Nutrition plays a vital role in boosting the immune system and its ability to fight infection, and it’s more important in infants because they have weak immune systems.

Whether HIV-positive or not, health experts advise that prioritising the baby’s nutrition is important, especially in exclusive breastfeeding during the first six months. However, mothers with HIV should be more careful on how the infant is breastfed, which is also part of nutrition at their early stage of life. Prof Joseph Mucumbisti, a pediatrician and president of Rwanda Heart Foundation, says it would be best to avoid breastfeeding at all for mothers with HIV to reduce the risk of transmitting the virus to the infant.

He, however, says poor mothers who can’t afford formula feed, and that for the benefit of the baby, breastfeeding becomes an option, but should be done under close supervision on both the child and the mother.

"For HIV-positive mothers, breastfeeding their babies depends on their immunity level. Also, if they have been on antiretroviral therapy (ART) during their whole pregnancy, they can go ahead and breastfeed,” says Mucumbitsi.

"Ideally, if the mother has HIV, close monitoring of the baby starts while it’s still in the womb. This is to ensure that the right medication is provided when the mother attends antenatal visits,” he says.

According to Daniel Gahungu, a general practitioner at Polyclinic de l’Etoile in Kigali, at birth, the mother is protected from transmitting the virus to their infants. The same should be carried on while handling the infant, as one way of ensuring that it gets proper feeding.

"However, a mother with HIV should always be on medication. Failure to do this means there are high chances of transmitting the virus to the baby. Additionally, the infants are given medication on the first day of their life to hinder any transmission,” he says.

And this should be followed by tests which take place at six, nine and 18 months.

The World Health Organisation (WHO) recommends that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old.

WHO research also says the child can benefit from breastfeeding with very little risk of becoming infected with HIV. All mothers, regardless of their HIV status, should practice exclusive breastfeeding, which means no other liquids or food are given in the first six months. After six months, the baby should start on complementary foods.

However, Mucumbitsi notes that the longer a child is breastfed by an HIV-positive mother, the higher the risk of HIV infection; therefore, at six months the baby should be introduced to complementary foods if possible.

Yasin Uwimana, a Kigali-based obstetrician and a gynecologist, also says babies born to mothers with HIV should be exclusively breastfed for the first six months. Apart from just baby being healthy, it also reduces HIV associated stigma on the mother.

He points out that there are also high chances of a baby getting the virus if the mother has a low CD4 count, gets infected with HIV during breastfeeding, has cracked nipples and breast abscess, as well as if the baby has mouth sores.

On the other hand, Uwimana says breastfeeding mothers should takewell-balanced and healthy diet since they have high energy and nutrient needs. This will ensure that their babies get enough milk which helps them to grow and boost their immune system.

He advises that mothers should ensure that their infants suckle in the right position, adding that if the baby has sores in the mouth immediate medication should be provided.

For the mothers who decide not to breastfeed, Gahungu says apart from introducing formula feed, they should take their infants for regular check-ups and seek medication if they realise any unusual behaviour or symptoms.