Factors influencing HIV positive mothers' choices regarding infant feeding in a rural African context.
The purpose of this study was to determine the efficacy of infant feeding choices and support provided in the current PMTCT programme in KwaZulu-Natal. A case study format was utilised. Follow-up was done over six months with ten HIV positive women enrolled in the PMTCT programme at St. Apollinaris Hospital. Transcripts of interviews were made, pattern-matching was done, and the process of replication was used to develop a cross-case report as the final analysis of the study. All of the women decided to and intended to exclusively breastfeed for between four and six months at the time of the first interview. There was a poor rate of return for follow-up interviews, therefore the actual feeding practice of half of the women after six weeks could not be determined. The case studies were developed with the information available, and thus conclusions were reached during cross-case analysis. Decision-making ability and the capacity to overcome the barriers to the maintenance of their original feeding choice were related to the women's educational levels, employment status, financial and social circumstances and support systems, knowledge and experience of HIV/AIDS, quality of PMTCT education and support, cultural beliefs, and parenting and family values. The age of respondents and differences in marital status had no obvious correlation to maintenance of feeding choice. Parity and level of education had only a limited effect on maintenance of feeding choice. Cues to mixed feeding included a fatalistic view and a loss of hope for preventing transmission of HIV to their infants. Some of the women did not seem to believe that maintaining a specific infant feeding regime was enough to prevent transmission of HIV to their infants. Fear of stigmatisation due to disclosure of their positive HIV status led to non-disclosure of many women, and this in turn led to a lack of support for their feeding choice. Cues to exclusive feeding included an internal pressure to succeed and so decrease the chances of HIV transmission to her infant. Those women who disclosed their HIV status to a significant other and established a good support system were more likely to maintain their original decision. Although none of the women enjoyed good social circumstances, those who were more financially secure, employed, and who had a stable home environment were more likely to maintain their exclusive feeding regime.