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Dr Sam Elliott GP and a director on the board of the Australasian Society for HIV , Viral Hepatitis and Sexual Health Medicine .

How black market breastmilk is spreading misinformation .

References : 1 . Spikevax Bivalent Original / Omicron BA . 4-5 Product Information , February 2023 . 2 . Chalkias S et al . A bivalent Omicron-containing booster vaccine against COVID-19 . Available at : https :// www . medrxiv . org / content / 10.1101 / 2022.06.24.22276703v1 . Accessed April 2023 . 3 . Andersson NW , et al . Comparative effectiveness of the bivalent BA . 4-5 and BA . 1 mRNA-booster vaccines in the Nordic countries . medRxiv . Published online 2023:2023-01 . 4 . Link-Gelles R et al . MMWR Morb Mortal Wkly Rep 2022 ; 71:1526 – 30 .

Moderna Australia Pty Ltd . Level 6 , 60 Martin Place , Sydney , NSW 2000 . © Copyright 2023 . Prepared : April 2023 . AU-COV-2300027 . MOD0210 _ AD _ A4 .

Recent articles in The Guardian , SBS News and Australian Doctor describe an emerging black market , with buyers sourcing it for a range of purposes — from infant feeding to fitness benefits or a cure for cancer . But common to these stories are cautions that breastmilk sourced from unregulated markets carries a risk of disease .

This is true , and I would advise against anyone buying breastmilk online for human consumption . But when talking about the risk of disease transmission , some of these articles have suggested that bloodborne viruses ( BBVs )

— including hepatitis B , hepatitis C and HIV — can be transmitted via breastmilk .

Professor Valerie Verhasselt , director of the Centre of Research for Immunology and Breastfeeding at the University of WA and the Telethon Kids Institute , told Australian Doctor that buyers should be wary of purchasing breastmilk from a mother “ who may have a disease that is transmissible through breastmilk , particularly HIV or hepatitis ”.

Such commentary could be misinterpreted as suggesting that mothers with HIV or hepatitis risk transmitting the virus to their infants when breastfeeding .

This is , in most instances , not the case .

For patients living with BBVs , misinformation about transmission risk makes it difficult to make informed decisions about whether to breastfeed and adds to existing stigma about these patients being a health threat to those around them .

If your patient has hepatitis B or C , you can support them to breastfeed safely .

Breastfeeding by those with chronic hepatitis B is not considered to be a risk factor for transmission to their infant . This is reflected in the Australasian Society for HIV , Viral Hepatitis and Sexual Health Medicine guidelines on the management of BBVs and STIs in antenatal care .

In addition , children born to people with hepatitis B receive hepatitis B immunoglobulin in the first 12 hours of life , in addition to a dose of hepatitis B vaccine as part of their regular vaccination schedule .

They will also get regular doses of hepatitis B vaccine over the subsequent six months . Patients who require antiviral therapy may also continue to breastfeed .

Molly , a patient of mine living with chronic hepatitis B , reacted with tears of joy when she was encouraged to breastfeed . This was contrary to advice she had received elsewhere .

She chose to breastfeed , and her self-esteem grew immensely , creating a positive bonding experience . Patients with hepatitis C who wish to breastfeed their newborns should be similarly reassured . The proviso in this scenario is that breastfeeding should be avoided if cracked and bleeding nipples develop .

Breastfeeding for people living with HIV can be more complex , as HIV can , in rare cases , be transmitted via breastmilk . The only way to eradicate transmission risk completely is formula feeding . However , for those with HIV who may want to breastfeed , it can be a viable option if they engage in strategies to reduce the risk of HIV transmission .

These include adherence to HIV treatment and regular viral load monitoring to ensure a suppressed viral load of less than 50 RNA copies / mL throughout the pregnancy and breastfeeding . However , these strategies cannot eliminate HIV transmission risk entirely .

Even in the optimal scenario — where a patient has a viral load of below 400 copies / mL — transmission risk is estimated at between 0.5 % and 1 % with 6-12 months of breastfeeding .

This may be an acceptably lowlevel risk for you and your patient , and more information will allow them to make a decision about whether to breastfeed .