Understanding International Policy
on HIV and Breastfeeding:
a comprehensive resource

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Section 6: Glossary, definitions and further resources

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This section contains:

Glossary/definition of terms
Acronyms and Abbreviations
Resources on HIV and breastfeeding listed alphabetically and with website addresses, where known, on

o Policy
o Reports
o Training materials, manuals and job aids
o Slides and videos
o Review articles
o The Code

Glossary/Definition of Terms Used

Abrupt weaning means immediate cessation of breastfeeding which may be forced on the infant by the mother, or on the mother and infant by others.

AIDS means Acquired immunodeficiency syndrome: the active pathological condition that follows the earlier, non-symptomatic state of being HIV-positive.

AFASS Acceptable, feasible, affordable, sustainable and safe – the conditions required for safe replacement feeding in previous policy, now updated

ART, an abbreviation of antiretroviral therapy and usually meaning one or two antiretroviral drugs used to treat people infected with HIV to reduce their viral load.

ARV, an abbreviation of antiretrovirals, meaning antiretroviral therapy or antiretroviral prophylaxis

Breastmilk substitute refers to any food being marketed or otherwise represented as a partial or total replacement for breastmilk, whether or not suitable for that purpose.

CD4 cells (also known as T4 or helper T cells) are lymphocytes (a type of white blood cell), which are important in immune responses. These are the main target cells for HIV. Their numbers decrease during HIV infection, and their level is used as a marker of progression of the infection.

Cessation of breastfeeding means completely stopping breastfeeding, which includes no more suckling at the breast.

Child refers to a child aged aged 0 – 5 years.

Commercial infant formula, a product that meets the applicable Codex standard for infant formula.

Complementary food means any food, whether manufactured or locally prepared, used as a complement to breastmilk or to a breast-milk substitute, when either becomes insufficient to fully satisfy the nutritional requirements of the infant.

Codex Alimentarius Standards are internationally recognised standards of food and food safety, developed by a Commission established by WHO and FAO.

Cup feeding means feeding an infant or child using a cup.

ELISA means the Enzyme Linked Immunosorbent Assay HIV test which identifies antibodies to HIV in an infected person's blood.

Exclusive breastfeeding means an infant receives no other food or drink, not even water, other than breastmilk (which can include expressed breastmilk), with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines. When expressed milk is given, the preferred term is breast milk feeding.

Formula feeding: involves the use of commercial infant milk that is formulated industrially in accordance with applicable Codex Alimentarius standards.

HAART means highly active antiretroviral therapy – a combination of three or more different antiretroviral drugs at the same time.

Health care worker means a person who is involved in the provision of health services to a user, including lay counsellors and community caregivers.

HIV, Human Immunodeficiency Virus, the viral infection which destroys parts of the body's immune system

HIV-exposed infant: Infant born to an HIV-positive woman.

HIV-free survival means the absence of a combined outcome of either (1) HIV infection or (2) death before HIV infection due to other causes. This concept has emerged as a consensus outcome to evaluate strategies.

HIV-negative refers to people who have had an HIV test and who know that they tested negative, or to young children who have tested negative and whose parents or guardians know the result.

HIV-positive refers to people who have had an HIV test and who know that they tested positive, or to young children who have tested positive and whose parents or guardians know the result.

HIV postnatal transmission is defined in an infant who has had a negative HIV-1 PCR at 30 days of age and who later has either a positive PCR result or, if older than18 months, shows a positive HIV serology.

HIV status unknown refers to people who either have not taken an HIV test or who have had a test but do not know the result.

HIV-infected refers to people who are infected with HIV, whether or not they areaware of it.

Infant refers to a baby or child less than 12 months of age.

Informed choice means receiving or acquiring sufficient information with which to reach a knowledgeable decision.

Mixed feeding means breastfeeding with the addition of fluids, solid foods and/or non-human milks such as formula and ready-to-use therapeutic foods before the age of six months.

MTCT means Mother To Child Transmission of HIV, also known as vertical transmission, postnatal transmission, or parent-to-child transmission (PTCT) or HIV-transmission to infants. MTCT is the term most often used for HIV transmission during pregnancy, birth or breastfeeding, because the immediate source of the child's HIV infection is the mother. Some people advocate for use of the terms parent-to-child transmission, or vertical transmission to avoid the blame for infection seeming to be the responsibility of the mother alone, when she is likely to have been infected through unprotected sex with an infected partner; often the child's father. Consensus on the use of one or other of these terms has not been reached. In this HIV Kit WABA also uses terminology such as paediatric HIV and perinatal HIV transmission in preference to MTCT.

