{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:15:10Z","timestamp":1784740510739,"version":"3.55.0"},"reference-count":79,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":731,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2019]]},"abstract":"<jats:p>To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.<\/jats:p>","DOI":"10.1177\/1073110519840495","type":"journal-article","created":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T10:23:52Z","timestamp":1555496632000},"page":"152-160","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":34,"title":["Breastfeeding with HIV: An Evidence-Based Case for New Policy"],"prefix":"10.1017","volume":"47","author":[{"given":"Marielle S.","family":"Gross","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly A.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Tomori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenell S.","family":"Coleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,1,1]]},"reference":[{"key":"S1073110500021951_bib7","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000212"},{"key":"S1073110500021951_bib24","first-page":"1","article-title":"\u201cInfant Mortality Statistics from the 2013 Period Linked Birth\/Infant Death Data Set,\u201d","volume":"64","author":"Matthews","year":"2015","journal-title":"National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System"},{"key":"S1073110500021951_bib39","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/QAD.0000000000001707","article-title":"\u201cImproving Postpartum Retention in Care for Women Living with HIV in the United States,\u201d","volume":"32","author":"Momplaisir","year":"2018","journal-title":"AIDS"},{"key":"S1073110500021951_bib66","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052224"},{"key":"S1073110500021951_bib44","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30098-5"},{"key":"S1073110500021951_bib26","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-008-1007-7"},{"key":"S1073110500021951_bib49","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000433008.93971.6a"},{"key":"S1073110500021951_bib65","unstructured":"65. 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American College of Obstetricians and Gynecologists Women's Health Care Physicians and Committee on Health Care for Underserved Women, supra note 49."},{"key":"S1073110500021951_bib6","unstructured":"6. Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission, supra note 1."},{"key":"S1073110500021951_bib74","unstructured":"74. Jacobson et al., supra note 47; American College of Obstetricians and Gynecologists Women's Health Care Physicians and Committee on Health Care for Underserved Women, supra note 49; Jordan et al., supra note 53; Islami et al., supra note 56."},{"key":"S1073110500021951_bib52","unstructured":"52. Victora et al., supra note 2; Kochanek et al., supra note 30."},{"key":"S1073110500021951_bib64","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2010.01791.x"},{"key":"S1073110500021951_bib48","unstructured":"48. Victora et al., supra note 2."},{"key":"S1073110500021951_bib72","unstructured":"72. 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