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The global rate of mother-to-child transmission of HIV has dropped in recent years as scientists have learned more about HIV. The use of cesarean delivery as well as prescribing anti-HIV drugs to the mother during the second and third trimesters of pregnancy, as well as to the infant for the first 6 weeks of life, has reduced mother-to-child HIV transmission to less than 2% in the United States and Europe (from over 20%) (Torpey et al., 2010). However, the incidence of perinatal HIV remains at about 1.75 per 100,000 live births in the United States. Over two-thirds of the HIV infected children born in 2002–2013 were to Black or African American mothers (63%) and about 18% to Hispanic or Latina mothers (A. W. Taylor et al., 2017). A combination of socioeconomic factors influence these health disparities, such as lack of insurance, limited health literacy, and poverty and its associated sense of powerlessness which may prevent women from seeking assistance. HIV medications and treatment are expensive and an HIV diagnosis is often stigmatizing and may alienate individuals from their communities. Aggressive treatment may further reduce the transmission of HIV to newborns, and research suggests that it may even induce remission (National Institute of Allergy and Infectious Diseases, 2014; Pollack & McNeil, 2013; Rainwater-Lovett, Luzuriaga, & Persaud, 2015). However, women of color and those in poverty are less likely to experience HIV treatment.

Mother-to-child transmission of HIV has declined as scientists have learned more about HIV. However, HIV remains a worldwide problem especially in developing nations where cultural, economic, and hygienic reasons prevent mothers from seeking alternatives to breastfeeding, a primary cause of mother-to-child transmission of HIV.

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HIV rates are highest for infants in developing countries where interventions are widely unavailable. Worldwide, mother-to-child HIV transmission remains a serious issue. About 80% of children living with HIV reside in Sub-Saharan African countries (Kassa, 2018). Globally, 20% to 30% of neonates with HIV develop AIDS during the first year of life and most die in infancy (United Nations Children’s Fund, 2013). Breastfeeding accounts for 30% to 50% of HIV transmission in newborns (Sullivan, 2003; World Health Organization, 2011). The World Health Organization (2010) recommends providing women who test positive for HIV with information about how HIV may be transmitted to their infants and counseling them not to breastfeed. Yet cultural, economic, and hygienic reasons often prevent mothers in developing nations from seeking alternatives to breastfeeding. For example, the widespread lack of clean water in some countries makes the use of powdered formulas dangerous. Also, in some cultures, women who do not breastfeed may be ostracized from the community (Sullivan, 2003). Balancing cultural values with medical needs is a challenge.

Children with HIV are at high risk for a range of illnesses and health conditions, including chronic bacterial infections; disorders of the central nervous system, heart, gastrointestinal tract, lungs, kidneys, and skin; growth stunting; neurodevelopmental delays, including brain atrophy, which contribute to cognitive and motor impairment; and delays in reaching developmental milestones (Blanchette, Smith, Fernandes-Penney, King, & Read, 2001; Laughton, Cornell, Boivin, & Van Rie, 2013; Sherr, Mueller, & Varrall, 2009).