As I write this, I am sitting on a train, making my way back to Toronto after spending two days at Concordia University (in Montréal), which housed the premiere (and potentially only) Beyond Failure! Symposium.

The purpose of the symposium was to provide a space to discuss the various areas within HIV which we have failed at, whether that be research, policy, activism, prevention or frontline services. The HIV and AIDS industry (and this is not exclusive to HIV) strives for success in all areas – in proposing projects, in the work done by AIDS service organizations (ASOs), in grant writing, etc. While striving for success and achievement can be viewed positively, the fixation placed on succeeding rarely provides the opportunity to reflect on challenges, shortcomings, or failures. 

Failure is uncomfortable. In evaluating failure, we are forced to examine our flaws, slip-ups, and transgressions under a microscope. Perhaps this is why many shy away from this kind of evaluation. Sometimes it’s easier to sweep our faux pas under the rug and move on. Unfortunately, in failing to address the failures, the opportunity to learn from these mistakes is lost and we run the risk of replicating our mistakes over and over again, never having learned the lesson in the first place.   

Failure is threatening and often personal as we (occasionally) tie our successes to our identities and by default, our failures have the potential to negatively impact how we understand ourselves. When failure is conceptualized so closely to our identity or sense of self, it’s no wonder it has the potential to create considerable discomfort.

Beyond being uncomfortable and depending on your role and/or relationship to the HIV movement, failure can mean the loss of funds, the end of a research project or ASO or in a far more corporeal sense, the difference between life and death.   

As Tim McCaskell so eloquently stated in his keynote address at the symposium, “AIDS is like a lens: when you look through it, all of society’s problems are magnified.” From here, Tim provided an insightful way of re-framing the concept of failure within the context of HIV by asking: is the goal to destroy or break the lens? Or is the goal to challenge the social conditions that create HIV? The point? Failure can be determined by the perspective applied to the circumstance or scenario and the often imaginary line between failure and success is both arbitrary and subjective.  

A call for abstracts for the symposium was released in fall 2012; anyone interested in submitting an abstract was asked to briefly outline what aspect of failure they would like to discuss. Abstracts were categorized into small groups (5-7 people per stream) based on common themes including prevention, risk, community, and social policy & state. For those whose abstracts were accepted there was the expectation of completing a paper in advance of the symposium that would be distributed to other members of your group. The intention was for everyone to read the papers in advance of the symposium and come prepared to address commonalities, divergences, and of course, failures. This symposium format created the space and possibility to have rich meaningful dialogue, which allowed for a more nuanced engagement with other presenters’ work.   

I submitted an abstract which used my undergraduate and graduate experiences in international HIV research as a case study to highlight failure. Within my larger paper, I discussed how in both cases (undergraduate and graduate research), I felt unprepared, untrained and naïve yet I was situated as the research “expert” regardless of my inexperience both in HIV (particularly as an undergraduate) and in Namibian culture and history (where both my research projects took place). For more details on this work, check out my previous PositiveLite.com article here.  

I was grouped within the community stream along with another young female activist from Toronto, a delightful Parisian, and a post-doc from Montréal. The groups were facilitated by the symposium’s organizing committee (our group was lucky enough to have Viviane Namaste in it), which allowed for bilingual and cultural exchanges.   

Many important and critical reflections arose from our group discussion including who is “community” and who defines it? Can we belong to a community if you don’t share the same lived experiences as other members? In identifying competing definitions of community, do we inadvertently exclude people from various communities? And how do we negotiate multiple social locations and identities in the context of community? 

I found that my own work (using anecdotal experiences as a young researcher) drew close parallels to another group member who spoke about the role of allies in the HIV movement and encouraged people who might take up the identity of “ally” (both with the context of HIV and beyond) to critically reflect on what motivated them to engage in this work. Comparing the work of researchers and allies, I found many convergent points including: that the choice to do research or join a movement often starts from a place of “good intentions”; the failure to meaningfully involve and incorporate PLWHA creates situations of tokenism; the existence of the insider/outsider dilemma (who can be a researcher and/or ally?); and that often if advantages or benefits are up for grabs, it is usually the researcher (sometimes the ally) who is on the receiving end of them.   

