“I did not feel like a mother”: The success and remaining challenges to exclusive formula feeding among HIV-positive women in Brazil

Abstract

Exclusive and safe formula feeding can eliminate the risk of vertical HIV transmission due to breastfeeding. Therefore, many countries advise all HIV-positive women to avoid breastfeeding their infants. However, little research explores the experiences of women attempting to exclusively formula feed in countries with free and universal access to highly active antiretroviral therapy (HAART). This article examines the success of Brazil in supporting HIV-positive women as engage in exclusive formula feeding (EFF). We conducted in-depth interviews with 30 HIV-positive women receiving care at the primary facility for HIV/AIDS in Salvador, Brazil about their attitudes and practices related to EFF as well as challenges with adhering to EFF. All interviews were recorded, professionally transcribed and translated, and then analyzed. Our results showed that one woman reported both breastfeeding and formula feeding her infant; all others reported EFF. Postpartum counseling regarding the risk of HIV transmission through breastfeeding was the primary motivation for EFF. Challenges included difficulty reconciling their perceptions that breastfeeding is an important maternal responsibility, trouble accepting that breastfeeding can cause potential to harm their infants, confronting HIV-related stigma associated with EFF, and unexpected financial burdens due to EFF. We conclude that HIV-positive women adhered to national guidelines recommending EFF; this phenomenon has likely contributed to declining rates of vertical transmission in Brazil. Despite this success, many women experienced challenges with EFF. Greater support services may enhance Brazil's success in empowering HIV-positive women and eliminating vertical HIV transmission via breastfeeding.

Keywords:

• HIV/AIDS
• exclusive breastfeeding
• exclusive formula feeding
• Brazil

Acknowledgements

This publication resulted from research supported by the Training Grant entitled “HIV and Other Infectious Consequences of Substance Abuse” (T32DA13911-12). In addition, this publication was made possible with help from the Lifespan/Tufts/Brown Center for AIDS Research (P30AI042853) from the National Institute of Allergy and Infectious Diseases. Further we would like to thank UNAIDS, UNIFEM, the Brazilian National Department of STD, AIDS and Viral Hepatitis of the Ministry of Health, the Foundation for Research Support of the State of Bahia (FAPESB), the HIV/AIDS Reference Center of the Bahia Department of Health (CEDAP/SESAB) and the Pathfinder Foundation for their support. The study was approved by an Ethics Committee at the State Secretary of Health in Salvador, Brazil and by the Harvard School of Public Health in Boston, USA.