Attitudes and Perceptions of Health Providers and HIV Positive Mothers on Adopting Breastfeeding for HIV Exposed Children: A Qualitative Study in Rural Haiti.

Abstract

Transmission of HIV via breast milk is a pressing public health dilemma confronted by HIV/AIDS prevention programs around the world, especially in developing countries. The dilemma is that HIV-positive mothers, can either give their babies the benefits of breastfeeding but expose them to the risk of HIV infection, or they can avoid breastfeeding to minimize the risk of HIV transmission, but increase the risk of infant death from diarrhea and malnutrition. However, studies provided evidence that taking Anti-retroviral therapy (ART) during exclusive breastfeeding can significantly reduce the risk of HIV transmission through breast milk. Since March 2010, the World Health Organization (WHO) has recommended exclusive breastfeeding for all HIV exposed infants but indicated that some countries can still use formula feeding replacement when it is acceptable, feasible, affordable, sustainable and safe (AFASS). In 2012, based on evolving scientific evidence and recommendations from national authorities, Partners in Health (PIH), a community-based NGO working in rural Haiti, changed their formula feeding policy. Instead, they adopted breastfeeding for all HIV-exposed infants and ART for nursing mothers. Transitioning from the AFASS formula-feeding option to universal breastfeeding has been challenging for health care providers and patients in Haiti, because both were skeptical about moving away from a successful formula-feeding program. Using interviews and participant-observation, this qualitative study investigates the perceptions and attitudes of HIV-positive mothers and health care providers about this policy change.