Newborn or neonate means an infant aged from birth to 28 days.

Opportunistic infection means an infection that can infect people when their immune system is weakened, as with HIV infection, but not when they are healthy.

Parent to child transmission or PTCT means vertical transmission or postnatal transmission. This term is used to avoid the blame for infection seeming to be the responsibility of the mother alone, when she is likely to have been infected through unprotected sex with an infected partner; often the child's father. Consensus on the use of one or other of these terms has not been reached. MTCT remains the most commonly used term.

Paediatric HIV means HIV in children. This term is used in connection with the child's infection and illness, whatever the source and to recognise that not all children's infections come from the mother.

Perinatal HIV transmission is defined as HIV transmission from mother to child during pregnancy, labor and delivery.

PCR means the Polymerase Chain Reaction HIV test, which tests for copies of HIV in blood and other body fluids including breastmilk.

PITC means Provider Initiated Testing and Counselling.

PMTCT means Prevention of Mother To Child Transmission, and is often used to describe preventive programmes.

Postnatal transmission means vertical transmission of HIV during the breastfeeding period, measured as occurring 4 – 6 weeks after birth in a baby who is breastfed. It may be used interchangeably with MTCT, PTCT or vertical transmission.

Replacement feeding means the process of feeding a child who is not receiving any breastmilk with a diet that provides all the nutrients the child needs until the child is fully fed on family foods.

'Spillover' is a term used to describe the unnecessary spread of artificial feeding among mothers who either know that they are HIV-negative or do not know their HIV status – they do not breastfeed, or they breastfeed for a short time only, or they mix-feed, because of unfounded fears about HIV, or misinformation, or the ready availability of breast-milk substitutes.

Stigma means a mark or sign of disgrace or discredit.

Vertical transmission means transmission of HIV from the mother to an infant, during pregnancy, birth or breastfeeding, also known as mother to child transmission, or MTCT.

Weaning means the process of feeding the infant any other food or drink apart from breast milk or expressed breast milk and drops or syrups consisting of vitamins, mineral supplements or medicines.

Young child means a toddler or child from aged from 12 – 36 months.

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Acronyms and Abbreviations

BHITS study

WHO Guidelines 2010

less than or equal to
Acquired Immune Deficiency Syndrome
Antiretroviral therapy, usually means 1-2 drugs, used in early studies
zidovudine (also known as ZDV)
Baby Friendly Hospital Initiative
Breastfeeding and HIV International Transmission Study
Combined antiretroviral therapy
Centers for Disease Control and Prevention
Deoxyribonucleic Acid
Exclusive Breastfeeding
Enzyme Linked Immunosorbent Assay
Food and Agrigulture Organization
Fixed dose combination ART, e.g., lamividine, stavudine, and nevirapine
Highly Active Antiretroviral Therapy, 3 or more drugs for more effective treatment used in later studies
Human Immunodeficiency virus
International Atomic Energy Agency
Infant feeding
Infant and young child feeding
cubic millimetre
Mother-to-Child Transmission of HIV
Non-governmental organization
Polymerase Chain Reaction
People Living with HIV
Prevention of Mother-to-Child Transmission
Replacement Feeding
Ribonucleic acid, one of the three major macromolecules (along with DNA and proteins) that are essential for all known forms of life
single dose NVP
United Nations Agencies
Joint United Nations Programme on HIV/AIDS
United Nations Population Fund
United Nations Commissioner for Refugees
United Nations Children's Fund
U.S. Agency for International Development
World Alliance for Breastfeeding Action
United Nations World Food Programme
World Health Assembly
WHO 2010 Guidelines on HIV and infant feeding
World Health Organization
Zidovudine (same drug as AZT)

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Policy Documents

American Academy of Pediatrics 2012, Breastfeeding and the use of Human Milk, Policy Statement, published online Pediatrics, February 27, 2012;DOI: 10.1542/ peds.2011-3552 - full pdf + html

