Abstract
BackgroundInfant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya.MethodsWe used a qualitative study design. Between March and August 2011, we conducted in-depth interviews (n = 9) and focus group discussions (n = 10) with purposively selected hospital and community respondents at Kilifi County Hospital, Kenya. These respondents had all experienced of infant feeding in the context of HIV. These interviews were informed by prior structured observations of health care worker interactions with carers during infant feeding counselling sessions.ResultsOverall, women living with HIV found it difficult to adhere to the HIV infant feeding guidance. There were three dominant factors that influenced decision making processes: 1) Exclusive breastfeeding was not the cultural norm, therefore practising it raised questions within the family and community about a mother’s parenting capabilities and HIV status. 2) Women living with HIV lacked autonomy in decision-making on infant feeding due to socio-cultural factors. 3) Non-disclosure of HIV status to close members due to the stigma.ConclusionInfant feeding decision-making by women living with HIV in rural Kenya is constrained by a lack of autonomy, stigma and poverty. There is an urgent need to address these challenges through scaling up psycho-social and gender empowerment strategies for women, and introducing initiatives that promote the integration of HIV infant feeding strategies into other child health services.
Highlights
Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements
In this context women living with HIV who had not disclosed their status to their family members found it difficult to undertake feeding practices that departed from the norm, even when they were motivated to do so
Our study showed that women living with HIV in this community were constrained from adhering to the infant feeding guidance by three main factors: fear of going against cultural norms of infant feeding as exclusive breastfeeding is alien to this community, a lack of autonomy in the infant feeding decision-making and nondisclosure of HIV status to close family members
Summary
Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. Data from more rural African populations suggest that the use of replacement feeds and/or rapid weaning off breast milk at 6 months of age are strategies that are nutritionally hazardous and detrimental to child survival, with limited benefit of HIV-free survival [16,17,18,19,20,21,22,23] The reasons for this include poverty, lack of access to clean water and adequate sanitation, and low literacy rates in many rural African settings [7, 24]. With maternal combination antiretroviral treatment (ART) and infant prophylaxis with nevirapine or zidovudine, the risk of vertical transmission in exclusively breastfed infants can be reduced to less than 1% [25,26,27,28,29], and HIV-free survival at 24 months increased to more than 87% [20]
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