As someone who identified both as a researcher and as an ally (in various movements), it was uncomfortable to put my failures on the table and bring into question my role as an ally. The more and more I engage in critical work, the more I relish in the circumstances which force me into those uncomfortable corners. I believe that when we’re in these places, we have the potential to radically re-vision ourselves, the work we do, how we show up in the world and how we engage with it.

I think one of the biggest learnings that came out of the symposium (and through engaging in thought-provoking conversations with other participants) was the re-realization that becoming an ally* (and a critical, ethical researcher) is a continuous process which requires of us that we always put ourselves uncomfortably under the microscope to examine our privileges, how much space we take up (physically, intellectually, verbally, etc.), how we are oppressed and how we oppress others.

Many of the same principles of doing ally work can easily transfer to the role of researcher, particularly when the researcher isn’t working within a community they immediately/wholly identify with. In addition to the constant assessment of social location and privilege, when locating yourself as ally or researcher, it’s important to recognize that that will usually mean not taking a leadership role in either the movement or the project, taking your cues from those community members with lived experience and working collaboratively. 

Though I didn’t necessarily encounter any earth-shattering revelations at this symposium, I did very much appreciate the fact that it took place and am grateful to have been able to participate in it. Creating space to talk about our collective and individual failures is rare but frankly, shouldn’t be. So many crucial lessons can be learned through failure and if we spend our time hiding/trying to forget where we went wrong, we’ll miss the important opportunity to learn how to do things differently –and hopefully better - next time.   

* If you’re interested in reading more about becoming an ally, check out Anne Bishop’s website here .

The title quote was written by George Bernard Shaw in ‘Saint Joan’ in 1923 but if ever a saying is timeless it’s this one.

The reason I’m dragging it out of the cliché locker is because I feel I have to take issue with a couple of articles that have appeared on PositiveLite.com recently.  

They are IS HIV TRANSMISSION POSSIBLE WHEN VIRAL LOAD IN THE BLOOD IS UNDETECTABLE? from CATIE and INFECTIOUSNESS coming from Aidsmap.com

I respect the work that people in HIV organisations put in to the struggle to control the virus and I appreciate the time and effort put in by writers who do their best to provide us with information – we’d be in a sorry state without them. I also know the perils of one article writer criticising another but I genuinely mean no disrespect. These two articles are pretty representative of what you will find all over the net and therefore my problem is more with the genre than the individual articles themselves.

The CATIE article addresses a question which is in the back of everybody’s mind. It’s crucial, both for positive and negative sex partners. The title suggests that the question will be answered but unfortunately that’s anything but the case. The first paragraph sums up what viral load actually is but hardly gives hard and fast rules which we can hang our hats on. It talks about the viral load being measured in the bodily fluids of a positive person. Surely it’s not. It’s measured in the blood and only very rarely in semen, saliva etc.

“Research shows that successful HIV treatment can reduce the viral load to “undetectable” levels and this can reduce the risk of HIV transmission. However, HIV transmission may be possible when the viral load is undetectable…The risk of HIV transmission when taking antiretroviral treatment may increase if sexually transmitted infections (STIs) are present…This risk may also be higher for anal sex than for vaginal sex.”

What do they mean, ‘can’ and ‘may’? We’re thirty years into the history of the virus. We should be hearing ‘does’ and ‘will’, not bet-hedging to cover all possibilities!

The following is something we’re all very aware of but what does a statement like this actually tell us?

“Viral load tests used in Canada cannot detect HIV in the blood if there are less than 40–50 copies/ml. Therefore, an undetectable viral load means the amount of virus in the blood is too low to detect, it does not mean that there is no virus present.”

First of all, we know the testing procedures are still limited but surely we’re entitled to ask why? Secondly, what the hell are we supposed to take from such a statement? Getting everybody to undetectable status is the universal aim but is pretty pointless if we don’t know how much of the virus has escaped detection because the procedures are lacking. Of course ‘undetectable’ suggests ‘less infectious’ but thirty years into the disease and its treatment and we still don’t know whether that’s entirely true. Until other bodily fluids are routinely tested we’re no closer to an answer and even then, the virus may be hiding in bone marrow, organs and brain tissue. Testing every susceptible piece of the body may never be possible but telling us we’re undetectable but maybe still dangerous, tells us almost nothing; we deserve better.

Another pretty meaningless statement is:

“Research shows that a lower amount of virus in the blood is usually associated with a lower risk of transmitting HIV to others, and a higher viral load is associated with a higher risk.”

