If no care is taken to prevent mother-to-child HIV transmission, about a third of children born to HIV-infected women will get HIV, including 20% infected before or during delivery, and another 10%-15% infected from breastfeeding (approximately 0.5% per month).
HIV transmission from mother-to-child is almost entirely preventable. If you are pregnant, it’s a good precaution to get tested for HIV during antenatal care. Ensure the blood test is safe. (If you are infected, it’s a good precaution to get your husband tested, because if he is HIV-negative you can protect him. IMPORTANT: If you and/or your husband test HIV-positive, that says nothing about anyone’s sexual behavior; either of you might have gotten HIV from trace amounts of blood on skin-piercing instruments during healthcare or cosmetic services.)
If you are infected, you can protect your baby (and yourself!) by starting antiretroviral therapy (ART), no matter your stage of infection, and continuing ART for the rest of your life.[recommendation 4.3.2 on page xxxi in reference 1] WHO recommends that you breastfeed your baby at least 12 months, or as long as you want (unless you live in a rich country with very safe water and very low infant mortality). As long as you are on ART, there is little chance for you to infect your baby by breastfeeding.
Technology and programs to prevent mother-to-child transmission have been getting better year-by-year. If you are HIV-positive and pregnant, ask around to find the best program to prevent mother-to-child transmission. Check with friends, NGOs, public hospitals, and private doctors to see what is available. You may find local options; eg, some rich countries recommend nevirapine or other antiviral for breastfeeding babies in some circumstances; but I don’t see any such recommendation for Africa.
1. WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2nd edition. Geneva: WHO, 2016. Available at: http://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf?sequence=1 (accessed 20 October 2018).
2. WHO, UNICEF. Guideline updates on HIV and breastfeeding. Geneva: WHO, 2016. Available at: http://apps.who.int/iris/bitstream/handle/10665/246260/9789241549707-eng.pdf?sequence=1 (accessed 20 October 2018).
3. Waitt C, Low N, Van de Perre P, et al. Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income countries. Lancet HIV 2018; 5: e531-e536. Available at: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30098-5/fulltext (accessed 26 October 2018).