Odeny Beryne Mikal, Pfeiffer James, Farquhar Carey, Igonya Emmy Kageha, Gatuguta Ann, Kagwaini Florence, Nduati Ruth, Kiarie James, Bosire Rose
1 Department of Global Health, University of Washington , Seattle, Washington.
2 Department of Anthropology, University of Washington , Seattle, Washington.
Breastfeed Med. 2016 Jun;11(5):252-8. doi: 10.1089/bfm.2016.0014. Epub 2016 Apr 19.
Exclusive breastfeeding (EBF) means giving only breast milk to an infant. Although it is the optimal mode of feeding for infants younger than 6 months, its prevalence is low in HIV-endemic regions. Extensive promotion of EBF for 6 months in prevention of mother-to-child HIV transmission (PMTCT) programs could inadvertently result in stigma due to women's perceived association of EBF with HIV infection. In this qualitative study, we describe how stigma impacts the uptake of EBF among HIV-positive and -negative women.
Pregnant and postpartum women and their male partners were recruited to participate in a total of 22 focus group discussions (FGDs). Transcripts were analyzed using ATLAS.ti. Codes were identified both a priori and inductively using the open coding approach. Major themes and subthemes were identified.
There was a broad and strong consensus among some FGD participants that HIV-related stigma was a barrier to EBF. EBF was perceived as a practice for HIV-positive women. Thus, fear of discrimination deterred both HIV-positive and -negative women from EBF. However, with health education, peer counselor, and male partner support, some women were able to breastfeed exclusively regardless of opposing social norms.
Stigma related to HIV poses a formidable barrier to EBF in HIV-endemic regions. There is an urgent need to widely target all women with EBF information and support EBF practices regardless of maternal HIV infection status. The lessons learned from this study indicate that vertical programs can hinder promotion of infant health interventions and therefore negatively affect child survival.
纯母乳喂养是指仅给婴儿喂母乳。尽管这是6个月以下婴儿的最佳喂养方式，但在艾滋病流行地区其普及率较低。在预防母婴传播（PMTCT）项目中广泛推广6个月的纯母乳喂养，可能会因女性认为纯母乳喂养与艾滋病毒感染有关而无意中导致耻辱感。在这项定性研究中，我们描述了耻辱感如何影响艾滋病毒阳性和阴性女性对纯母乳喂养的接受情况。
招募孕妇、产后妇女及其男性伴侣参与总共22次焦点小组讨论（FGD）。使用ATLAS.ti软件对记录进行分析。通过先验和归纳的方式，采用开放编码方法确定编码。确定主要主题和子主题。
一些焦点小组讨论参与者广泛且强烈地达成共识，即与艾滋病毒相关的耻辱感是纯母乳喂养的障碍。纯母乳喂养被视为艾滋病毒阳性女性的行为。因此，对歧视的恐惧阻碍了艾滋病毒阳性和阴性女性进行纯母乳喂养。然而，通过健康教育、同伴咨询和男性伴侣的支持，一些女性能够不顾相反的社会规范进行纯母乳喂养。
在艾滋病流行地区，与艾滋病毒相关的耻辱感对纯母乳喂养构成了巨大障碍。迫切需要广泛地向所有女性提供纯母乳喂养信息，并支持纯母乳喂养行为，无论母亲的艾滋病毒感染状况如何。从这项研究中吸取的教训表明，垂直项目可能会阻碍婴儿健康干预措施的推广，从而对儿童生存产生负面影响。