Duh! And by the way, what research? We probably all accept the truth of this statement but what research proves that? Far too often the words ‘Research shows…’ are thrown at us in the expectation that we’ll accept that as gospel. Very often research is so small-scale and out of date that it is barely relevant. It is wrong to assume that the reader can’t cope with references to the exact piece of research and it should be expected that research is looked at with a critical eye but very often, ‘research shows…’ will back up a multitude of assumptions.

CATIE quotes HPTN 052 research to back up theories that a lower viral load reduces risk but that research was conducted amongst tiny groups of sero-discordant heterosexual partners in Africa and Thailand. The research is ongoing but trials to measure the same risk reduction when it comes to homosexual, anal sex…well you can whistle for that one! A lot of people hang a lot of credence on HPTN 052 but for HIV+ gay people, it suggests absolutely nothing and proves even less. To be fair, the CATIE article does point this out and even questions the relevance of the research but still draws conclusions that say we can reasonably assume that the same applies to anal sex. Uhm sorry, no it doesn’t!

When a paragraph begins with:

“Successful antiretroviral treatment can lower the viral load in the blood and other bodily fluids to undetectable levels and this can reduce the risk of sexual HIV transmission...Antiretroviral treatment may be much less effective than 96% when these conditions are not met.”

You know that it means very little. We want to know that in the majority of cases, ‘it will’!

More woolly information follows:

“A higher level of HIV in the semen, vaginal fluid, and rectal fluid may increase the risk of transmission when the blood viral load is undetectable. However, it is unclear how often this happens and how significant it is in terms of HIV transmission. Research shows it may be more common if a person has an STI, but can also happen in the absence of STIs.”

There they are again: ‘may’ and ‘can’, plus a ‘research shows’ and an ‘unclear’. How exactly is this useful information? The fact is that the research in all areas of HIV is still shockingly lacking and in the meantime we have to put up with guesswork. That's not good enough in 2013. If there’s no more money for  extensive and indisputable research; or no plans are on the table; or government and scientific bodies are standing in the way; or moral objections are blocking funds it’s the responsibility of HIV sites and organisations to say so and tell their readers the truth. “We just don’t know and this is why we don’t know,” is far more acceptable than ‘cans and maybes’. At least then we know where we stand.

Doesn’t this next sentence just sum it up?

“Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.”

Pitiful, really! Are we going to have to take to the streets again to demand efficient and relevant research which will end up saving the state millions in health care and why aren’t our large HIV organisations leading the charge?

The second article comes from aidsmap.com, which is generally regarded (just like CATIE) as a reliable and up-to-date source of information. The introduction is as follows:

“Aidsmap.com reports about 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. Whether or not this level of HIV in semen is associated with transmission is unknown.”

Now I thought this was interesting and went in search of this new research. It stemmed from a University of California study into the effect of the herpes virus on HIV transmission (read more here.) It involved 46 people, split between so-called HIV transmitters and non-transmitters and could hardly be called ‘large scale’. The Aidsmap article refers to 114 men in the study but even that’s hardly a significant research group. The point is that Aidsmap presents this as fact, based on ‘a US study’ when in fact it’s a little more complex than that and to state that 10% of men on HART have low levels of HIV in their semen seems pretty conclusive, yet it is based on a small study concentrating on the Herpes virus. Again, the statement may be true; it may be relevant and important but we need more evidence to back up global statements like that. (Editorial comment. PositiveLite.com says: even more important is whether such low levels of virus have any significance, i.e the ability to result in transmission. Is in fact the semen issue a complete red herring? We suspect yes, given the transmission history -  or lack of it -  in people with undetectable viral load in their blood.)

PositiveLite.com has quite rightly questioned the accuracy of aidsmap's references to the HPTN052 research, which is trundled out yet again yet proves practically nothing for gay men.  (Editorial comment; PositiveLite.com has since received acknowledgement from aidsmap that the aidsmap information was incorrect and that a retraction (apology?)  will be issued shortly. The moral is, as Dave says, question EVERYTHING you read.)

The article then goes on to say:

“But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load”.

