Navigating Guidelines and Realities: HIV and Breastfeeding in Global and Local Contexts

Infant feeding counseling is an essential part of HIV care throughout reproductive life. Ideally, this counseling starts preconception, continues during pregnancy, and is revisited postpartum. A patient-centered approach highlights shared decision-making, aligning clinical guidance with individual values, preferences, and feeding plans. While U.S. guidelines have traditionally recommended formula feeding or the use of pasteurized donor milk to eliminate any risk of HIV transmission, this approach does not fully recognize the benefits of breastfeeding for both mother and infant. Emerging evidence indicates that for individuals on antiretroviral therapy (ART) with a consistently undetectable viral load, the risk of HIV transmission through breastfeeding is very low—though not completely absent. Therefore, counseling must weigh risk reduction with respect for maternal autonomy and the psychosocial, cultural, and health benefits of breastfeeding.

Although most data on HIV transmission through breast milk originates from studies in low- and middle-income countries, interest in breastfeeding among people with HIV and their healthcare providers is increasing in high-income settings, including the United States. Emerging challenges—such as mastitis, low milk supply requiring supplementation, fluctuations in viral load, and difficulty with weaning—highlight gaps in clinical guidance and underscore the need for further research. In particular, optimal strategies for managing infant feeding following perinatal HIV exposure remain underexplored and warrant focused attention.

We welcome submissions that critically engage with the multifaceted dimensions of infant feeding among people living with HIV (PLWH). Manuscripts may address a range of social, clinical, policy, and advocacy themes across local and global contexts.
Themes of Interest:
• Multilevel Influences on Infant Feeding Decisions:
o Individual, interpersonal, community, and structural factors
o Cultural norms, stigma, and reproductive autonomy
o Shared decision-making in clinical care
• Clinical Practice and Guideline Implementation:
o Impact of evolving perinatal HIV guidelines on provider practices
o Management of breastfeeding complications (e.g., mastitis, viral load fluctuations)
o Infant feeding and prophylaxis strategies (e.g., preterm infants, mixed feeding)
o Counseling and support strategies before, during, and after pregnancy
• Advocacy and Equity Considerations:
o Reproductive justice and informed choice in infant feeding
o Ethical and policy considerations for perinatal care in high- and low-resource settings
o Health equity frameworks for supporting PLWH and their families
• Lived Experiences and Community Perspectives:
o Narratives from parents living with HIV
o Community-led interventions or support networks
o Role of doulas, peer counselors, and other birth workers
Types of Manuscripts Welcomed:
• Original Research Articles (qualitative, quantitative, or mixed methods)
• Policy Analyses and Commentaries
• Case Studies and Implementation Reports
• Review Articles and Evidence Syntheses
• Opinion Pieces and Advocacy Essays
We encourage contributions from researchers, clinicians, advocates, and community members working across disciplines to advance understanding and support of infant feeding in the context of HIV.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Policy Brief
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: chest/breastfeeding, HIV, pregnant people, infant feeding, maternal and child health

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.