This updated guidance for healthcare providers with regard to the infant feeding options available to people living with HIV in Australia titled The Optimal Scenario and Context of Care offers guidance for a shared decision-making process between a person living with HIV and their healthcare providers to ensure that informed choices are made concerning infant feeding options.

People living with HIV in Australia who are pregnant or considering pregnancy will want to have discussions with their healthcare providers to make informed decisions regarding their infant feeding options. This extends to all healthcare professionals working on any perinatal care team.

In recent years, there has been a growing recognition among healthcare providers, researchers and clinicians that breastfeeding can be a viable choice for people living with HIV if they follow several criteria and are willing to engage in strategies to reduce the risk of HIV transmission. This situation is described as the ‘Optimal Scenario’ and summarised in an important discussion paper published in 2018 in the Swiss Medical Weekly.

This guidance provides the following recommendations to healthcare providers:

• That all healthcare providers should become familiar with and practice gender-inclusive language to support people living with HIV who are considering their infant feeding options.
• That the safest choice to minimise HIV transmission is formula feeding.
• That healthcare providers should not actively recommend breastfeeding.
• That an approach based on shared decision-making and counseling, with a risk management approach for supporting people living with HIV who do choose to breastfeed should be used.
• That healthcare providers supporting people living with HIV who choose to breastfeed work together to evaluate whether the optimal scenario and context of care are in place to minimise HIV transmission through breastfeeding.

This new guidance has been several years in the making with a review panel of over 45 experts representing a variety of disciples in maternal and child health, infectious diseases, women’s health and HIV across Australia and abroad.

Launched at the ASHM 2021 Virtual Conference 8 September 2021, ASHM commends this guidance to you in your support and considerations with your patients living with HIV, and we encourage you to share this document with colleagues with other health professionals who may be part of teams providing clinical care, including perinatal care, to people living with HIV.