Support the wellbeing of children with HIV in SA

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Breastfeeding and prevention of mother to child transmission of HIV

Breastfeeding is universally accepted as the food of choice for all young infants. It provides all the nutritional requirements for infants up to six months of age – there is no need for additional food or water and also has other non-nutritional properties that are necessary for optimal growth and brain development in young babies. As such, the global recommendations for optimal nutrition of young infants and children by the WHO and UNICEF is exclusive breastfeeding for the first six months of an infant’s life and introduction of nutritionally adequate and safe complementary feeding beginning at six months of age with continued breastfeeding for up to two years of age.

The benefits of breastfeeding, both short and long term are multiple and varied.

Benefits for the baby

Breastfeeding is cost effective and readily available. Breast milk makes the baby’s immune system strong because it contains unique antibodies. Infections like pneumonia and ear infections are more common and more severe in infants who are not breastfed. Breastfeeding has been shown to have a protective effect against necrotizing enterocolitis (inflammation of the bowels) in premature infants. Breastfeeding reduces the risk of allergy mediated diseases such as type one diabetes and asthma later in life. Breastfeeding is associated with greater intelligence in older childhood and adulthood. Breastfeeding has also been shown to potentially have a protective effect on obesity and childhood leukaemia. The use of formula milk in developing countries may increase the risk of mortality in young children by causing diarrhoeal diseases. Formula feeding is also associated with poor growth and development.

Benefits for the mother

Breastfeeding also has short and long term benefits for the mother. It results in a quicker contraction of the womb after delivery and thus minimizes bleeding after delivery. Breastfeeding promotes mother and child bonding and has been shown to be protective against depression or post-delivery “blues”. Breastfeeding assists may also be a form of contraception by delaying the periods from returning after the baby. (You still need to use additional contraception though!) Women who breastfeed their infants have been found in studies to have a decreased risk of having breast and ovarian cancer than their non breastfeeding counterparts.

Unfortunately, the HIV pandemic has resulted in conflicting messages about breastfeeding and this has overshadowed the benefits associated with breastfeeding. Breastfeeding has also been under threat from the competitive and often unethical promotion of industrial breast milk substitutes by companies producing formula milk.

Research has shown that the HI virus is transmitted through breast milk from the breastfeeding mother to her infant, and the risk of transmission is present for as long as the infant is breastfed. Public health experts estimate that HIV-infected mothers have a 10 to 15 percent chance of passing the virus to their newborns through their breast milk.In developed countries, women who are HIV infected are encouraged to avoid breastfeeding. This is because avoidance of breastfeeding in the developed world is not accompanied by the adverse results of formula feeding seen in developing countries. In the developing countries, avoidance of breastfeeding is associated with increased risk of death and poor growth and development due to increased risk of diarrhoeal and respiratory infections and malnutrition. As such, HIV infected women in developing countries are faced with the dilemma of either transmitting the HI virus to their infants through breastfeeding or risking their children dying, malnutrition and poor growth if they avoid breastfeeding.

Policies that encouraged the avoidance of breastfeeding are based on studies from developed countries and have been shown to be inappropriate for the developing countries.

We now know from extensive research that exclusive breastfeeding lowers the risk of mother to child transmission of HIV. Antiretroviral treatment given to the mother and the baby also lowers the transmission of HIV from mother to infant. Antiretroviral treatment for the prevention of mother to child transmission (PMTCT) has evolved over the years from a single drug (Nevirapine) given to the mother in labour to fixed dose combination antiretroviral drugs. Atroiza is a combination of three drugs that are used in treating HIV: Tenofovir, Emtricitabine and Efavirenz. Atroiza is taken once daily by all pregnant women who test HIV positive during their antenatal care. The combination treatment is continued throughout the pregnancy and during breastfeeding. The newborn HIV exposed baby is also started on a daily dose of Nevirapine syrup for six weeks. The provision of combination antiretroviral drugs to both mother and baby and exclusive breastfeeding for six months with continued breastfeeding up to one year as recommended in the current South African PMTCT policy of April 2013 makes breastfeeding much safer even in HIV positive women.

The problem is that most breastfeeding mothers do not practice exclusive breastfeeding. Breastfed babies often receive water, formula and even other foods in combination with breastmilk before six months of age. Mixed feeding (mixing breast milk with water, other foods or formula) increases the risk of the HI virus being transmitted to the baby because the young infants delicate bowels become damaged by the foods which make it easy for the virus to get into the baby through the cracks.

The challenge for health care professionals is to educate and support mothers to exclusively breastfeed for the first six months of an infant’s life. There is a need to expel myths and change mindsets towards exclusive breastfeeding by continuous education and support. This together with the provision of antiretroviral drugs as per national policy will ensure that babies get the full benefits of breastfeeding and remain free of HIV infection.

In conclusion

Exclusive breastfeeding, even in HIV positive women is an important strategy for child survival. If antiretroviral drugs are given to both mother and baby and an HIV-positive woman is fully adherent with the treatment throughout the duration of breastfeeding, the actual risk of transmitting HIV through breast milk is exceedingly low.

The best food for all babies is still breast milk. This is true whether or not a mother is HIV infected.

Some exciting developments have been taking place for the “My Living Positively Handbook” which helps children cope with living with HIV and the associated stigma, treatment regimens, communicating with others, and self- esteem. A community nurse, from the Matunkha Centre in Northern Malawi contacted Children’s Rights Centre, with interest in our handbook. I have copied part of her email to us below:

“I am doing home based care and palliative care. In our program we have at least 60 children who are HIV-positive. It's very difficult to find good teaching materials for these children. Next month I hope to open a ART- clinic and I think more children will come.

