Challenges of the postpartum period in women living with HIV

Key take-home messages

• The rate of transmission of HIV to a newborn is <1% if the mother is adherent to antiretroviral therapy during pregnancy, if the infant is on antiretroviral prophylaxis, and if breastfeeding is avoided.
• In Canada, exclusive formula feeding remains the preferred method for feeding infants born to women living with HIV, as it is the only strategy that completely eliminates postnatal risk of HIV transmission. However, women living with HIV who choose to breastfeed their infants should be supported to do so.
• Similarly, the most recent U.S. guidelines also recommend supporting the choices of people living with HIV to breastfeed, if they are virally suppressed.
• There are some studies from high-income countries that have examined the risk of HIV transmission via breastfeeding. These studies have small sample sizes and there is considerable variability; for example, maternal antiretroviral regimens, breastfeeding practices, infant antiretroviral prophylaxis, and HIV testing protocols vary across studies.
• During the postpartum period, adherence to antiretroviral therapy can be challenging for some women living with HIV, and they may have suboptimal viral load suppression.
• In general, there is a high prevalence of depression among postpartum women living with HIV. Factors related to living with HIV, such as stigma and disclosure of one’s status to others, can contribute to postpartum depression.
• Evidence-based interventions to support HIV care during the postpartum period are limited. Case management programs, care coordination teams, financial incentives, and group prenatal care appear to improve HIV care continuum outcomes.

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Social support
  • Health services
  • Stigma/discrimination
• Population(s)
  • Women
  • Children or Youth (less than 18 years old)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Retention in care
  • Treatment
• Prevention
  • Biomedical interventions
• Mental Health
  • Depression
• Health Systems
  • Governance arrangements
  • Delivery arrangements