A Longitudinal Qualitative Study of Infant-Feeding Decision Making and Practices among HIV-Positive Women in South Africa

The availability of effective short course antiretroviral (ARV) regimens in the peripartum period provides the potential for significant reductions in utero and intrapartum mother-to-child HIV transmission (MTCT)6 (1,2). With the widespread introduction of prevention of mother-to-child transmission (PMTCT) programs containing peripartum ARV prophylaxis, MTCT in the postpartum period through breast-feeding is becoming increasingly important. Exclusive breast-feeding or complete avoidance of breast-feeding through exclusive replacement feeding is currently the main focus of attention, but little is known about how to achieve these practices (3,4).

UNICEF/WHO has recommended that HIV-positive women avoid all breast-feeding when replacement feeding is acceptable, feasible, affordable, sustainable, and safe for their circumstances.

If the available replacement feeding methods do not meet these criteria, exclusive breast-feeding (EBF) is recommended during the first months of life (5). The application of these recommendations in operational settings is a challenge. Both clinical trials and evaluations of PMTCT programs have found that rates of exclusive infant feeding, both breast-feeding and formula-feeding,are suboptimal (69). In South Africa, although the majority of mothers initiate EBF, only 10.4% exclusively breast-feed until their infant is 3 mo of age and the percentage decreases to 1.2% for those who breast-feed their infant until 6 mo of age (10).