In Support of Breast-/Chestfeeding by People With HIV in High-Income Settings.

This article focuses on the evolving perspectives and guidelines regarding breastfeeding (also termed chestfeeding) among individuals with HIV in high-income settings. Historically discouraged due to significant HIV transmission risks through breast milk, recent advances in antiretroviral therapy (ART) and neonatal postexposure prophylaxis have reduced transmission rates to approximately 0.3–1%, prompting the US Department of Health and Human Services to revise its Perinatal Guidelines in 2023 to support shared decision-making on infant feeding. The article highlights the well-established health benefits of breast-/chestfeeding for both infants and parents, acknowledges persistent racial disparities affecting breastfeeding rates and HIV prevalence—particularly among Black women in the United States—and underscores the importance of respecting patient autonomy in feeding choices. While recognizing residual uncertainties about HIV transmission through breast milk despite maternal viral suppression, the authors advocate for individualized, multidisciplinary counseling to empower informed decisions that balance risks and benefits in resource-rich contexts.