title: Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance.
abstract: OBJECTIVE
  Early and rapid cessation of breastfeeding has been recommended by WHO to reduce mother-to-child transmission of HIV. This study assessed how HIV-infected mothers planned and experienced breastfeeding cessation as part of an HIV prevention strategy and how counsellors facilitated this process.
  
  
  METHODS
  A qualitative study was conducted among HIV-infected mothers and counsellors from local clinics and an intervention research project in Durban, South Africa.
  
  
  RESULTS
  Mothers enrolled in the research setting reported many success stories in contrast to mothers attending routine services. Consistent counselling and ongoing support from counsellors facilitated this, though specific advice on how to stop breastfeeding and introduce complementary feeds was inadequate amongst both sets of counsellors. Few mothers had a plan for what they were actually going to do on the day when they had decided to stop breastfeeding. Their primary motivation for wanting to rapidly stop breastfeeding, even with the difficulties involved, was to avoid infecting their child with HIV. Both counsellors and HIV-infected mothers expressed concern about practical issues, including social consequences, associated with early cessation. Mothers who had stopped breastfeeding offered some, albeit limited, recommendations to assist and guide other women.
  
  
  CONCLUSIONS
  The experiences of HIV-infected mothers planning for and stopping breastfeeding early illustrate the complexity of this recommendation and demonstrate that counsellors are ill-prepared to support mothers accomplish this safely. Guidance that acknowledges the cultural context and psychological stresses is urgently needed to direct policy, training and service delivery.
authors.affiliation: Fafo Institute for Applied International Studies, Norway. marina.de.paoli@fafo.no
authors.forename: Marina M
authors.initials: MM
authors.lastname: de Paoli
authors.forename: Ntombizodumo B
authors.initials: NB
authors.lastname: Mkwanazi
authors.forename: Linda M
authors.initials: LM
authors.lastname: Richter
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards; D036301:Qualitative Research; D013019:South Africa; D013997:Time Factors; D055815:Young Adult