What breastfeeding means to an HIV positive mother in the informal settlements of Nairobi, Kenya

INTRODUCTION:   In Sub Sahara Africa, 60% of all new HIV/AIDS infections occur among mothers, infants and young children and 90% of paediatric infections result from maternal to child transmission (MTCT) . HIV among adults in Kenya is currently at 5.6% while it is estimated at 5%g in Nairobi Province, though higher in the urban slums- with the prevalence being 12%. Testing for HIV is high (92%) among women who attended antenatal care (ANC), while 90% received either maternal or infant antiretroviral prophylaxis to prevent mother-to-child transmission of HIV. PMTCT program has been scaling up rapidly in the past several years, reaching a high coverage of 71% in 2010. Breastfeeding remains a possible route for the mother to child transmission of HIV despite it being critical to the survival of the child. Risks of exclusive breastfeeding by HIV-infected mothers have not been adequately reported in Kenya. HIV positive mothers in urban slums face myriad challenges when making infant feeding decisions especially regarding breastffeding in the first six months after giving birth due to the dynamic nature of infant feeding behaviours as well as varying local perceptions, practises and norms.

METHODS:  Focus group discussions, key informant interviews and In-depth interviews were conducted with women of child-bearing age, community health workers community leaders including religious leaders and village elders, traditional birth attendants, and women and youth group leaders. Data were coded in NVIVO and analysed thematically.   

RESULTS:   Rampant poverty in urban slums has pushed up levels of paediatric HIV infection and weakened the existing health systems in dealing with the issue. Cost of food, poor advice by health workers, influence of relatives, stigma and difficulties with using an exclusive feeding mode together with deeply-sitted traditional, social and cultural practises that may be difficult to influence affect decision making on infant feeding options. 

CONCLUSIONS:  In resource poor settings, programmes that promote exclusive breastfeeding for at least 6 months, irrespective of HIV status of the mothers remain the most appropriate infant feeding option. The confusion brought about by the rapidly changing international recommendations on PMTCT and guidelines for infant and young child feeding options among HIV positive mothers together with incomplete and solid knowledge on the safety of exclusive breastfeeding continues to offers a challenge to breastfeeding mothers.