What rare case reports? How many? Why isn’t this being investigated right now, on a large scale, to actually establish some facts? It’s almost as if HIV organisations and sites have become so accustomed to writing generalised pieces that repeat the same old suspicions and assumptions, that it has become a new truth of its own. Why aren’t they screaming out for new research and not settling for worn out cliché responses?

It goes on:

“Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.”

‘May’! Why don’t we know for sure?

Finally, statistics are rolled out:

“They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load…A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.”

Okay, let’s assume that the study involved 114 men and not 46. 36% of 114 is 41. Is it really valid to come to wide-reaching conclusions based on the results of 41 people? The urethral bacteria numbers are even less relevant: 5 people out of 114!

The point is that readers take headlines and believe them to be true, when in fact they’re often based on such small-scale studies that they barely merit a mention. Of course, all these studies may be revealing vital information and should be reported but if one (small) study suggests a trend then it should be replicated on a wide scale across the HIV community in order to establish whether it is more than just a medical soundbite. It’s the responsibility of authors and their organisations to look at these things more critically and if necessary make readers aware of the scale and validity of studies, statistics and suppositions.

The reader also needs to question anything that’s not clear, or seems to be stated as fact when it’s not proven. The problem is that life’s just too short to take the time to do that. So the promulgation of half-truths and loaded headlines becomes the easy way out, eventually leading to mistrust and suspicion.

This article of mine may seem like an attack on two highly regarded HIV information sources; it’s not meant to be. I have used them as examples of what we see every day in articles and discussions throughout the HIV community. We really do deserve better than to be fed meaningless conclusions based on ‘maybes’ and ‘possibilities’ but it’s not the fault of the authors. News has to be reported, no matter how tenuous the facts.

Unfortunately, it looks like the HIV community has to start demanding again. Demanding proper, well, funded and large scale research at home and abroad. The World Health Organisation has a responsibility (and the finances), as does the pharmaceutical industry and every other research or research-funding facility across the globe, including the major philanthropists like Bill Gates etc.

I’m fed up with endless arguments as to whether an undetectable status is safe or not, or whether TASP, PrEP, PEP and various other acronyms are the way forward, or whether the viral load in your blood reflects the true levels in your body. Just how safe is condomless sex between sero-positive people on HART? The questions are endless but I would like answers and soon. Some people and organisations are dragging their feet in providing them. It’s a question of having the political will to do the necessary research and damn well prove things once and for all and if the ‘climate’ makes it difficult to instigate the discussion and find the evidence, then we’ll just have to scream and shout until that changes. If it doesn’t happen then confusion drives apathy and stigma grows.

When you next read an article about the latest theory concerning HIV treatment and transmission; count up the number of ‘statistics, if’s, may’s, possibly’s and researches show’ and ask yourself if you are being presented with new facts and are you learning anything new. If the answer is negative then you may well be being short-changed!

I’m fully aware that some people will be irritated by this article but then I hope they’ll respond and widen the discussion. If I’m talking out of my backside, I hope you will say so  - but you’re going to have to prove it! 

I changed roles from Positive Prevention to Women’s Community Development about, oh, eight months ago or so, which means that I’ve gone from working with mostly gay men, to working mostly with women.

Like a lot of people in this role, I sit on quite a few committees. There are planning committees, steering committees, research committees, working groups, alliances, the list goes on. Naturally, committees involve a lot of group collaboration and negotiation.  From writing a scholarly article to putting on a health forum to getting a research project funded, a cohesive group necessitates the active participation and voices of all members.

All of the committees I sit on (and there are about 15 of them) are made up entirely, or almost entirely, of women. One of things I noticed right away when I changed positions was the difference in how women tend to communicate on committees. While this is certainly not the case in every situation, I have noticed a tendency for many women to be quite cautious when they share their opinions. In many causes, non-assertive language is used, voices are lowered, and opinions are hedged by phrases like, “this is just my idea,” “…or we can go with your original plan” and “but I’m fine with either way.” In one meeting, the chair encouraged the participants to share (and keep sharing) their emotions after she had recommended a change of plans. “Are you sure you’re all okay with this? I feel like some of you might be holding back…”

It’s interesting to observe. I think back to my participation in male-dominated committees during my Positive Prevention work and the difference is startling. When I showed up to the Positive Prevention Working Group (an all-male committee), to obtain feedback on ACG’s Train-the-Trainer manual in 2009, the feedback was delivered – how shall I say – very directly. Attend any Gay Men’s Sexual Health Summit and you will find an abundance of men who are not afraid to challenge one another or share their views. I believe that the capacity to debate and challenge one another is a strength; the diversity of opinions that are shared in these committees and summits helps to push us all towards a higher level of accountability and excellence in our work, from theory to practice.

