CHAPTER ONE
INTRODUCTION
UNAIDS (2007) estimated that 33.2 million women had HIV infection worldwide. In many regions of the world more women than men are at risk of HIV infection with not less 50% of all new daily infections in sub-Saharan Africa being in women. Children account for 12% of all new infections and globally 2.5 million children less than 15years of age were living with HIV in 2007, about 1,200 children under the age of 15years became infected with HIV daily (UNAID/WHO, 2007), without appropriate care and treatment, more than 50% of newly infected children will die before the second birthday. In 2008, around 430,000 children under 15years become infected with HIV, mainly through mothers –to child transmission (MTCT), infection occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival. In high income countries MTCT has been virtually eliminated thanks to effective HIV counseling and testing, access to antiretroviral therapy ART, Safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year. Owing to the transmissibility of HIV from mother to child, the feeding of HIV-exposed infants remains a significant challenge in controlling the spread of HIV/AIDS. The dilemma concerning feeding infants of HIV-positive mothers is how to balance the risk of HIV transmission through breastfeeding with the risk of death from causes other than HIV such as pneumonia, diarrhoeal diseases and malnutrition among formula-fed infants (WHO, 2010). Exclusive breastfeeding (EBF) plays a critical role in the overall health of infants. It is estimated that 3% of all under-5 mortalities in low-income countries could be prevented through optimal breastfeeding during the crucial first year of life (WHO, 2013). Optimal breastfeeding is considered to be EBF for the first 6 months of life, followed by continued breastfeeding combined with safe and nutritionally adequate complementary feeding up to 24 months of age (WHO, 2009).EBF is regarded as a global health goal given its strong association with reduced morbidity and mortality, particularly in low-income countries where safe water and sanitation are often lacking. The HIV/AIDS epidemic is one of the major factors challenging women's health with 20 million women living with the virus and more than 2 million pregnancies occurring in HIV sero-positive women annually. Thus, HIV infection has become a major problem complicating the management of pregnancy. In Africa, HIV prevalence varies considerably, with most countries in Southern Africa having more than one in five pregnant women infected, and in a few sub-Saharan countries, median HIV prevalence in antenatal clinics in 2003 exceeded 10% (McIntyre,2005). As at 2005 the prevalence in Nigeria was 4. 4%, and by the end of 2006, it was estimated that there are 2. 99 million Nigerians living with HIV, with 305, 080 adult new infections and 74, 520 in children, largely (up to 90%) acquired through mother-to-child transmission (MTCT).