11 月
在有艾滋病病毒的环境中母乳喂养，女性应知道什么？
免责声明：
以下的哺乳资源和链接不是源自或不代表国际母乳会，不过对您可能有用。
What women need to know about breastfeeding in the HIV context
在有艾滋病病毒的环境中母乳喂养，女性应知道什么？
翻译：盛菲菲
审稿：Missy、Daisy
This pamphlet is written for women living with HIV who want to explore the possibility of breastfeeding their babies. The information set out below is not intended to replace medical advice that you may have received from your doctors and HIV clinicians. Please discuss the information in this leaflet with your healthcare providers so that, together, you can make an informed decision about how to feed your baby that will best fit your own individual circumstances.
本文是为携带艾滋病病毒但仍想母乳喂养她们宝宝的母亲而写的。本文提到的信息不能取代您从医生和艾滋病毒临床医生处或已获得的专业医疗建议。 请和您的医生或者健康顾问一起讨论，以便您根据所获信息做出如何喂养宝宝与您个人情况最适合的知情决定。
Breastfeeding is one of the foundations of child health, development and survival, especially where diarrhoea, pneumonia and undernutrition are common causes of illness or death among children under five years of age. The World Health Organization and UNICEF recommend that babies should:
母乳喂养是儿童健康、发育和生存的重要基础之一，尤其是在常因腹泻，肺炎和营养不良导致五岁以下儿童患病或死亡的地区。世界卫生组织和联合国儿童基金会建议，婴儿应：
• Begin breastfeeding within the first hour after the birth;
• Receive no food or drink other than breast milk (exclusive breastfeeding) for the first six months;
• Continue breastfeeding after six months for two years or more, while also receiving other foods and drinks that are suitable for their age.
•在出生后一小时内开始哺乳;
•头六个月内不接受除母乳以外的食物或饮品（纯母乳喂养）;
•六个月后继续哺乳两年或更长时间，同时接受适合其年龄阶段的其他食物和饮品。
HIV, (the Human Immunodeficiency Virus), which leads to AIDS, (the Acquired Immunodeficiency Syndrome), can be acquired from a sexual partner. HIV can then be transmitted to a baby before, during or after birth, including through breastfeeding. While it may seem that the risk might be reduced by not breastfeeding, the health risks of artificial feeding may be even more serious for your baby.
从性伴侣那获得的HIV（人类免疫缺陷病毒）会导致艾滋病（AIDS，获得性免疫缺陷综合征）。HIV会在孕期、分娩时或分娩后传播给婴儿，也包括通过母乳喂养传播。对于您的宝宝来说，虽然不母乳喂养似乎能降低他们感染艾滋病病毒的风险，但是人工喂养的健康风险可能更严重。
Breastfeeding is very important to the health of the babies of HIV-positive women since babies who are not breastfed experience higher rates of illness, malnutrition and death due to infections such as pneumonia, diarrhoea or sepsis. Research also shows that exclusive breastfeeding greatly reduces the risk of the baby acquiring HIV, even if women are unable to access Antiretroviral Therapy (ART), although this is not ideal. Breastfeeding benefits women too; it can prevent breast cancer, increase the time between the birth of babies, and reduces a woman’s risk of diabetes, ovarian cancer and heart disease.
对于HIV阳性妇女的宝宝来说，母乳喂养对宝宝的健康非常重要，因为没有母乳喂养的宝宝由于肺炎、腹泻或败血症等感染而生病，营养不良或死亡的可能性更高。 研究还表明，即便是母亲无法接受抗逆转录病毒疗法（ART）的非最理想的情况下，纯母乳喂养也大大降低了婴儿感染艾滋病毒的风险。 母乳喂养对女性也有好处，它可以预防乳腺癌，延长下次怀孕生产的时间，并降低女性糖尿病，、卵巢癌和心脏病的风险。
ROUTES OF TRANSMISSION OF HIV
Horizontal infection
The commonest source of infection is through unprotected sex with an HIV-infected partner who is not taking antiretroviral therapy.
艾滋病毒传播路线
横向感染
最常见的感染源是通过与未进行抗逆转录病毒治疗的艾滋病毒携带者伴侣的无保护性行为。
Blood-borne infection
Individuals can also be infected by receiving a contaminated blood transfusion, or by being injected or cut by contaminated needles, syringes or knives.
输血感染
个别人也会通过输入或注射被污染的血液，或被污染的针头、注射器、刀割伤而感染艾滋病。
Vertical infection
If a mother is infected with HIV, her baby can be infected during pregnancy, birth or breastfeeding.