A friend gave me 'My living positively handbook'. I'd like to try-out this book to see if it is useful here. One of the steps I have to take is to translate it in Chitumbuka.”

At least two significant aspects of this feedback are important for us. Firstly that the book has reached not only children in South Africa, but that people believe in it so much to share it with others even so far as Malawi. Secondly, the impact that this book is having in children’s lives is significant enough for people to invest their own time, money and energy to translate it into their own language. We have been able to share the necessary documents and templates with this organization to allow for an easier update of this book, and will review the content once it has been translated to ensure the quality is still maintained.

We would like to thank you, our donors once again for your support and we hope that this feedback encourages and inspires you, as your support makes a real difference in children’s lives.

Thank you,

Kyle Ballard

Dear Valued Donors,


We are pleased to share with you that the My Living Positively Handbook for HIV infected and affected children has had continued impact into 2013.


In the months of January and February 2013 we have distributed a total of 401 Handbooks for children and 421 Guides for adults. These went to 7 provinces in South Africa including Mpumalanga, Free State, Limpopo, Gauteng, KwaZulu-Natal, and Western Cape. These have been specifically distributed into rural areas to provide a valuable resource for children and adults for understanding their HIV treatment, and dealing with the stigma they experience. Often this handbook is the first book a child or household owns, and therefore has a huge impact in assisting children and their caregivers to understand HIV and provides the tools needed to help cope with its effects.


We would like to thank you for your continued support of this project as your contributions truly have a lasting impact on the wellbeing of children in South Africa.

If you have not done so already, please consider also supporting our newly launched Campaign aimed at preventing HIV transmission to new born babies.

Thank you,

Kyle Ballard.

Dear valued Donors,

We are pleased to announce our newly launched project on Global Giving! We are very excited about this project which focuses on preventing HIV being transmitted from HIV positive mothers to their babies. This is a major issue needing to be addressed in South Africa and one that we are excited to be working on.

Please click the link below to see the project on the Global Giving website, and the next link below to see our first report giving additional details about what work we have started on the project. We would greatly appreciate if you could support us in this project in any way.

Thank you,

Kyle Ballard.

"My Living Positively" Book
"My Living Positively" Book

Congratulations, It's a Book!

Earlier this year, I was fortunate to visit the Children's Rights Centre in Durban.

I met their program and communications staff at their brand new building in order to get a tour of their facilities and spend a few hours chatting via skype with a beneficiary of their most recent publication, "My Living Positively" children's book. The hour-long conversation was spirited, informative, and inspiring. But the icing on the cake was getting to join the office for a delicious leftover "brai" (South African BBQ).

The "My Living Positively" workbook is already impacting thousands of children, aiding caregivers and social workers to better explain to young children and teenagers the realities of HIV, including how they can better advocate for themselves. The book, a glossy and attractive booklet of photos, real stories, coloring material, charts, facts, and figures, is the ultimate companion for children, caregivers, and practioners.

My favorite piece of feedback came from Shanaaz Randeria of the Wits Reproductive Health & HIV Institute, who has been using the book to run workshops and play therapy for children:

"Using the stories from the book makes it a lottle more acceptable for children and their caregivers to normalize HIV. Also, the advantage of using the handbook is that it speaks in a language that is understandable to children and caregivers, but still gives relevant and important information."

The CRC's Play-full Environment

Besides the huge success of "My Living Positively" it was a treat getting to know the staff at CRC as well. 

I will never forget the many conversations I had with Julie, CRC's executive director, about what it means to do truly transformational work in the children's rights arena, and the importance of partnering with young people (with all their "digital talents") in future advocacy efforts. As a relatively young person myself, it gave me hope to hear from leadership of a well-established organization that it's still important to create space for people like myself.

Janet, who hosts workshops for HIV+ children in the townships and rural areas, was excited to show me another publication that CRC released called the "The Chance to Play", which details and documents various do-it-yourself and street play games for children across South Africa, from self-made board games on cardboard to soccer goal posts constructed from wood and/or plastic.

Jacquie, who works on communications and social media for the organization, was knee-deep in preparations for their Annual General Meeting presentation on "virtual learning" for a group of community stakeholders. Her passion for using technology to further social progress shone through when she took an impromptu 20 minutes to chat with me in the staff room about NGO culture, new media trends, and using youth pop culture as a gateway for education.

Meanwhile, Kyle, whose office is nicknamed the "fish tank" (and so who makes funny floating-fish movements when you walk by, is the go-to guy for nearly everything: from setting up skype meetings to gather feedback from practioners, to managing the GlobalGiving profile (really well, I must add), and being the liason between government and civil society's new initiative to create a national guide to disclosing (HIV status) for children.

CRC's culture of openness, determination, creativity, and "fun" oozes from every single member of the staff. I'm so inspired by their dedication to empowering HIV+ children to better understand their illness, to boost their confidence when it comes to working with health practitioners, and most importantly, to maximize the impact of their work by sharing their research, findings, and successful strategies with the world. I can't express how thankful I am for their work here.

About Project Reports

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Project Leader

Kyle Ballard

Durban, KwaZulu-Natal South Africa

Where is this project located?

Map of Support the wellbeing of children with HIV in SA