I must object most strongly to the conclusions drawn by Wolf et al1 in the third clinical scenario presented in their article, "When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency Virus Transmission." As the authors state, no data exist to show the safety of breastfeeding by a mother infected with human immunodeficiency virus (HIV). No data exist because ethically such a study could not be conducted in the United States and probably not in any country that adheres to the Declaration of Helsinki. As a pediatrician, my patient is the infant. I cannot allow the possible cultural and social discomfort of an adult to justify putting an infant at risk for an incurable, lethal viral infection. When a safe, risk-free alternative exists (formula feeding), no-risk exposure to an infant is acceptable. How could you justify the risk-benefit ratio favoring the mother in this circumstance? My ethics and training force me to favor the infant and I would be obligated to ask the courts to intervene.
Murray PE. Exposure to Possible Risk Is Unethical. Arch Pediatr Adolesc Med. 2002;156(1):87. doi: