Breastfeeding and HIV in high‐income settings: Exploring women living with HIV and health care providers' perspectives in Belgium

OBJECTIVES: In high-income countries, breastfeeding among women living with HIV remains controversial, despite evidence of a residual transmission risk below 1% on effective antiretroviral therapy (ART) with sustained viral suppression. Following the recent adoption of Belgian national guidance allowing breastfeeding in selected cases, we explored breastfeeding intentions among women living with HIV and assessed the knowledge, attitudes, practices and ethical perceptions of healthcare providers (HCPs). METHODS: A single-centre cross-sectional study and a national cross-sectional survey were conducted between November 2024 and April 2025. Twenty pregnant women living with HIV receiving care at an HIV referral centre in Brussels were interviewed using a semistructured questionnaire. In parallel, an online survey was distributed to HCPs involved in the care of pregnant women living with HIV. RESULTS: Nearly half of the women (9/20) wished to breastfeed, motivated by perceived benefits for the child, mother-infant bonding, cultural norms and concerns about HIV disclosure; the risk of transmission was the most frequently endorsed factor, and 15/17 reported that their provider's opinion had influenced their decision. Among 97 HCPs, 78/97 (80.4%) would inform and support a woman choosing to breastfeed, yet 61/93 (65.6%) read the national guidance as advising against it. Although 88/97 (90.7%) knew the current recommendations, only 36/96 (37.5%) had received specific training on breastfeeding and HIV, and 79/97 (81.4%) requested more. CONCLUSIONS: Our findings reveal a gap between women living with HIV's growing openness to breastfeeding and a healthcare workforce not yet fully equipped to support it. Closing this gap will require harmonized protocols, targeted training and culturally sensitive, patient-centred counselling.