BHIVA & CHIVA Position statement on infant feeding in the UK, Nov 2010 (accessed 2 February 2011 ) Published as: Taylor GP, Anderson J, Clayden P, Gazzard BF, Fortin J, Kennedy J, Lazarus L, Newell M-L, OsoroB, Sellers S, Tookey PA, Tudor-Williams G, Williams and De Ruiter A for the BHIVA/CHIVA Guidelines Writing Group. British HIV Association and Children's HIV Association position statement on infant feeding in the UK 2011. HIV Medicine DOI: 10.1111/j.1468-1293.2011.00918.x

IBFAN-Asia Position Statement on HIV and Infant Feeding, 13 October 2008

South African Tshwane Declaration on breastfeeding, S Afr J Clin Nutr 2011 ;24(4)

UNAIDS 2010, Strategy Getting to Zero, UNAIDS Strategy 2011 – 2015

UNAIDS 2010, Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, 2010-2014

UNAIDS 2011, Countdown to Zero: Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011 - 2015

UNAIDS 2011 Press Release, 9 June, World leaders launch plan to eliminate new HIV infections among children by 2015

UNICEF Convention on the Rights of the Child

UNICEF 2010, Facts for Life

UNICEF 2011, Programming Guide, Infant and Young Child Feeding, 26 May 2011

WHO/UNICEF 2003, Global strategy for infant and young child feeding

WHO 2007, Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis

WHO, UNAIDS, UNICEF 2009, Towards universal access: scaling up priority HIV/AIDS interventions in the health sector : progress report 2009

WHO 2009, Women and health, Today's evidence tomorrow's agenda

WHO 2009, Acceptable medical reasons for use of breast-milk substitutes

WHO 2009, Rapid advice: use of antiretroviral drugs for treating pregnant womenand preventing HIV Infection in infants

WHO 2009, Rapid advice: revised WHO principles and recommendations on infant feeding in the context of HIV

WHO 2010, Priority Interventions – HIV/AIDS prevention, treatment and care in the health sector

WHO 2010, Guidelines on HIV and infant feeding: Principles and recomendations for infant feeding in the context of HIV and a summary of evidence

WHO 2010, Annexure 7b to Guidelines on HIV and infant feeding. Williams B, HIV-free survival in infants ARV and breastfeeding or replacement feeding: What is the best strategy?

WHO 2010, Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, Recommendations for a public health approach

WHO Feb 2010, PMTCT strategic vision 2010–2015 : preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals

WHO 2010, Guidelines on HIV and infant feeding, an updated Framework for Priority Action (copyright WHO 2012)

WHO/UNICEF/UNAIDS 2011, Global HIV/AIDS response – Epidemic update and health sector progress towards Universal Access – Progress Report 2011

WHO 2011, Global health sector strategy on HIV-AIDS, 2011 – 2015

WHO 2012, Programmatic Update – Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants (versions available in English, French, Spanish and Portuguese)

Yezingane Network and UNICEF, December 2010, updated July 2011, Infant feeding in South Africa in the context of HIV, Questions and Answers

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IAS, WHO, UNICEF, UNAIDS, Consensus Statement, "Asking the Right questions: Advancing an HIV Research Agenda for Women and Children", dated 8 March, 2010

IBFAN, Press Release 2012 on the Right to Adequate Food, Digest of the "Report of the Special Rapporteur on the Right to Food to the Human Right Council (A/HRC/19/59)"

IYCN Project Preventing malnutrition of mothers and children within the context of HIV and emergencies (Haiti)

UNICEF 2011, Levels & trends in child mortality, Report 2011

US Expert Panel Report & Recommendations to the US Congress and US Global AIDS Coordinator Prevention of Mother-to-Child Transmission of HIV, Jan 2010, Summary of successes and challenges of PMTCT, as well as recommendations for improved implementation

UNAIDS 2011, Countdown to Zero: Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011 - 2015

UNAIDS 2011 (with WHO and UNICEF) Global epidemic update

UNICEF 2011, Levels & trends in child mortality, Report 2011

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Training Materials and Manuals

Academy of Breastfeeding Medicine, lactation/breastfeeding protocols

BPNI/IBFAN Asia, The '4 in 1' Training Programme, Capacity building initiative for building health workers' skills in Infant and Young Child Feeding Counseling, Updated and revised course based on WHO and UNICEF's 3 training courses on breastfeeding, Complementary feeding, HIV& Infant feeding counseling with addition of Growth monitoring as the 4th component launched on 3rd December 2011. Brochure

