HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya

Abstract

BackgroundThe World Health Organization (WHO) recommends that HIV-infected women practice exclusive breastfeeding (EBF) for the first 6 months postpartum to reduce HIV transmission. The aim of this study was to determine the effects of HIV/AIDS knowledge and other psychosocial factors on EBF practice among pregnant and postpartum women in rural Nyanza, Kenya, an area with a high prevalence of HIV.MethodsData on baseline characteristics and knowledge during pregnancy, as well as infant feeding practices 4–8 weeks after the birth were obtained from 281 pregnant women recruited from nine antenatal clinics. Factors examined included: fear of HIV/AIDS stigma, male partner reactions, lack of disclosure to family members, knowledge of prevention of mother-to-child transmission (PMTCT) and mental health. In the analysis, comparisons were made using chi-squared and t-test methods as well as logistic multivariate regression models.ResultsThere were high levels of anticipated stigma 171(61.2%), intimate partner violence 57(20.4%) and postpartum depression 29(10.1%) and low levels of disclosure among HIV positive women 30(31.3%). The most significant factors determining EBF practice were hospital delivery (aOR = 2.1 95% CI 1.14-3.95) HIV positive serostatus (aOR 2.5 95% CI 1.23-5.27), and disclosure of HIV-positive serostatus (aOR 2.9 95% CI 1.31-6.79). Postpartum depression and PMTCT knowledge were not associated with EBF (aOR 1.1 95% CI 0.47-2.62 and aOR 1.2 95% CI 0.64-2.24) respectively.ConclusionsHealth care workers and counselors need to receive support in order to improve skills required for diagnosing, monitoring and managing psychosocial aspects of the care of pregnant and HIV positive women including facilitating disclosure to male partners in order to improve both maternal and child health outcomes.

Intimate Partner Violence Against HIV-Positive Women is Associated with Sub-Optimal Infant Feeding Practices in Lusaka, Zambia

“…In addition to IPV, this study provides evidence from Zambia to the growing body of literature linking women’s disclosure of an HIV-infected status to following the recommended infant feeding practices (Doherty et al, 2007; Doherty, Chopra, Nkonki, Jackson, & Greiner, 2006; Fadnes et al, 2010; Farquhar et al, 2001; Madiba & Letsoalo, 2013; Onono, Cohen, Jerop, Bukusi, & Turan, 2014; Sibeko, Coutsoudis, Nzuza, & Gray-Donald, 2009). Since exclusive breastfeeding is often perceived as being abnormal in Zambia (Omari et al, 2003), disclosing one’s HIV status to the husband/partner may help a woman justify why she is practicing a certain infant feeding strategy as well as garner support from the husband in order to follow the recommend protocols.…”

High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women

“…The timeline of the present study coincided with major efforts by NASCOP to increase EBF, and differences exist between the current study population of HIV-infected women intending to breastfeed at enrollment, prior study populations, 26,27 and cross-sectional cohorts. 20,21,[35][36][37] The high prevalence of EBF observed in the present study could have been inflated by social desirability bias, as subjects may have felt compelled to over-report EBF in an effort to please the interviewer. This phenomena has been observed in Kenya with mothers reporting higher proportions of EBF when interviewed face-to-face than with audio computerassisted self-interviewing (ACASI).…”

“…36 Another cross-sectional study of HIVinfected and -uninfected women during 2011 at three Kenyan facilities found that EBF prevalence was significantly lower among HIV-uninfected mothers, a population not targeted by NASCOP's EBF promotion efforts, than among HIVinfected mothers of infants aged 3, 4, and 5 months. 37 Research in Kenya indicates that HIV-infected women receive more EBF promotion counseling through PMTCT programs than their HIV-uninfected counterparts, 36,37 and qualitative work suggests that this health-service disparity may be leading to stigmatization of EBF as an indicator of maternal HIV infection, which could limit the effectiveness of future EBF promotion initiatives. 36 Recent studies have suggested that long-duration, supportbased interventions that feature frequent visits after delivery, often weekly or biweekly, are among the most successful ways to increase EBF.…”

“…24,26,27 However, local barriers must also be addressed with contextualized solutions to promote EBF among HIV-infected women in sub-Saharan Africa where any exclusive feeding method could stigmatize an HIV-infected woman, and healthcare providers have frequently changed feeding recommendations for HIV-exposed infants-or continue to provide incorrect messages despite updated guidelines. 29,30,36,37 This intervention did not feature high numbers of frequent visits but was based on current scientific evidence, health policies, and formative research. The intervention addressed local barriers, including common misconceptions about the inadequacy of EBF for infant nutrition, peer pressure to introduce new substances, accurate definitions of ''exclusive'' breastfeeding, and stigma.…”

Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors

“…This is even more challenging in societies where EBF is known to be a recommended feeding practice for HIV-positive mothers (Thairu et al, 2005;Buskens et al, 2007). Conversely, HIV status disclosure to a partner and/or family members gave women the needed support to practice EBF, whilst non-disclosure was associated with the practice of mixed feeding within 6 months postpartum (Fadnes et al, 2010;Marembo et al, 2014;Onono et al, 2014).…”