Emily L Tuthill
“In the United States, we say, ‘No breastfeeding,’ but that is no longer realistic” : provider perspectives towards infant feeding among women living with HIV in the United States
Tuthill, Emily L; Tomori, Cecilia; Van Natta, Meredith; Coleman, Jenell S
Authors
Cecilia Tomori
Meredith Van Natta
Jenell S Coleman
Abstract
Introduction: Currently, the United States (U.S.) recommends that infants born to women living with HIV (WLHIV) be fed formula, whereas many low‐resource settings follow the World Health Organization's recommendation to exclusively breastfeed with ongoing antiretroviral therapy. Evidence on infant feeding among WLHIV in high‐resource countries suggest that these contrasting recommendations create challenges for providers and patients. Our study used multiple methods to understand providers’ infant feeding perspectives on caring for their pregnant and post‐partum WLHIV in the U.S. Methods: We sent a survey (n = 93) to providers across the U.S. who have cared for WLHIV. A subset of survey participants opted into a follow‐up qualitative interview (n = 21). These methods allowed us to capture a broad understanding of provider attitudes via the survey and more nuanced qualitative interviews. The study was completed prior to an updated breastfeeding section of the U.S. Perinatal Guidelines. Results: The majority of providers (66.7%) discussed infant feeding intent with their patients using open‐ended questions. Many also discussed alternative feeding methods (37.6%) and disclosure avoidance strategies (34.4%). Over 75% (95% confidence interval (CI): 65.1 to 84.2) of participants reported that a WLHIV asked if she could breastfeed her child, and 29% (95% CI 20 to 40.3) reported caring for a patient who breastfed despite recommendations against breastfeeding. Providers reported that their patients’ primary concern was stigma associated with not breastfeeding (58%), while providers were primarily concerned about medication adherence during breastfeeding (70%). Through qualitative analysis, four overarching categories emerged that reflect providers’ sentiments, including (1) U.S. guidelines inadequately addressing WLHIV's desire to breastfeed; (2) negotiating patient autonomy amidst complex feeding situations; (3) harm reduction approaches to supporting WLHIV in breastfeeding; and (4) providers anticipating multilayered patient stigmatization. Conclusions: The majority of provider respondents cared for a WLHIV who desired to breastfeed, and a third had WLHIV who breastfed despite recommendations against it. Providers found that the status of U.S. guidelines and their incongruity with WHO guidelines left them without adequate resources to support WLHIV's infant feeding decisions. Our findings provide important insight to inform professional associations’ discussions about public health policy as they consider future directions for infant feeding guidelines among WLHIV.
Citation
Tuthill, E. L., Tomori, C., Van Natta, M., & Coleman, J. S. (2019). “In the United States, we say, ‘No breastfeeding,’ but that is no longer realistic” : provider perspectives towards infant feeding among women living with HIV in the United States. Journal of the International AIDS Society, 22(1), https://doi.org/10.1002/jia2.25224
Journal Article Type | Article |
---|---|
Acceptance Date | Dec 5, 2018 |
Online Publication Date | Jan 18, 2019 |
Publication Date | Jan 18, 2019 |
Deposit Date | Jan 22, 2019 |
Publicly Available Date | Jan 22, 2019 |
Journal | Journal of the International AIDS Society |
Publisher | Wiley Open Access |
Peer Reviewed | Peer Reviewed |
Volume | 22 |
Issue | 1 |
DOI | https://doi.org/10.1002/jia2.25224 |
Files
Published Journal Article
(246 Kb)
PDF
Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/
Copyright Statement
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
You might also like
Breastfeeding with HIV: An Evidence-based Case for New Policy
(2019)
Journal Article
Changing Cultures of Night-time Breastfeeding and Sleep in the US
(2018)
Book Chapter
Sudden infant death and social justice: A syndemics approach
(2018)
Journal Article
Downloadable Citations
About Durham Research Online (DRO)
Administrator e-mail: dro.admin@durham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search