title: HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate.
abstract: Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.
authors.affiliation: ZVITAMBO Project, Harare, Zimbabwe.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Lunney
authors.forename: Alison L
authors.initials: AL
authors.lastname: Jenkins
authors.forename: Naume V
authors.initials: NV
authors.lastname: Tavengwa
authors.forename: Florence
authors.initials: F
authors.lastname: Majo
authors.forename: Dzivaidzo
authors.initials: D
authors.lastname: Chidhanguro
authors.forename: Peter
authors.initials: P
authors.lastname: Iliff
authors.forename: G Thomas
authors.initials: GT
authors.lastname: Strickland
authors.forename: Ellen
authors.initials: E
authors.lastname: Piwoz
authors.forename: Lora
authors.initials: L
authors.lastname: Iannotti
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
mesh_terms: D001942:Breast Feeding; D004032:Diet; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000592:standards*; D007227:Infant Nutritional Physiological Phenomena; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009752:Nutritional Status; D011203:Poverty; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D014886:Weaning; D015030:Zimbabwe