- Clinical guidelines support shared decision-making on infant feeding for parents with HIV
- A study of lactation consultants in Canada and the U.S. found varying attitudes
- Gaps in lactation support were linked to lack of awareness of current guidelines
Lactation consultants (LCs) can play a critical role in supporting parents who are breastfeeding/chestfeeding, particularly for those navigating complex or chronic conditions such as HIV. Current Canadian guidelines recommend formula feeding for infants born to individuals living with HIV. However, they also include recommendations on how to support someone who chooses to breast/chestfeed, including when it is appropriate to do so, as well as the necessary monitoring and follow-up.1,2 Considering this, it is essential that LCs possess HIV-specific knowledge and training related to breastfeeding/chestfeeding support for people living with HIV. A study conducted in Canada and the United States examined LCs’ HIV-related knowledge, attitudes toward breastfeeding/chestfeeding among people living with HIV, HIV-related stigma and experiences with tele-lactation.
Study details
The study used a cross-sectional survey to collect quantitative and qualitative data from 207 LCs between February and May 2024. Participants were Canada- or US-based certified LCs with at least two years of experience supporting clients with lactation. Most participants (98.6%) were reported as female and only one-quarter (24.6%) had supported at least one person living with HIV in the postpartum period in the last two years.
Key findings
- Overall: LCs showed high general HIV knowledge, moderate HIV-specific breastfeeding/chestfeeding knowledge and low levels of HIV-related stigma.
- HIV-specific breastfeeding/chestfeeding knowledge: HIV-specific breastfeeding/chestfeeding knowledge scores were higher among LCs who had prior experience supporting people living with HIV in the postpartum period or were aware of the updated infant-feeding guidelines.
- Stigma: LCs who were not up to date on infant-feeding guidelines had higher HIV-related stigma. Stigma levels were not associated with general HIV knowledge, age, years of experience or prior work supporting people living with HIV.
- Support for patient autonomy in infant-feeding decisions: LCs were highly supportive of patient autonomy in infant-feeding decision-making overall. LCs with lower levels of HIV-related stigma were more likely to agree that people with HIV should be able to choose whether to breastfeed/chestfeed despite the residual risk of HIV transmission.
- Endorsement of breastfeeding/chestfeeding in high-resource settings: LCs with lower HIV-related stigma were more cautious of endorsing breastfeeding/chestfeeding in high-resource settings (i.e., when clean water and formula were available).
- Tele-lactation: Most participants (95.7%) reported experience with providing tele-lactation support.
- Education: Almost all LCs demonstrated willingness to learn more about HIV and breastfeeding/chestfeeding, with 99% interested in additional education related to HIV-specific care.
Implications
Overall, LCs were highly supportive of upholding the autonomy of people living with HIV in infant-feeding decision-making, expressed strong willingness to improve their HIV-specific knowledge about breastfeeding/chestfeeding and were experienced with tele-health platforms to deliver lactation support, indicating a workforce that is both receptive to and capable of adapting to evolving care models.
LCs with lower HIV-related stigma were more supportive of shared decision-making, but less likely to support breastfeeding/chestfeeding in high-resource settings where safer alternatives are available. This suggests that reducing stigma alone is not enough to increase endorsement of breastfeeding/chestfeeding. Increased awareness of updated infant-feeding recommendations may be required to improve LCs’ confidence in supporting people living with HIV in the postpartum period.
Tele-lactation support by LCs may help to expand access to HIV-specific lactation support by facilitating connections to knowledgeable LCs across geographic and institutional boundaries. Tele-health platforms offer an added layer of privacy and confidentiality that can minimize the stigma associated with accessing support and are a promising avenue to engage geographically isolated and underserved populations.
Overall, these findings suggest that limitations in the quality of care that LCs provide are largely driven by structural factors, such as lack of up-to-date training and educational supports, rather than individual bias. While LCs generally possess strong foundational HIV knowledge, there is a clear need for targeted, HIV-specific lactation support training that emphasizes current recommendations and shared decision-making. Strengthening knowledge in these areas, as well as integrating tele-lactation support into HIV care systems, can better equip LCs to provide informed and non-stigmatizing support to people living with HIV in the postpartum period.
Limitations
This was a cross-sectional study, and as such no causal relationships can be established. As data were collected through a self-reported survey, responses may also be subject to social desirability bias. In addition, the sample included a larger number of US-based LCs, which may limit the generalizability of the findings to Canada or broader global settings.
Resource
Barr E, Abuogi L, Lingwall M et al. Breastfeeding support for women with HIV: lactation consultant HIV-knowledge, attitudes, stigma, and tele-lactation experiences. AIDS.2026 Mar 16;40(5):547–55.
REFERENCES:
- Khan S, Tsang KK, Brophy J et al. Canadian Pediatric & Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context. Journal of the Association of Medical Microbiology and Infectious Disease Canada. 2023 Jan 26;8(1):7-17.
- US Department of Health and Human Services. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. 2024 May 15. Available from: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/preventing-transmission-infant-feeding