Psychosocial Experiences of HIV-Positive Women of African Descent in the Cultural Context of Infant Feeding: A Three-Country Comparative Analyses

Abstract

Infant feeding among mothers of African descent living with Human Immunodeficiency Virus (HIV) is a critical practice that is influenced by policies, cultural expectations, and the resultant psychosocial state of the mother. Hence, this paper draws insights from a broader infant feeding study. It provides insights into how guidelines on infant feeding practices, cultural expectations, migration, or geographic status intersect to influence the psychosocial experiences of mothers living with HIV. We compared psychosocial experiences of Black mothers of African descent living with HIV in Nigeria versus those in high-income countries (Canada and USA), in the context of contrasting national infant feeding guidelines, cultural beliefs about breastfeeding, and geographic locations. Survey was conducted in venue-based convenience samples in two comparative groups: (Ottawa, Canada and Miami-FL, USA combined [n = 290]), and (Port Harcourt, Nigeria [n = 400]). Using independent samples t-statistics, we compared the means and distributions of six psychosocial attributes between Black mothers in two distinct: Infant feeding groups (IFGs), cultural, and geographical contexts at p < 0.05. Psychosocial attributes, such as discrimination and stigma, were greater in women who exclusively formula feed (EFF) than in women who exclusively breastfeed (EBF) at p < 0.01. Heightened vigilance, discrimination, and stigma scores were greater in women whose infant feeding practices were informed by cultural beliefs (CBs) compared to those not informed by CBs at p < 0.001. Discrimination and stigma scores were greater among mothers in Canada and the USA than in Nigeria at p < 0.001. Heightened vigilance and perceived stress scores were less among women in Canada and the USA than in Nigeria at p < 0.001. The guidelines on infant feeding practices for mothers with HIV should consider cultural expectations and migration/locational status of mothers.

Research and Professional Literature to Inform Practice, November/December 2023

“…Additionally, HIV is a virus that carries significant stigma, which can be especially difficult for those living in areas where breastfeeding is widely practiced. For parents living with HIV who want to abstain from breastfeeding for safety reasons, this practice can also be an indicator to others that they may be living with the virus, posing various social risks 5‐7 …”

“…For parents living with HIV who want to abstain from breastfeeding for safety reasons, this practice can also be an indicator to others that they may be living with the virus, posing various social risks. [5][6][7] The guidelines recommend that clinicians inform all birthing individuals and potential breastfeeding parents living with HIV about all infant feeding options, regardless of gender identity. Parents that may also be taking testosterone should have a conversation with their clinician about more specific timing on when to restart testosterone after giving birth if considering breastfeeding.…”

Understanding the Intersections of IPV and HIV and Their Impact on Infant Feeding Practices: A Narrative Literature Review

“…According to the Centers for Disease Control and Prevention (CDC) in the United States, Black women accounted for the majority of new HIV diagnoses among women in 2018 [7]. Sub-Saharan Africa is heavily impacted by HIV, and within that region, Black women face a higher risk due to various social, economic, and cultural factors [58]. HIV prevalence per 100 000 individuals is 800.9 among women who identify as Black compared with 45.3 among White women [7].…”

“…Cultural beliefs associated with HIV and feeding practices have been investigated in the context of immigrant Black women. Many researchers have studied how Black women living with HIV sustained their cultural beliefs about infant feeding upon migrating to Canada, and that the desire to breastfeed was a mutual existential perception shared by Black women, including those living with HIV [58]. For example, Greene et al, found that Black women, including those living with HIV, said that breastfeeding was inseparable from their maternal role [63].…”

“…Nearly half of the total HIV cases in the world are women of child-bearing age [58]. As a result of concerted worldwide efforts, the number of new child HIV infections dropped by approximately 40% between 2003 and 2011 [66].…”