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Nutritional Epidemiology

HIV-Positive Poor Women May Stop Breast-feeding Early to Protect Their Infants from HIV Infection although Available Replacement Diets Are Grossly Inadequate^1,2

³ ZVITAMBO Project, Harare, Zimbabwe; ⁴ Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201-1559; ⁵ Academy for Educational Development, Washington DC 20009-5721; and ⁶ Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD 21205

^* To whom correspondence should be addressed. E-mail: jhumphrey{at}zvitambo.co.zw.

Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3–5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.

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				W. T. Shearer Breastfeeding and HIV Infection Pediatrics, May 1, 2008; 121(5): 1046 - 1047. [Full Text] [PDF]