Future directions

Despite progress in promotion and support of breastfeeding over the past decade, the HIV pandemic necessitates new actions based on human rights, such as voluntary and confidential testing and counseling, offering HIV-positive women objective information on the risks and costs of all infant feeding options, and providing appropriate support for their decisions. Implementation of the Baby-Friendly Hospital Initiative and the International Code of Marketing are essential components of a rights-based policy response to HIV and will lessen spillover of replacement feeding among HIV-negative women. Protective effects of nevirapine and exclusive breastfeeding, as well as the listed additional topics, require further research. We have yet to make exclusive breastfeeding easy and common when mothers choose to breastfeed.