At a public health level, occasional individual infections via breastfeeding are a small price to pay for a compelling benefit to the majority. The low frequency of transmission during breastfeeding, even when risk is increased, allows time to optimise maternal cART to reduce risk rather than promoting formula feeding. A weak point in the old early infant diagnosis programme was a tendency towards early termination of breastfeeding around 10–12 weeks when receiving the negative result from the 6-weeks test. This pattern suggested a missed opportunity to support breastfeeding at this critical juncture. It is unclear whether counselling specifically encouraged women to stop breastfeeding or whether messaging around the need for retesting inadvertently failed to convey the importance of continued breastfeeding. Vigilance is needed when counselling mothers about the meaning of negative birth PCR tests to ensure that this counselling does not inadvertently discourage breastfeeding. Breastfeeding and breastmilk feeding remain the best feeding method to optimise health outcomes in PMTCT, even when mothers are failing first- and second-line treatment. The counselling messages after birth testing must include clear support for breastfeeding if we are to leverage the full health benefits of very early HIV diagnostic testing and strengthened prophylaxis.