Obviously, strong, confident women exist in this field too – indeed, there are many of them - but I can’t help but notice that many of the committees upon which I sit tend to operate in a reserved, restrained manner. In many of these committees, women use words like “maybe,” and phrases like, “as long as you’re on board,” or “I hope I’m not being difficult or demanding.” Opinions are rarely shared as confidently as they were at the Positive Prevention Working Group.

Am I being male-normative, to assume that women-operated meetings must be carried out with the same level of speed and self-assurance as those led by men? Perhaps we, as women, should feel justified in having our own method of building relationships, building trust, and gaining the confidence of the other members. Perhaps we lead more quietly, and with more empathy.

Or, perhaps we operate in a more cautious and restrained way because we are trained to be overly-concerned about other people’s feelings, because we are taught that our opinions are less important, and because we have learned – often through lived experience – that women who are bold and assertive get labeled as “bitches”.  Perhaps we have learned that women who display “too much” confidence and self-assurance often take a social penalty.

It’s something I wrestle with personally. I desire to be a good leader and cultivate my own leadership abilities.  When I chair a committee or contribute as a participant, I try to do what is right – I give myself permission to assert my own voice, my own thoughts and ideas. I aim to express myself with some tact and diplomacy, and make a genuine effort to listen openly to the ideas of others, validate their suggestions, and cultivate mutual discussion. But I also try not to limit my own self-expression, or downplay the credibility of my suggestions.

I do not want to contribute to a culture that reinforces social norms in which women should not speak confidently or assert their viewpoints. I do not want to contribute to gendered norms that hold women back from being successful. I do not want to let fear limit our ability to be efficient and create change.  Instead, I want to contribute to a culture that encourages women to speak with conviction. I want to contribute to a culture that says, ‘it is okay to disagree and to challenge one another.’ I want to contribute to a culture that allows women to profess their knowledge, assert their beliefs, and engage in healthy debate without having to worry about being labeled a bitch. 

This is my goal, but the truth is, chairing meetings brings anxiety. It usually happens after the meeting is over. I lead the meeting in a way I think is most appropriate, balancing the aforementioned goals. But after, I worry - was I too assertive? Do the other women think that I am over-bearing, or too controlling, or that I think too much of myself?

I want to talk about the sexy topic of monogamy. No so much whether monogamy is achievable or whether it goes against our natural inclinations. The internet is littered with that stuff.  Is monogamy impossible? Are men designed to cheat? There are whole books dedicated to the topic: Eric Anderson's "The Monogamy Gap: Men, Love, and the Reality of Cheating" and the bestselling "Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships" by Chris Ryan and Cacilda Jetha,  to name a few.

Call me cynical but you know what I get from these articles?  Maybe it’s not so much monogamy that’s impossible, maybe its lifetime relationships. Only having sex with one person may be no problem for a period of time, but when everything that one person does begins to drive you nuts - that’s the problem. Maybe we just aren’t designed to be with one person our whole life, because, let’s face it, people get annoying. But apparently I’m jaded…

What I actually want to talk about is monogamy assumption. Rather, I suppose I want to learn about monogamy and try to understand why it is so often assumed in (largely heterosexual ) relationships. I have been out of the dating circuit for almost a decade, so perhaps something changed while I was busy doing whatever it is one does in a monogamous relationship: taking Friday night walks through Home Depot, shopping for furniture, having scheduled sex. Maybe I have just been ill-informed by damaging television shows such as Sex and the City but I thought single people dated. A lot. I thought single people went out on multiple dates with multiple people. And not even just people who were looking for relationships; people who didn’t want anything serious too, I thought they dated as well.

"In fact, based on my limited findings, it would seem that straight people at least prefer monogamy."

When I started paying attention and asking around, I realized that people do in fact date, but most people don’t date multiple people at the same time. Why, you might ask? Well, the most common answer I’ve gotten is that people aren’t comfortable sleeping with more than one person at a time. In fact, based on my limited findings, it would seem that straight people at least prefer monogamy. And since, if you’re lucky, dating often leads to sex, people therefore tend to only date one person at a time.

