title: HIV-positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed.
abstract: Before the prevention of mother-to-child transmission (PMTCT) program was widely implemented in Malawi, HIV-positive women associated exclusive breastfeeding with accelerated disease progression and felt that an HIV-positive woman could more successfully breastfeed if she had a larger body size. The relationship between breastfeeding practices and body image perceptions has not been explored in the context of the Option B+ PMTCT program, which offers lifelong antiretroviral therapy. We conducted in-depth interviews with 64 HIV-positive women in Lilongwe District, Malawi to investigate body size perceptions, how perceptions of HIV and body size influence infant feeding practices, and differences in perceptions among women in PMTCT and those lost to follow-up. Women were asked about current, preferred, and healthy body size perceptions using nine body image silhouettes of varying sizes, and vignettes about underweight and overweight HIV-positive characters were used to elicit discussion of breastfeeding practices. More than 80% of women preferred an overweight, obese, or morbidly obese silhouette, and most women (83%) believed that an obese or morbidly obese silhouette was healthy. Although nearly all women believed that an HIV-positive overweight woman could exclusively breastfeed, only about half of women thought that an HIV-positive underweight woman could exclusively breastfeed. These results suggest that perceptions of body size may influence beliefs about a woman's ability to breastfeed. Given the preference for large body sizes and the association between obesity and risk of noncommunicable diseases, we recommend that counseling and health education for HIV-positive Malawian women focus on culturally sensitive healthy weight messaging and its relationship with breastfeeding practices.
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Croffut
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Gloria
authors.initials: G
authors.lastname: Hamela
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Innocent
authors.initials: I
authors.lastname: Mofolo
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.|Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.|Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Valerie L
authors.identifier: 0000-0003-0200-3355
authors.initials: VL
authors.lastname: Flax
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001828:Body Image / Q000523:psychology; D015992:Body Mass Index; D049628:Body Size; D001942:Breast Feeding / Q000523:psychology*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006679:HIV Seropositivity / Q000188:drug therapy; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008295:Malawi; D009765:Obesity / Q000523:psychology; D050177:Overweight / Q000523:psychology*; D013851:Thinness
chemical_list: D044966:Anti-Retroviral Agents
keywords: Africa; HIV; body image; breastfeeding; overweight; women