title: The impact of safer breastfeeding practices on postnatal HIV-1 transmission in Zimbabwe.
abstract: OBJECTIVE
  We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status.
  
  
  METHODS
  Mothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission.
  
  
  RESULTS
  Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status.
  
  
  CONCLUSIONS
  The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice.
authors.affiliation: Center for Nutrition, Academy for Educational Development, Washington, DC, USA.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Piwoz
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Naume V
authors.initials: NV
authors.lastname: Tavengwa
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Iliff
authors.forename: Edmore T
authors.initials: ET
authors.lastname: Marinda
authors.forename: Clare D
authors.initials: CD
authors.lastname: Zunguza
authors.forename: Kusum J
authors.initials: KJ
authors.lastname: Nathoo
authors.forename: Kuda
authors.initials: K
authors.lastname: Mutasa
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ward
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D001942:Breast Feeding; D003376:Counseling; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006266:Health Education / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008895:Milk, Human / Q000821:virology*; D017063:Outcome Assessment, Health Care; D016133:Polymerase Chain Reaction; D016016:Proportional Hazards Models; D015030:Zimbabwe / Q000453:epidemiology