Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me"
Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me"
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DOI：
10.2471/blt.04.019448
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发表时间：
2006-02-01
期刊：
影响因子：
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通讯作者：
Greiner, Ted
中科院分区：
文献类型：
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作者：
Doherty, Tanya;Chopra, Mickey;Greiner, Ted
目的探讨人类免疫缺陷病毒（HIV）流行如何影响南非艾滋病毒阳性母亲的婴儿喂养经历。方法这是一项前瞻性队列研究中的定性访谈研究。我们有目的地从 650 名 HIV 阳性母亲组成的更大队列中选择了 40 名女性子样本进行深入访谈。 研究结果 HIV 流行改变了婴儿喂养选择的制定和实施环境。这项研究中的艾滋病毒呈阳性母亲——主要是年轻、单身和失业者——正在努力保护自己的决策自主权。母乳喂养安全性的不确定性增加了卫生工作者的权力和影响力，他们现在不仅是这一新知识的看门人，也是配方奶等重要资源的看门人。对艾滋病毒感染状况和耻辱的恐惧也削弱了母亲抵制根深蒂固的家庭和社区规范的能力，这些规范鼓励尽早引入液体和食物，并对非母乳喂养提出质疑。由于政策不灵活和诊所供应不足，选择纯配方奶喂养的妇女很难获得配方奶。有限的产后支持导致社会孤立，母亲们怀疑自己照顾孩子的能力。结论 HIV 阳性母亲的婴儿喂养经历对旨在防止 HIV 母婴传播的项目的运作效果产生严重影响。更好地了解艾滋病毒如何改变婴儿喂养方式可以为改善婴儿喂养咨询和产后支持的干预措施的制定提供信息。
Objective To explore how the human immunodeficiency virus (HIV) epidemic has affected the infant-feeding experiences of HIV-positive mothers in South Africa.Methods This was a qualitative interview study within a prospective cohort study. We purposively selected a subsample of 40 women from a larger cohort of 650 HIV-positive mothers for in-depth interviews.Findings The HIV epidemic has changed the context in which infant-feeding choices are made and implemented. HIV-positive mothers in this study-who were predominantly young, single and unemployed -were struggling to protect their decision-making autonomy. Uncertainty about the safety of breastfeeding has increased the power and influence of health workers, who now act as gatekeepers to not only this new knowledge but also to essential resources such as formula milk. Fear of disclosure of HIV status and stigma has also weakened the ability of mothers to resist entrenched family and community norms that encourage early introduction of fluids and foods and that question non-breastfeeding. Women who chose to exclusively formula feed had difficulties accessing formula milk because of inflexible policies and a lack of supplies at clinics. Limited postpartum support led to social isolation and mothers doubting their ability to care for their children.Conclusion The infant-feeding experiences of HIV-positive mothers have serious implications for the operational effectiveness of programmes that aim to prevent HIV transmission from mother to child. A better understanding of how HIV is changing infant-feeding practices can inform the development of interventions to improve infant-feeding counselling and postpartum support.