Emergency Nutrition Network 2007, Infant Feeding in Emergencies: Version 1.1 for health and nutrition workers in emergency situations, Developed through collaboration of ENN, IBFAN-GIFA

Fondation Terre des hommes, Action Contre la Faim, CARE USA, Linkages, UNICEF, UNHCR, WHO and WFP. for training, practice and reference, December 2007

IBFAN Training Courses on the Code

ICAP, 2010 Improving Retention, Adherence, and Psychosocial Support within PMTCT Services: Implementation Workshop for Health Workers

IYCN Project, The roles of grandmothers and men: evidence supporting a familyfocused approach to optimal infant and young child nutrition

IYCN Project Mother-to-Mother Support Groups Trainer's Manual - Facilitator's Manual with Discussion Guide

IYCN Project, 2010, Infant Feeding and HIV: Trainer's guide and participant's manual for training community-based workers and volunteers

IYCN Project 2010, Infant Feeding and HIV: Participant's manual for community-based workers and volunteers

IYCN Project, Infant and Young Child Feeding and Gender: A Training Manual for Male Group Leaders and Participant Manual for Male Group Leaders

IYCN Project 2012, Helping an HIV-positive breastfeeding mother decide how to feed her child at 12 months: A checklist for health care providers

IYCN Project
2012, Community interventions to promote optimal breastfeeding; evidence on early initiation, any breastfeeding, exclusive breastfeeding and continued breastfeeding; literature review, January 2012

UNICEF 2011, Community IYCF Counselling Package - The technical content of this package reflects the Guidelines on HIV and Infant Feeding 2010: Principles and Recommendations for Infant Feeding in the Context of HIV and a Summary of Evidence related to IYCF in the context of HIV. The package was reviewed by WHO headquarters colleagues and external reviewers, with input from the Ministry of Health, UNICEF-Zambia. The package contains:

UNICEF 2011, Participant materials, the community IYCF counselling package

UNICEF 2010, Facilitator Guide

UNICEF 2010 Community based infant and young child feeding materials

UNICEF 2010, Key messages booklet

UNICEF 2010, IYCF Counselling cards for community workers

UNICEF 2010, Training Aids

USAID, South African Paediatric Care & Treatment Toolkit

Wellstart International, Infant and Young Child Feeding in Emergency Situations, updated 2005

WHO/UNICEF 1993 Breastfeeding Counselling: A Training Course, Participants Manual, from World Health Organization/CDR/93.3-6, 1993 a 40-hour course for counsellors who care for women and young children

WHO 2007, Safe preparation, storage & handling of powdered infant formula

WHO 2007 Guidance on provider-initiated HIV testing and counseling in health facilities. May 2007

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Slides and Videos

Abrams E, Eliminating vertical transmission, Rights here, right now: Slide presentation at XVIII International AIDS Conference, July 18-23, 2010, Vienna, Austria

ICAP Infant Feeding in the Context of HIV slide set

ICAP Video, Saving two lives: Improving retention, adherence & psychsocial support within PMTCT services, Uploaded by ICAP Columbia on 3 Mar 2011
This video is a component of the "Improving Retention, Adherence and Psychosocial Support within PMTCT Services: A Toolkit for Health Workers," ; reinforces key PMTCT messages; can be shown to a wide range of audiences, including PMTCT clients, family members, and caregivers of HIV-exposed and HIV-infected children; including in clinic waiting rooms, as part of group education sessions, and in the community.

Israel-Ballard K, HIV in breastmilk killed by flash-heating, new study finds, Demonstration of flash-heating breastmilk, UC Berkeley, 15 May 2007

Mbori-Ngacha D, Elimination of mother-to-child transmission, Plenary presentation, CROI 2012 Seattle, Washington, 7 Mar 2012

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Useful Review Articles

Cavarelli M and Scarlatti G, Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies. Journal of Internal Medicine, 2011. doi: 10.1111/j.1365-2796.2011.02458.x

Coovadia H, Kindra G. Breastfeeding to prevent HIV transmission in infants: balancing pros and cons. Curr Opin Infect Dis. 2008 Feb;21(1):11-5.

