Recently, the World Health Organization updated its recommendations of 20001 on infant feeding in the context of HIV.2 At that time, data had just been published quantifying the risk of infection through breast feeding so avoiding breast feeding was acknowledged as the only effective way of avoiding transmission.3 WHO had also just published a meta-analysis of the mortality risks of not breast feeding, but in non-HIV infected populations.4 Considerations of these data resulted in the statement that “When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended.”1 Since the 2000 recommendations, the main emphasis of most national programmes aimed at preventing mother to child transmission of HIV has been to avert transmission of HIV in young infants.

The most difficult challenge has been how to make breast feeding safer in communities with a high prevalence of HIV where breast feeding is the traditional mode of feeding. Remarkably, the dilemma of infant feeding and HIV has split scientific communities and programme managers into opposing camps. Even with the risk of HIV transmission, some maintain that breast feeding may still be the best option for many mothers infected with HIV because of its anti-infective and nutritional advantages.567 Others promote commercial infant formula, arguing that the risks of diarrhoea and malnutrition associated with formula …