There are ways to reduce postnatal transmission of HIV via breastfeeding. This is a list of the current recommendations:

*Providing adequate lactation counseling and support to prevent breast conditions. Improper positioning and attachment at the breast and infrequent feedings can cause cracked nipples and mastitis (an inflammation of the breast). A breast abscess—a localized collection of pus—usually results from untreated mastitis. Cracked nipples, mastitis, and breast abscess are three conditions associated with higher transmission of HIV through breastfeeding. Studies suggest that approximately 11–13 percent of HIV-infected women experience one or more of these conditions during breastfeeding, often during the early weeks when the risk of HIV transmission is thought to be greater. Preventable and treatable breast conditions may be responsible for up to half of HIV transmission through breastfeeding.4 Counseling on good breastfeeding techniques at the onset of lactation can help prevent breast problems. In a study in Bangladesh, the prevalence of severe inflammation of the breast was three times greater in women who had not received counseling than those who had.

*Counsel women to recognize breast conditions and seek treatment immediately.

*Counsel on exclusive breastfeeding (feeding only breastmilk, with no other foods, fluids, or even water). For mothers who are HIV-negative or who do not know their status, exclusive breastfeeding is universally recommended as the optimal infant feeding practice for the first 6 months of life.

*Assist families with decisions about transitioning from breastfeeding to replacement feeding (replacing breastmilk with a diet that provides all the nutrients the child needs).

*Antiretroviral treatment to keep HIV-infected mothers healthy may be one of the most important ways of preventing postnatal HIV transmission. Treat the mother with a combination of antiretroviral (ARV) drugs. The World Health Organization recommends that if mothers taking ARV treatments to delay disease progression choose to breastfeed, they should continue their ARV regimen even though the effects on infant health and on transmission through breastfeeding have not yet been evaluated.

*Provide antiretroviral prophylaxis for PMTCT. In situations where combination therapy is either not indicated or not available, prophylactic therapy with antiretroviral drugs taken by the mother and infant about the time of delivery reduces the risk of perinatal transmission. Several regimens are approved for this purpose. The regimen most commonly used in resource-limited settings involves 200mg of nevirapine given orally to the mother at delivery and 2mg/kg given to the neonate within 72 hours.

*Counseling on safer sex should be a component of PMTCT programs. The risk of transmission through breastfeeding is higher if the mother is newly infected during lactation.

*Nutritional interventions for the HIV-infected mother may improve her health and quality of life, provide additional nutrients to support pregnancy and lactation, and meet the increased energy needs resulting from the HIV infection.

*Some micronutrient supplements have been shown to improve the survival of HIV-infected adults with more advanced infection. Lactation also increases nutritional requirements. To support lactation and maintain maternal reserves, breastfeeding mothers (whether infected or not) should consume the equivalent of about one extra meal per day.