Academic journal article Bulletin of the World Health Organization

Infant Feeding Counselling for HIV-Infected and Uninfected Women: Appropriateness of Choice and practice/Conseils a L'intention Des Femmes Infectees et Non-Infectees Par le VIH Pour L'alimentation Des Nourrissons: Pertinence Des Options Choisies et Des Pratiques Mises En ouevre/Asesoramiento Sobre Alimentacion del Lactante Para Mujeres VIH-Positivas Y VIH-Negativas: Idoneidad De Las Decisiones Y Las Practicas

Academic journal article Bulletin of the World Health Organization

Infant Feeding Counselling for HIV-Infected and Uninfected Women: Appropriateness of Choice and practice/Conseils a L'intention Des Femmes Infectees et Non-Infectees Par le VIH Pour L'alimentation Des Nourrissons: Pertinence Des Options Choisies et Des Pratiques Mises En ouevre/Asesoramiento Sobre Alimentacion del Lactante Para Mujeres VIH-Positivas Y VIH-Negativas: Idoneidad De Las Decisiones Y Las Practicas

Article excerpt

Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. [TEXT NOT REPRODUCIBLE IN ASCII.]

Introduction

United Nations (WHO/UNICEF/ UNAIDS/UNFPA) recommendations on infant feeding to prevent posmatal mother-to-child transmission (MTCT) of HIV state that when replacement feeding is not acceptable, feasible, affordable, sustainable and safe, then exclusive breastfeeding is recommended. (1) The recommendations promote fully-informed and free choice for HIV-infected women, who should receive the best available information on the benefits and risks of exclusive breastfeeding or replacement feeding to select the most suitable option for their situation. Furthermore, full support needs to be given to protecting, promoting and supporting breastfeeding for mothers who are HIV-negative or do not know their serostatus. (2)

Putting these recommendations into practice is challenging. Individual women find it difficult to balance risks and benefits in settings where access to safe replacement feeding and support is limited. (3,4) For counsellors, the task of presenting information so that women can reach feasible, informed decisions requires effective counselling skills. Training staff to understand the complexities of feeding practices takes time and dedicated supervision. (5)

The decision to replacement feed is critically important for an HIV-infected woman, as it may either potentially save her child's life or expose the newborn infant to unacceptably high risks of diarrhoea and malnutrition. (6) The decisions of such women, and the way counselling is conducted, may also affect the feeding practices of HIV-uninfected mothers. Experience from MTCT programmes in southern Africa confirm that counsellors do not always present clear, impartial messages, (7,8) that HIV-uninfected mothers at MTCT sites are inadvertently influenced to give commercial infant formula more often than at non-MTCT sites (9) and that longitudinal follow-up of mothers and children in programmes is frequently inadequate. (10)

While there is increasing literature on the feeding practices of HIV-infected women postnatally, (11-13) there have been few reports on the choices women make antenatally, and on whether these choices are consistent with the UN recommendations. Furthermore, little is known about processes of counselling on infant feeding, and whether they are achieving their goal of helping women to make the most appropriate decisions for their circumstances. Anecdotally, it has been reported that HIV-negative women increasingly avoid breast milk because of the spillover effect of infant formula introduced into areas of high HIV prevalence. However, to our knowledge there is no research that documents the feeding choices of HIV-negative women in areas where there is high HIV prevalence.

This paper examines the infant feeding intentions of HIV-infected and uninfected mothers in an area with one of the highest HIV prevalences in the world. It also examines the appropriateness of these choices given the resources available; and additionally, the women's adherence to these choices in the first postnatal week.

Population and methods

Design

Pregnant women attending seven rural clinics, one semi-urban clinic and one urban clinic in KwaZulu Natal, South Africa, were offered confidential HIV counselling and testing as part of a cohort study investigating breastfeeding and MTCT. From August 2001 to June 2003 all HIV-infected, and a subsample of uninfected, women were offered enrolment in the study. From July 2003 all women attending antenatal clinics were offered enrolment before HIV testing. After post-test counselling, HIV-infected women were offered a further infant feeding counselling session one to two weeks later. HIV and infant feeding counselling were provided by lay staff who had completed 12 years of schooling and were selected after assessment of literacy, numeracy and basic counselling skills. …

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