Infants Possibly Exposed to HIV via Breast Milk Donated Over Social Media

Health officials from California are warning about the risks of acquiring breast milk outside of vetted channels after multiple infants were potentially exposed to HIV from donor milk obtained via social media. According to a report, a pregnant woman who was donating breast milk through social media groups was found to be HIV-positive, and her donated milk may have been consumed by several infants.

## Background The investigation started when the Santa Clara Public Health Department was notified of a pregnant woman who received a positive HIV test result at a prenatal screening. The woman had been donating breast milk through social media groups since May of that year, and her pretreatment HIV viral load was 119,000 copies/mL. Her daughter began receiving postexposure prophylaxis and tested negative for HIV shortly thereafter.

## Risks of Unpasteurized Breast Milk Unpasteurized breast milk can be contaminated with viruses or bacteria if improperly stored. Accredited milk banks pasteurize their product and screen donors for infectious diseases and medications that can transmit to infants. The American Academy of Pediatrics recommends breastfeeding for various health benefits, but it's not recommended for mothers with an HIV viral load of more than 50 copies/mL due to the risk of transmission.

## Investigation Challenges The health department faced several challenges during their investigation, including being accepted into closed social media groups, facing skepticism from contacted parents, and being barred from posting messages in social media groups about safety risks associated with sharing breast milk through these groups. Despite these challenges, the investigators were able to identify and test infants at highest risk for potential exposure to HIV. The following table summarizes the key findings: | Category | Description | | --- | --- | | Donor Milk | Unpasteurized breast milk donated through social media | | HIV Viral Load | 119,000 copies/mL (donor), <30 copies/mL (donated milk) | | Infant Testing | All infants tested negative for HIV | | Recommendations | Children exposed to such milk should be tested for HIV immediately after their last exposure, and at 14-21 days, 4-6 weeks, and 4-6 months after the last breastfeeding |

## Public Health Implications The report highlights the importance of patient education on risks associated with unpasteurized breast milk and the unique role social media can play in public health investigations. Social media groups can be used to focus public health interventions toward persons informally exchanging breast milk that has not been properly screened. However, reaching these communities can be challenging, particularly because contact through social media can appear unofficial. Health officials may benefit from additional training on how to conduct investigations through verified profiles in such groups.