Maman Suzanne, Cathcart Rebecca, Burkhardt Gillian, Omba Serge, Thompson Deidre, Behets Frieda
Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, NC, USA.
AIDS Care. 2012;24(2):259-65. doi: 10.1080/09540121.2011.597708. Epub 2011 Jul 25.
HIV transmission through breastfeeding is a significant public health challenge. While breastfeeding provides important nutrition, and results in reduced morbidity and mortality, there is a risk of HIV transmission through breastfeeding. International prevention of mother-to-child transmission (PMTCT) guidelines recommend exclusive breastfeeding for six months among HIV-infected women on antiretroviral therapy. Promoting exclusive feeding has proved difficult in settings where mixed feeding is a cultural norm. Understanding the factors that influence HIV infected women's infant feeding choices and practices is critical to promoting adherence to PMTCT guidelines. We conducted in-depth interviews with 40 HIV+ pregnant and post-partum women in Kinshasa, Democratic Republic of Congo to understand their infant feeding experiences. Interviews were conducted in Lingala, and transcribed and translated into French for analysis. Deductive and inductive codes were applied, and matrices were created to facilitate cross-case analysis. Women had limited understanding of the specific mechanisms through which their infant feeding practices influenced HIV transmission risk. Clinical staff was the primary source of women's knowledge of HIV mother-to-child-transmission. Among the 24 post-partum women in the sample, seven women adhered to exclusive breastfeeding and two women to exclusive formula feeding for at least six months. Women's beliefs and awareness about HIV transmission through breastfeeding, as well as the information and support from clinical staff and other members of their support networks positively influenced their exclusive feeding. Common barriers to exclusive feeding included financial constraints, breast health problems, misinformation about HIV transmission, local norms, and prior feeding experiences. Health care workers play a key role in providing correct information on PMTCT and supporting women's infant feeding choices to adhere to guidelines of exclusive infant feeding. Optimizing provider-patient communication and creating a supportive environment surrounding infant feeding is critical.
通过母乳喂养传播艾滋病毒是一项重大的公共卫生挑战。虽然母乳喂养能提供重要营养，并降低发病率和死亡率，但存在通过母乳喂养传播艾滋病毒的风险。国际预防母婴传播（PMTCT）指南建议，接受抗逆转录病毒治疗的感染艾滋病毒妇女应纯母乳喂养六个月。在混合喂养成为文化规范的环境中，推广纯母乳喂养已证明困难重重。了解影响感染艾滋病毒妇女婴儿喂养选择和做法的因素，对于促进她们遵守PMTCT指南至关重要。我们对刚果民主共和国金沙萨的40名感染艾滋病毒的孕妇和产后妇女进行了深入访谈，以了解她们的婴儿喂养经历。访谈使用林加拉语进行，随后转录并翻译成法语进行分析。我们应用了演绎和归纳编码，并创建了矩阵以促进跨案例分析。妇女对其婴儿喂养做法影响艾滋病毒传播风险的具体机制了解有限。临床工作人员是妇女了解艾滋病毒母婴传播知识的主要来源。在样本中的24名产后妇女中，有7名妇女坚持纯母乳喂养，2名妇女坚持纯配方奶喂养至少六个月。妇女对通过母乳喂养传播艾滋病毒的信念和认识，以及临床工作人员和其支持网络其他成员提供的信息和支持，对她们的纯喂养产生了积极影响。纯喂养的常见障碍包括经济限制、乳房健康问题、关于艾滋病毒传播的错误信息、当地规范和以往的喂养经历。医护人员在提供关于PMTCT的正确信息以及支持妇女的婴儿喂养选择以遵守纯婴儿喂养指南方面发挥着关键作用。优化医患沟通并营造围绕婴儿喂养的支持性环境至关重要。