 I recognize that this little “study” is extremely limited, but I’m hard pressed to find many people who feel differently.  It seems that even if people are dating multiple people, once they find someone they like, they stop dating the others. Which leaves me questioning- what if you like them all? What if you’re dating multiple people and you like all of them? What if you are sleeping with all of them? What if they’re sleeping with other people? What if they’re assuming you’re monogamous? Which leads me to my next question:

When do you have the monogamy discussion?

Is it the first date? First time you have sex? First time you say “I love you”? It seems to me, from my own experience, from my friends’ experiences, and from my inevitable exposure to pop culture, that exclusitivity is assumed from the beginning- at the very latest from the first time you have sex. Where does this come from, I wonder? Is this bred into us? Is it “natural” to assume once we are having sex with someone they aren’t having sex with anyone else? Are we taught this through pop culture? When did sex suddenly equal exclusivity? And furthermore, how did I miss this?

"Multiple studies suggest that monogamy is neither necessarily assumed nor the norm among gay male couples."  

So, I know this rant is slightly heteronormative. I am aware of this, since I can only truly speak from my own experience and my own interpretations of the world. I recognize that this is largely different among the LGBTQ community, particularly among gay men. Multiple studies, such as The Couples Study and Hoff’s survey of 566 gay male couples in the San Francisco Bay Area, suggest that monogamy is neither necessarily assumed nor the norm among gay male couples.  I’ve been lead to believe by my gay male friends that monogamy is not assumed until discussed.

So why is it so different among straight people? The obvious answer is that they are socialized that way, whereas queer people have always had to challenge “conventional” relationships.  Is the assumption of monogamy just another backwards thing we “breeders” do? Don’t get me wrong, I have nothing against monogamy, I just don’t want it forced on me or assumed, and I sure as hell don’t want to be judged for my aversion to it or mere desire to simply date. 

The “Breast is best” mantra has become the chant pregnant women and new mothers hear, and it’s no surprise- breast milk is amazing stuff. Breastfeeding helps build a child’s immune system, develop healthy gut flora, and prevent allergies, obesity, asthma and SIDS.  It also boosts a baby’s brain power. But as we learn more about how breastfeeding contributes to infant and child development, women who can’t or are advised not to breastfeed for medical reasons can be profoundly affected. A couple of pieces I read last week brought the issue up again.   

HIV and Breastfeeding - No

HIV is present in breast milk, so women with HIV who live in areas where clean water supplies are available are advised to formula feed to avoid transmission risk. This can be complicated for women with pressure from surrounding friends, family, or social norms that they will breastfeed. This tension was presented in a study of women of African descent living in the UK. It was shared recently at the British HIV Association conference.

Twenty-three women with HIV (pregnant or new moms) took part in a study to discuss their feelings about breastfeeding. Having been raised with the expectations that mothers breastfeed, they felt that breastfeeding was “an essential aspect of being a woman and a mother.” Roger Pebody’s coverage of the study also noted that these feelings were echoed by women in a Canadian study last year.

For women who haven’t disclosed to people in her circles, fear of discrimination and judgment loom large. The pressure to breastfeed could feel enormous. Women in this situation reported they often isolated themselves and their babies.

HIV and Breastfeeding - Yes

Pebody’s piece also reported on confusing health education women receive. Breast IS best for women with HIV when there are no dependable clean water supplies. In these situations, the risk of water-borne illness to babies outweighs the risk of HIV transmission from breast milk, and positive moms are advised to breastfeed exclusively.  There should be no use of formula at all (using both breast milk and formula is called mixed feeding). On top of putting an infant at risk for water-borne infections, formula can cause inflammation in an infant’s gut, which can open the way for HIV infection.

Refer here. 

Another piece breastfeeding women need to know about is weaning. It looks like transmission risk is more about how a woman weans than when. A study of 958 women showed that levels of HIV in their breast milk increased when they weaned abruptly when their babies were four months. In women who continued to breastfeed, those who did so exclusively had lower levels of HIV in their milk than the women who didn’t exclusively breast feed. This research indicates the benefits of exclusive breastfeeding past four months of age, and reinforces the importance of good health support and education for women.

Refer also here. 

This article first appeared on the website of Positive Women’s Network here.