title: The infant feeding choices and experiences of women living with HIV in Kinshasa, Democratic Republic of Congo.
abstract: HIV transmission through breastfeeding is a significant public health challenge. While breastfeeding provides important nutrition, and results in reduced morbidity and mortality, there is a risk of HIV transmission through breastfeeding. International prevention of mother-to-child transmission (PMTCT) guidelines recommend exclusive breastfeeding for six months among HIV-infected women on antiretroviral therapy. Promoting exclusive feeding has proved difficult in settings where mixed feeding is a cultural norm. Understanding the factors that influence HIV infected women's infant feeding choices and practices is critical to promoting adherence to PMTCT guidelines. We conducted in-depth interviews with 40 HIV+ pregnant and post-partum women in Kinshasa, Democratic Republic of Congo to understand their infant feeding experiences. Interviews were conducted in Lingala, and transcribed and translated into French for analysis. Deductive and inductive codes were applied, and matrices were created to facilitate cross-case analysis. Women had limited understanding of the specific mechanisms through which their infant feeding practices influenced HIV transmission risk. Clinical staff was the primary source of women's knowledge of HIV mother-to-child-transmission. Among the 24 post-partum women in the sample, seven women adhered to exclusive breastfeeding and two women to exclusive formula feeding for at least six months. Women's beliefs and awareness about HIV transmission through breastfeeding, as well as the information and support from clinical staff and other members of their support networks positively influenced their exclusive feeding. Common barriers to exclusive feeding included financial constraints, breast health problems, misinformation about HIV transmission, local norms, and prior feeding experiences. Health care workers play a key role in providing correct information on PMTCT and supporting women's infant feeding choices to adhere to guidelines of exclusive infant feeding. Optimizing provider-patient communication and creating a supportive environment surrounding infant feeding is critical.
authors.affiliation: Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, NC, USA. smaman@unc.edu
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cathcart
authors.forename: Gillian
authors.initials: G
authors.lastname: Burkhardt
authors.forename: Serge
authors.initials: S
authors.lastname: Omba
authors.forename: Deidre
authors.initials: D
authors.lastname: Thompson
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002755:Choice Behavior; D015023:Democratic Republic of the Congo; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D036301:Qualitative Research