Mothers and parents living with HIV need free infant formula
This International Women’s Day, we’d like to celebrate mothers living with HIV and focus on one of the many ways they can be supported. The historic progress made with antenatal testing and connecting pregnant people with HIV care has allowed so many women to raise happy families while managing their HIV.? By offering patient-centred healthcare that addresses the needs of pregnant women and mothers living with HIV, we empower women to live their lives without having to worry about the burden of HIV.??
However – we need to take this further, by supporting parents living with HIV when they are making decisions about how they feed their children.?
Unlike sexual transmission, U=U (‘Undetectable=Untransmittable’) does not apply to vertical transmission through breastmilk, so transmission is still possible despite a parent having adhered to treatment to the point of having an undetectable viral load. Because of this, the British HIV Association strongly recommends that parents formula feed to eliminate all risk of transmission. Whether or not they decide to chest feed or formula feed, finances should not be the deciding factor that prevents parents from making the decision that best meets the needs of mother and child.?
The rising cost of living means that infant formula is becoming increasingly inaccessible for parents. The stress of being a new parent compounded by the stress of not being able to afford infant formula is exhausting for the parents who experience this. The Healthy Start scheme is often seen as the best means of support for feeding an infant. However, according to research by the Food Chain, the average cost of a year’s worth of infant formula is ￡600 – but depending on the brands available it could be even higher. Healthy Start is capped at ￡448 a year so parents would have to cover the remaining expenses. This is simply not possible for every family. People seeking asylum and with no recourse to public funds are ineligible for the scheme, which means that a vulnerable key population with higher risk of HIV acquisition is less likely to be able to strictly formula feed their infants.?
No mother or parent should have to choose between their financial stability and feeding their child but this is unfortunately common. As many food banks do not offer infant formula, parents are forced to extremes if they wish to stick to formula feed. People are forced to dilute the formula milk with more water than is recommended to make it last longer, reducing its? nutritional value.??
But the consequences of lack of infant formula provision not only has an impact on the child but also on the parent. The intense changing demands that come with having a newborn must be balanced with a parent’s management of their antiretroviral therapy and overall health. Some mothers, especially those with no recourse to public funds, have had to choose between feeding themselves and affording to feed their children. These sacrifices make it difficult for the parent to prioritise their own mental and physical health as well as taking care of their children’s. Most antiretroviral treatment has to be taken with food to maintain effectiveness, so food poverty can make it difficult for some parents to become or remain virally suppressed.??
Currently provision is ad hoc and heavily reliant on the presence and capacity of voluntary sector organisations like the Food Chain, George House Trust, Sussex Beacon and Waverley Care. For some people, especially in lower prevalence areas, there is no provision through local HIV support services, local authorities or NHS trusts. Access to infant formula has become a postcode lottery that threatens to leave behind many parents living with HIV who are encouraged to formula feed but have limited means to do so.?
In order to reach zero new HIV transmissions and alleviate the pressures faced by many women with HIV, infant formula must be freely available to every parent living with HIV across the UK. If a prescription model is introduced that allows any person living with HIV to go to their nearest GP for free infant formula, the UK would be taking the necessary steps to reducing rates of new diagnoses via vertical transmission. By committing to free universal access to infant formula, the UK would be celebrating and supporting all the mothers and parents whose lives would be improved by this monumental change.??
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