Practices, support and stigma related to infant feeding and postpartum engagement in care among women living with HIV in Canada

ABSTRACT

Background: Breastfeeding is not recommended for women living with HIV (WLWH) in Canada. We described the prevalence of breastfeeding and explored experiences of care, support, and stigma related to infant feeding. Setting: Quebec, Ontario, and British Columbia (Canada). Methods: Data were obtained from the HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) surveys, conducted between 2013 and 2018. Results: Breastfeeding was reported by 73.5% of the 786 women who delivered before HIV diagnosis and 7.3% of the 289 women who delivered after HIV diagnosis. Among them, earlier year of delivery, delivery outside of Canada, and African, Caribbean, Black ethnicity were independently associated with increased odds of breastfeeding. Among WLWH who had a live birth during the last year, 77% (40/52) felt that they had received support regarding infant feeding practices, and 77% (23/30) were concerned that not breastfeeding could lead to them being identified as WLWH. Among 71 women within one year postpartum at any one of the study waves, 89% reported having an undetectable viral load. Conclusion: Breastfeeding experiences were common among WLWH, most often prior to HIV diagnosis. Fear of unintentional HIV status disclosure when not breastfeeding and challenges to maintain an undetectable HIV viral load are important issues to address during postpartum care.

KEYWORDS:

• HIV
• breastfeeding
• stigma
• postpartum

Acknowledgements

The members of the CHIWOS Research Team thank all of the women living with HIV who participated in the research and entrusted CHIWOS with their experiences of HIV treatment, care and support. They also thank the entire national team of co-investigators, collaborators and peer research associates. They acknowledge the three provincial community advisory boards, the national CHIWOS Aboriginal advisory board and their partnering organizations for supporting the study. They also acknowledge the BC Centre for Excellence in HIV/ AIDS for in-kind data management and analytic support.

Conflicts of Interest and Source of Funding

This work was supported by a Canadian Institutes of Health Research (CIHR) operating grant (MOP-111041), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. IB and ADP received salary support from the Fonds de la recherche en santé du Québec (FRQS). Angela Kaida received salary support from CIHR.

Additional information

Funding

This work was supported by Canadian HIV Trials Network, Canadian Institutes of Health Research: [Grant Number CTN 262]; Canadian Institutes of Health Research: [Grant Number MOP-111041]; Ontario HIV Treatment Network and the Academic Health Science Centres Alternative Funding Plans.