If replacement feeding is rejected by the HIV-positive mother, for whatever reasons, there are some things that she can do to reduce the risk of HIV transmission during breastfeeding. Counsel her to:

• Keep the intervals between breast feeds as short as possible (no longer than three hours) to avoid accumulation of the virus in her breast milk.
• If she develops a bacterial infection (mastitis) of the breast, or she has a cracked nipple, stop feeding from the infected breast and seek urgent treatment.
• Check the infant's mouth for sores and seek treatment if necessary.
• Make a transition to replacement feeding if her circumstances change and she can meet the AFASS criteria.

At six months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe, counsel her to continue breastfeeding, but with additional complementary foods. All breastfeeding should stop once a nutritionally adequate and safe diet without breast milk can be provided.