垂直感染
如果母亲感染了艾滋病毒，她的婴儿可能在怀孕，出生或哺乳期间感染。
KEY PRINCIPLES RELATING TO HIV AND INFANT FEEDING:
1. Women living with HIV who are not taking ART:
• A woman who is already infected with HIV can transmit the virus to her child during pregnancy, labour or delivery, or through breastfeeding. The risk of transmission to the baby is very much higher during pregnancy and especially during labour and birth, and much lower during breastfeeding.
• A woman who becomes newly infected with HIV during pregnancy or during breastfeeding has a very much higher risk (one in three) of passing the virus to her baby.
• When ART is not available, breastfeeding still provides HIV-exposed infants with a greater chance of survival. You should be counselled to exclusively breastfeed your baby for the first six months of life and continue breastfeeding after that time unless your circumstances are safe for and supportive of formula-feeding.
关于艾滋病和婴儿喂养的关键原则：
1. 对感染艾滋病毒，没有接受抗逆转录病毒疗法的女性：
• 已经感染艾滋病毒的女性可以在怀孕，分娩或生产期间或通过母乳喂养将病毒传播给她的孩子。 在怀孕期间，特别是在分娩和生产期间将艾滋病病毒传播给婴儿的风险非常高，而通过母乳喂养传播的风险则低得多。
• 在怀孕期间或母乳喂养期间新感染艾滋病毒的妇女将病毒传染给她的婴儿的风险非常高（三分之一的比例）。
• 当不能接受抗逆转录病毒疗法时，母乳喂养仍然为艾滋病毒暴露的婴儿提供更大的生存机会。 医生应该建议您宝宝的前六个月完全母乳喂养，并在此之后继续母乳喂养，除非您所处的环境喂配方奶是安全的，并可以在配方奶粉喂养方面获得支持。
2. Women living with HIV who are taking ART
• Women who suspect they may have been infected with HIV should receive an HIV test as soon as possible.
• Women who test HIV-Positive should receive ART for life.
• It is especially important for pregnant women who test HIV-Positive for the first time in early pregnancy to be started on ART straight away.
• You should be very careful to take your medication exactly as the doctor recommends and to take it regularly every day at the same time, without missing any doses (this is called ART-adherence)
• If you receive ART for at least 13 weeks and if you are adherent to your ART, then the risk of transmission of HIV to your baby is very low, as follows:
Ø Pregnancy, labour and delivery – 0.1%
Ø Exclusive breastfeeding, 0-6 months 0.3 – 0.8%
Ø Mixed breastfeeding with weaning foods 6-24 months, 1 – 1.1%
2、对感染了艾滋病毒感染并接受抗逆转录病毒疗法的女性：
• 怀疑感染了艾滋病毒的女性应尽快接受艾滋病毒检测。
• 检测为HIV阳性的女性应终生接受抗逆转录病毒疗法。
• 对于在怀孕早期首次检测为HIV阳性的怀孕女性来说特别重要的是，应立即开始接受抗逆转录病毒疗法。
• 您应该非常小心地按照医生的建议服用药物，并且每天定时服用药物，不减少任何剂量（这称为ART依从性）
• 如果您接受接受抗逆转录病毒疗法至少13周，你对抗逆转录病毒疗法的依从性很好，那么艾滋病毒传播给您的宝宝的风险非常低，如下：
ü 怀孕，分娩和生产 0.1％
ü 纯母乳喂养，0-6个月 0.3 – 0.8％
ü 混合母乳喂养与加辅食 6-24个月，1 – 1.1％
3. Women who are HIV uninfected or whose HIV status is unknown
Pregnant women or new mothers whose status is unknown should be offered HIV testing –
• If you test HIV-negative during early pregnancy, you should be offered another test during the last three months and again shortly after your baby is born.
• If you are living in a setting with high HIV prevalence, you, your partner and baby may be re-tested often (as per your doctor’s advice).
3.未感染艾滋病毒的女性或艾滋病毒感染状况未知的女性
应向艾滋病毒感染状况未知的孕妇或新妈妈提供艾滋病毒检测 –
• 如果您在早孕期测试HIV阴性，您应该在孕期的最后三个月内再次接受测试，并在宝宝出生后不久再次接受测试。
• 如果您生活在艾滋病毒感染率高的环境中，您，您的伴侣和婴儿应经常重复检查（根据医生的建议）。
4. HIV-exposed babies
• Babies of HIV-infected women should receive antiretroviral prophylaxis for 4 – 6 weeks after birth.
• Babies should be tested for HIV shortly after birth and at 6, 10 and 14 weeks.
• Babies who test HIV-positive should commence ART immediately.
4.暴露在艾滋病毒下的婴儿
• 艾滋病毒感染妇女的婴儿应在出生后4至6周接受抗逆转录病毒预防。
• 婴儿在出生后不久、第6、10和14周应进行艾滋病毒检测。
• 测试结果为HIV阳性的婴儿应立即开始抗逆转录病毒疗法。
WOMEN’S NUTRITIONAL NEEDS
• Making milk increases your nutritional requirements by 300-500 Kcal per day. To support breastfeeding and keep healthy, breastfeeding women (whether infected or not) should consume the equivalent of about one extra meal per day.
• Getting enough to eat helps maintain your ability to fight infections, keep up your energy levels and is essential for improving treatment outcomes with antiretroviral drugs.
• Your nutritional status before or during pregnancy and during breastfeeding influences both your health, and the health and survival of your baby.
• After birth, it is necessary for you to receive enough food to support the demands of breastfeeding and to keep up your own nutrition.
• HIV infection increases energy requirements due to higher resting energy expenditures and increased nutritional needs from HIV-related infections and illnesses.
• If you have poor appetite, you should be encouraged to eat well. Ensure that food is available, appetising and nutritious.
妈妈们的营养需求
• 为了制造乳汁，每天需要增加300-500千卡的营养需求。为了母乳喂养和保持健康，母乳喂养的女性（无论是否感染艾滋病）应该每天增加一次额外的用餐量。
• 足够的食物有助于保持你的抗病毒能力，保持你的能量水平，对于提高抗逆转录病毒药物的成效至关重要。
• 您在怀孕和哺乳期间的营养状况影响您的健康，以及您宝宝的健康与生存。
• 宝宝出生后，您必须获得足够的食物，以满足母乳喂养的需求，以及保持自己的营养。
• 艾滋病毒感染增加了精力上需求，因为艾滋病相关感染和疾病会需要更多的精力支出和营养需求。
• 如果你的胃口不好，也要吃得好些。确保食物可获取、开胃和营养。
RECOMMENDATIONS FOR WOMEN LIVING WIH HIV:
1. You should receive lifelong ART and prevention interventions to reduce HIV transmission.
• Every effort should be made to stress that women living with HIV should receive and keep taking ART, not only to prevent transmission of the virus to their babies, but also for their own health and well-being. This will enable them to live a normal lifespan with fewer opportunistic infections, and to take care of all their children.
2. Duration of breastfeeding by women living with HIV if she is receiving ART
• When you are able to continue breastfeeding for 24 months or beyond, your baby is likely to suffer fewer infections, especially where diarrhoea and pneumonia are significant causes of infant and child mortality.
• You and your baby will also enjoy other benefits of longer breastfeeding duration such as improved child development and lower risk of breast and ovarian cancer.
给感染艾滋病毒女性的建议：
1.您应该接受终身抗逆转录病毒治疗和干预，以减少艾滋病毒的传播。
再次强调，感染艾滋病毒的女性应该接受并持续接受抗逆转录病毒治疗，这不仅是为了防止病毒传染给婴儿，也是为了她们自身的健康和幸福。这将使他们能够减少感染机会，享有正常的寿命，并照顾他们的孩子。
2. 接受抗逆转录病毒治疗的艾滋病毒感染者的母乳喂养持续时间
l 当您能够持续母乳喂养24个月或更长时间时，您的宝宝可能会感染较少，特别是当腹泻和肺炎是导致婴儿和儿童死亡的主要原因。
l 您和您的宝宝享受更长的母乳喂养也会有其他好处，如改善儿童发育情况和降低乳腺癌和卵巢癌的风险。
3. When women decide to stop breastfeeding
• Breastfeeding should only stop when you are able to provide your baby with sufficient safe food without breastmilk. Stopping breastfeeding completely should be done gradually, and should take approximately one month. Always seek the help of a professional when considering stopping breastfeeding.
4. If your baby tests HIV-Positive
• If babies and young children are found to be HIV-Positive, women are strongly encouraged to protect their health and survival by exclusively breastfeeding for the first six months of life and continuing to breastfeed in accordance with the recommendations for the general population: that is, up to two years or beyond.
5. Your need for counselling
• Counselling is a helping relationship specific to the needs of the individual and her family. Most women benefit from a respectful, empathetic discussion of their situation. It is especially helpful if you and your partner receive counselling together as a couple, or with other key family members. Also, it is important for you to have access to family planning to prevent unintended pregnancy.
3.当妈妈决定停止母乳喂养
母乳喂养只有在您能够为宝宝提供除母乳外足够安全的食物时才能停止。完全停止母乳喂养应该循序渐进，需要大约一个月。考虑停止母乳喂养，应寻求专业人员的帮助。
4.如果你的宝宝检测出艾滋病毒阳性
如果发现婴儿和儿童是艾滋病毒阳性，强烈建议妈妈在宝宝六个月前纯母乳喂养，以保护他们的健康和生命，之后与一般人群相同，即继续母乳喂养至孩子两岁或以上。
5．寻求辅导
单独的咨询辅导可以帮助妈妈和她的家庭解决个性化的家庭问题。大多数妈妈从受尊重的、共情的讨论中受益。如果您和您的伴侣或其他关键家庭成员一起接受辅导，会更加有效。此外，能自主制定家庭生育的计划，以防止意外怀孕也很重要。
NOTES/ADDITIONAL INFORMATION:
The risk of replacement feeding and mixed feeding:
• Intentionally replacing breast milk with another kind of milk, usually formula-milk is known as replacement feeding.
