title: Breast milk as the "water that supports and preserves life"--socio-cultural constructions of breastfeeding and their implications for the prevention of mother to child transmission of HIV in sub-Saharan Africa.
abstract: OBJECTIVE
  Complementary breastfeeding represents an important source of risk of HIV infection for infants born to HIV positive mothers. The World Health Organisation recommends that infants born to HIV positive mothers receive either replacement feeding or exclusive breastfeeding (EBF) followed by early weaning. Beyond the clinical and epidemiological debate, it remains unclear how acceptable and feasible the two options are for rural populations in sub-Saharan Africa. This qualitative study aims to fill this gap in knowledge by exploring both the socio-cultural construction and the practice of breastfeeding in the Nouna Health District, rural Burkina Faso.
  
  
  METHODS
  Information was collected through 32 individual interviews and 3 focus group discussions with women of all ages, and 6 interviews with local guérisseurs.
  
  
  RESULTS
  The findings highlight that breastfeeding is perceived as central to motherhood, but that women practice complementary, rather than exclusive, breastfeeding. The findings also indicate that women recognise both the nutritional value of breast milk and its potential to act as a source of disease transmission.
  
  
  CONCLUSIONS
  The findings suggest that given the socio-cultural importance attributed to breastfeeding and the prevailing poverty, it may be more acceptable and more feasible to promote EBF followed by early weaning than replacement feeding. A set of operational strategies are proposed to favour the prevention of mother to child transmission of HIV in the respect of the local socio-cultural setting.
authors.affiliation: Institute of Ethnology, University of Heidelberg, Sandgasse 7, 69117 Heidelberg, Germany. siewlei@web.de
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hofmann
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
authors.forename: Malabika
authors.initials: M
authors.lastname: Sarker
authors.forename: Mamadou
authors.initials: M
authors.lastname: Sanon
authors.forename: Thomas
authors.initials: T
authors.lastname: Böhler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001942:Breast Feeding; D002050:Burkina Faso; D003469:Culture; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D008875:Middle Aged; D008895:Milk, Human; D012927:Social Control, Informal; D055815:Young Adult