Breastfeeding is a route of HIV transmission from an HIV-infected mother to her infant. However, breastfeeding is an important pillar of child survival and the ideal way of feeding an infant as well as providing a unique biological and emotional basis for child development. This article highlights the dilemma created by the risks and benefits of breastfeeding and will discuss factors which increase the risk of HIV transmission during breastfeeding as well as strategies which could be employed to reduce these risks. Many questions still remain unanswered. Until further research results are available, women should be encouraged to follow the UNAIDS guidelines "when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended, otherwise, exclusive breastfeeding (EBF) is recommended during the first months of life". Anti-retroviral therapy to the mother and/or infant is likely to offer the possibility of maintaining breastfeeding as a safe option for HIV-infected women.