• Replacement feeding poses a greater risk of death and disease if there is a lack of sanitation, clean water and lack of health care, than transmission of HIV through breastfeeding.
• In resource-poor settings, the use of infant formula may interfere significantly in the monthly expenditure of the family. Almost half of the family budget can be wasted buying infant formula, fuel, water and expenditure due to medications and medical consultations/hospital fees, as the non-breastfed baby suffers a greater number of infections.
• Feeding a baby with breast milk as well as other foods and / or liquids before the age of 6 months is known as mixed feeding. Mixed feeding before six months after birth can increase the risk of postnatal HIV transmission compared to exclusive breastfeeding, and therefore should be avoided as the worst option.
• Reversing the decision from formula-feeding to breastfeeding is difficult.
注意事项/附加信息：
替代喂养和混合喂养的风险：
l 有意地用另一种奶替代母乳，通常奶粉喂养被称为替代喂养。
l 如果缺乏卫生设施，清洁的水和健康保健，相对于母乳喂养传播艾滋病毒，替代喂养会造成更大的死亡和疾病风险。
l 在资源贫乏的环境中，婴儿配方奶粉可能会明显影响家庭的每月支出。由于非母乳喂养的婴儿有更多的疾病感染风险，几乎一半的家庭预算可能被用在购买婴儿配方奶粉、燃料、水和相关的医疗费用支出上。
l 在宝宝前6个月同时母乳喂养和其他食物/或液体喂养被称为混合喂养。与纯母乳喂养相比，出生后6个月的混合喂养可能增加产后艾滋病毒传播的风险，因此应该避免选择这个最坏的选择。
l 奶粉喂养转换为母乳喂养是困难的。
If you need any additional information on
(i) what to feed infants when you stop breastfeeding,
(ii) conditions needed to safely formula feed and
(iii) heat-treated, expressed breast milk,
please discuss your feeding plans with a skilled health professional, your HIV clinician, lactation consultant or peer counselling group.
如果您在以下方面需要其他信息：
（i）当你停止母乳喂养时，应该喂婴儿什么食物，
（ii）奶粉喂养需要的安全条件
（iii）如何加热挤出的母乳
请与专业的医疗人员、您的艾滋病临床医生、哺乳顾问或志愿互助咨询小组讨论您的喂养计划。
More information can be found in the following documents which are available on the internet:
更多信息可以在互联网上的以下文件中找到：
• WHO 2016, Guidelines on infant and young child feeding Fact Sheet, fs342
• WHO Guidelines: Updates on HIV and Infant Feeding (2016) http://www.who.int/maternal_child_adolescent/documents/hiv-infant-feeding-2016/en/
• Understanding International Policy on HIV and Breastfeeding: a comprehensive resource
• Duration of ART to achieve undetectable viral load: Chibwesha CJ, Giganti MJ, Putta N, Chintu N, Mulindwa J, Dorton BJ, Chi BH, Stringer JS, Stringer EM. Optimal Time on HAART for Prevention of Mother-to-Child Transmission of HIV. J Acquir Immune Defic Syndr. 2011 Oct 1; 58(2):224-8. doi: 10.1097/QAI.0b013e318229147e, http://www.ncbi.nlm.nih.gov/pubmed/21709566
• Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008 May 11;22(8):973-81.
• Morrison P, Greiner T, Israel-Ballard K, Informed choice in infant feeding decisions can be supported for HIV-infected women even in industrialized countries, AIDS 2011, 25:18071811 e-pub ahead of print AIDS, 1 August 2011, final version 24 September 2011, PMID: 21811145 [PubMed – as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/21811145
• Silverman MS. Interim Results of HIV Transmission Rates Using a Lopinavir/ritonavir based regimen and the New WHO Breast Feeding Guidelines for PMTCT of HIV. Abstract H1-1153, International Congress of Antimicrobial Agents and Chemotherapy (ICAAC), Chicago IL, 2011
• Ngoma M et al, Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia, J Int AIDS Soc 2015 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490793/pdf/JIAS-18-19352.pdf
• Gartland MG, Chintu NT, Li MS et al. Field effectiveness of combination antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission in rural Zambia. AIDS, 2013, 27(8). doi:10.1097/QAD.0b013e32835e3937.