Effects of Sociocultural Factors on Infant Feeding With Black African Immigrant Mothers Living With HIV

Monday, 30 October 2017: 3:45 PM

Jean Hannan, PhD
Nicole Werthiem School of Nursing and Health Sciences, Florida International Universiyt, Miami, FL, USA
Josephine B. Etowa, PhD, BNSc
School of Nursing, University of Ottawa, Ontario, ON, Canada
J. Craig Phillips, PhD
School of Nursing, University of Ottawa, Ottawa, ON, Canada
Seye Babatunde, MBBS, MPH
Director of CHD, University of Port Harcourt, Port Harcourt, Nigeria

Title: Effects of Socio-Cultural Factors on Infant Feeding with Black African Immigrant Mothers living with HIV

Background: in Canada and the US, African immigrant women represent the largest segment of the population living with HIV. These women have disproportionately high rates of MTCT and HIV-exposed infants (48%). HIV prevention guidelines in Canada, US, and other high-income countries strongly recommend that mothers living with HIV avoid breastfeeding their infants. Women in these countries are considered to have access to acceptable, feasible, affordable, sustainable and safe (AFASS) feeding alternatives, therefore mothers living with HIV are strongly advised to exclusively formula feed regardless of ARV use and plasma viral load. In contrast, breastfeeding is strongly promoted as the “normal and unequalled method of feeding infants.” This creates a paradox for women living with HIV, particularly those coming from countries and cultures where breastfeeding is an expectation of all new mothers, and where formula feeding implies illness.

Objective: The purpose of this review was to explore empirical studies between 2001 and 2016 that report the socio-cultural factors influencing infant feeding choices and practices among African women from HIV endemic countries.

Method: Using the PEN-3 cultural model as a guide, a search of the literature identified articles that reported on cultural factors influencing infant feeding choices or practices among women of African descent living with HIV. CINAHL, Global Health, HealthSTAR, PubMed, and Sociological Abstracts databases were searched using the keywords: “HIV”, “HIV and infant feeding”, “infant feeding practices”, “influence of breastfeeding duration”, “(WHO) infant feeding guidelines”, “developing countries”, “low-income countries”, and “Africa” to identify relevant literature. Included studies examined or reported on socio-cultural factors influencing infant feeding choices and practices, among women of African decent living with HIV in developed and developing countries.

Results: A total of 51 studies (qualitative, quantitative, mixed methods designs) published in the English language were reviewed. Four socio-cultural determinants of infant feeding choices and practices were identified: Individual maternal factors, family and community influences, health system support, and socio-economic and socio-demographic factors.

Discussion: This review represents the first use of Airhihenbuwa’s PEN-3 cultural model to assess how socio-cultural factors influence infant feeding choices among mothers living with HIV from African countries. Children born to immigrant women from HIV-endemic countries represent the largest group of HIV-exposed infants in Canada (48.3%) and the US (50%). Understanding the socio-cultural determinants of infant feeding choices and practices among these women is critical to support development, delivery and uptake of prevention initiatives that will enable HIV-free survival for their infants.

Funded by: The Canadian Institutes of Health Research (CIHR)