A qualitative study exploring attitudes and perceptions of HIV positive women who stopped breastfeeding at six months to prevent transmission of HIV to their children
R Mataya1, D Mathanga2, J Chinkhumba2, A Chibwana2, K Chikaphupha2, J Cardiello3 1. Loma Linda University School of Public Health, Loma Linda, California, USA 2. Malaria Alert Center, University of Malawi College of Medicine,Blantyre, Malawi
Introduction
Malawi has one of the highest levels of HIV infection in the world, with acquired immune deficiency syndrome (AIDS) being the leading cause of deaths among adults 15-49 years old1. In 2010, it was estimated that 910,000 adults and children were living with HIV and AIDS. The national adult prevalence rate among 15-49 year olds was 10.6 %, with 8.9% prevalence in rural areas and 17.4% prevalence in urban areas. Every year, 68,000 adult and child deaths are due to AIDS. Young women are disproportionally affected, with approximately one-half of new infections occurring in individuals 15-24 years old, and 9% of the overall total belonging to women in this age range (compared to 2% of men). In addition to adult mortality, approximately 150,000 children were living with HIV in 2010 and over 610,000 were orphaned due to AIDS-related deaths.2 Transmission of HIV to children can occur in utero, during birth and postpartum through breastfeeding4. If there is no intervention, 15 to 30% of infants of HIV-positive mothers are infected before or during delivery, or after birth through breastfeeding5. The standard WHO policy to curtail HIV transmission through breastfeeding is that HIV-infected women should breastfeed exclusively for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants. This recommendation is supported by research-based evidence demonstrating that exclusive breastfeeding (EBF) for up to six months is associated with a three to four fold reduction in risk of transmission of HIV from the mother compared to mix-feeding6. Breastfeeding remains the natural and best source of nutrition for the newborn and children. It greatly improves the quality of life for infants and young children through its nutritional, immunological, psychological, and contraceptive benefits7. The Malawi Ministry of Health policy promotes and supports all mothers, with known and unknown HIV status, to exclusively breastfeed for the first six months.8