616 - “What are my options”: The lived experiences of WLHIV and their infant feeding journey

Poster Number: 616
Publication Number: 616.500

Background: The American Academy of Pediatrics recommends that Women Living with HIV (WLHIV) exclusively use formula for infant feeding, in order to reduce the risk of mother-to-child transmission (MTCT). Given that a significant proportion of WLHIV in Canada are women who migrated from HIV-endemic countries where the World Health Organization recommends exclusive breastmilk use in infancy, this can be problematic for WLHIV. The sociocultural pressures and stigmatization these women face when advised by healthcare providers how to feed their infants is not always considered in practice.

Objective: This study explored the lived experiences of WLHIV in their infant feeding decisions in order to: better prepare healthcare professionals (HCPs) in patient discussions, as well as improve guidelines in breastmilk use in WLHIV.

Design/Methods: This was a qualitative research study of WLHIV who were patients at a tertiary hospital in Toronto, ON, Canada. Ten in-depth interviews were conducted with WLHIV who used a variety of feeding choices for their infants and manually analyzed thematically. Research Ethics Board approval was obtained.

Results: 15 WLHIV were identified and approached, and 10 consented to participate in the study. Interviews lasted anywhere from 15 to 75 minutes. All participants were immigrants to Canada with a median time since migration of 11 years (1-22); 80% (n=8) identified as African or Caribbean. More than half (n=6) knew about their HIV status before their first child and 70% (n=7) had been living with HIV for 11 years or more. Before immigrating to Canada 50% (n=5) of participants had at least one child of whom 40% (n=4) used their breastmilk without or without formula. For their most recent infant, 6 exclusively formula fed, 2 exclusively used their breastmilk and 2 used a combination of both. Culture and social norms were identified by most participants as the most significant issues they had to navigate, regardless of their feeding choice. Respect for their decisions was mentioned by all participants who used their breastmilk. Participants recommended information sharing, communication, and individualized care as approaches to better prepare HCPs to discuss infant feeding options.

Conclusion(s): The use of breastmilk, formula or both is a personal decision influenced by many factors for all mothers. However, the decision is further complicated for WLHIV who are very concerned about MTCT. WLHIV want to be informed about all their options and feel supported by their HCPs especially when they want to use their breastmilk.