Recognition that human immunodeficiency virus type 1 (HIV-1) could be
transmitted through breastfeeding precipitated a public health dilemma. Long
promoted as a means of decreasing infant morbidity and mortality, particularly
in resource-poor areas, breastfeeding now posed a potential health hazard.
Differences in the risk-benefit ratio associated with breastfeeding ultimately
led to 2 sets of public health recommendations. In settings with readily available
safe breast milk substitutes and low background infant mortality rates, withholding
breastfeeding was not expected to be associated with increased infant mortality
rates and thus HIV-infected women were advised not to breastfeed.1 In contrast, in resource-poor settings, withholding
breastfeeding was known to significantly increase infant morbidity and mortality
due to infectious diseases and malnutrition.2- 5
However, the risk-benefit ratio for an HIV-infected woman was not constant
throughout resource-poor settings: some women in such settings might in fact
be able to provide safe breast milk alternatives to their infants. This led
to the need to assess the risk-benefit ratio on an individual basis.
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