Coutsoudis A, Coovadia HM & Wilfert CM, HIV, infant feeding and more perils for poor people: new WHO guidelines encourage review of formula milk policies, Bulletin of the World Health Organization 2008;86:210–214

Coutsoudis A, Goga AE, Rollins N, Coovadia HM: Free formula milk for infants of HIVinfected women: blessing or curse? Health Policy Plan 2002 17(2):154-160).

International AIDS Society and 15 other leading organizations, including WHO, UNICEF and UNAIDS, Consensus Statement, "Asking the Right questions: Advancing an HIV Research Agenda for Women and Children", dated 8 March, 2010

International Breastfeeding Journal, Thematic issue on HIV and infant feeding: Lessons learnt and ways ahead, reports from sub-Saharan Africa, including South Africa, Uganda, Malawi and Ethiopia, edited by Dr Karen Marie Moland and Dr Astrid Blystad, Collection published: 26 October 2010

Kuhn L, Reitz C and Abrams EJ, Breastfeeding and AIDS in the developing world. Current Opinion in Pediatrics 2009, 21:83–93

Kuhn L and Aldrovandi G, Survival and Health Benefits of Breastfeeding Versus Artificial Feeding in Infants of HIV-Infected Women: Developing Versus Developed World. Clin Perinatol 37 (2010) 843–862.

Kuhn L, Aldrovandi G. Pendulum Swings in HIV-1 and Infant Feeding Policies: Now Halfway Back. Adv Exp Med Biol. 2012;743:273-87.

Latham M, Kisanga P. Current Status of Protection, Support and Promotion of Breastfeeding in four African Countries. Actions to Protect, Support and Promote Breastfeeding in Kenya, Namibia, Botswana and Uganda. Edited by UNICEF ESARO. UNICEF: Mbabane; 2001

Mofenson LM. Antiretroviral drugs to prevent breastfeeding HIV transmission. Antiviral Therapy 2010;15:537-553 (doi:10.3851/IMP1574)

Morrison P, Greiner T, Israel-Ballard K, Informed choice in infant feeding decisions can be supported for HIV-infected women even in industrialised countries, AIDS 2011, 25:1807–1811, e-pub ahead of print AIDS, 1 August 2011

NAM, ARV drug chart, Dec 2011

Sturt AS, Dokubo EK, Sint TT. Antiretroviral therapy (ART) for treating HIV infection in ART-eligible pregnant women. Cochrane Database Syst Rev. 2010;CD008440. Young SL, Mbuya MNN, Chantry CJ, Geubbels EP, Israel-Ballard K, Cohan D, Vosti SA and Latham MC, Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic, Adv. Nutr 2011 ;2: 225–243, doi:10.3945/an.11 0.000224 full pdf+html

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The Code

Allain A, Yeong JK. Eds. Code Essentials 1: annotated International Code of Marketing of Breastmilk Substitutes and Subsequent WHA resolutions. Penang, Malaysia; ICDC (International Code Documentation Centre), September 2008

Allain A, Yeong JK. Eds. Code Essentials 2: Guidelines for Policy Makers on Implementing the International Code of Marketing of Breastmilk Substitutes and Subsequent WHA resolutions. Penang, Malaysia; ICDC (International Code Documentation Centre), February 2009

Allain A, Yeong JK. Eds. Code Essentials 3: Responsibilities of Health Workers under the International Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions. Penang, Malaysia; ICDC (International Code Documentation Centre), March 2009

IBFAN breakdown of the Code, by section

IBFAN Penang (ICDC) Health Workers Guide to the Code - 11th edition, Jan 2010, completely rewritten and updated

IBFAN Training Courses on the Code

ICDC Focus, The Code and infant feeding in emergencies

UNICEF 2007, Protecting Breastfeeding in West and Central Africa: 25 years implementing the International Code of marketing of breastmilk substitutes
(authors Sokol E, Aguayo V, Clark D)

WHO 1981, International code of marketing of breast-milk substitutes. Geneva: WHO
Also see subsequent related World Health Assembly Resolutions and responses to frequently asked questions on the Code

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updated 9 May, 2015

World Alliance for Breastfeeding Action (WABA)

The Mother and Child Health and Education Trust
a U.S. 501(c)(3) non profit organization
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