title: "It pains me because as a woman you have to breastfeed your baby": decision-making about infant feeding among African women living with HIV in the UK.
abstract: UK guidance advises HIV-positive women to abstain from breast feeding. Although this eliminates the risk of postnatal vertical transmission of HIV, the impact of replacement feeding on mothers is often overlooked. This qualitative study examines, for the first time in the UK, decision-making about infant feeding among African women living with HIV.
  
  
  
  Between 2010 and 2011, we conducted semistructured interviews with 23 HIV-positive African women who were pregnant or had recently given birth. We recruited participants from three HIV antenatal clinics in London.
  
  
  
  Women highlighted the cultural importance of breast feeding in African communities and the social pressure to breast feed, also describing fears that replacement feeding would signify their HIV status. Participants had significant concerns about physical and psychological effects of replacement feeding on their child and felt their identity as good mothers was compromised by not breast feeding. However, almost all chose to refrain from breast feeding, driven by the desire to minimise vertical transmission risk. Participants' resilience was strengthened by financial assistance with replacement feeding, examples of healthy formula-fed children and support from partners, family, peers and professionals.
  
  
  
  The decision to avoid breast feeding came at considerable emotional cost to participants. Professionals should be aware of the difficulties encountered by HIV-positive women in refraining from breast feeding, especially those from migrant African communities where breast feeding is culturally normative. Appropriate financial and emotional support increases women's capacity to adhere to their infant-feeding decisions and may reduce the emotional impact.
authors.affiliation: School of Health Sciences, City University London, London, UK Department of Anthropology, University College London, London, UK.
authors.forename: Shema
authors.initials: S
authors.lastname: Tariq
authors.affiliation: School of Health Sciences, City University London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.affiliation: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
authors.forename: Pat
authors.initials: P
authors.lastname: Tookey
authors.affiliation: Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Annemiek
authors.initials: A
authors.lastname: de Ruiter
authors.affiliation: Greenway Centre, Newham University Hospital, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: O'Connell
authors.affiliation: Department of Anthropology, University College London, London, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Pillen
mesh_terms: D000328:Adult; D044383:Black People; D001942:Breast Feeding / Q000208:ethnology* / Q000523:psychology*; D003466:Cultural Characteristics; D003657:Decision Making; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008131:London / Q000453:epidemiology; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D036301:Qualitative Research
keywords: AIDS; CULTURAL DIFFERENCE; HIV WOMEN; PREGNANCY; QUALITATIVE RESEARCH