan White HIV/AIDS Program.
For more information, talk to your health care provider.