Abstract

Experiences of HIV positive women going through artificial infant feeding in an urban public clinic offering services to low income populations in São Paulo, Brazil

B. da Costa Thome^1,2, R.C.d.M. Succi¹, J. Pfeiffer<sup>2

1</sup>Federal University of São Paulo - UNIFESP, Pediatric Infectious Diseases, São Paulo, Brazil, ²University of Washington, Global Health - School of Public Health, Seattle, United States

Background: In Brazil, where breastfeeding is normally promoted, the HIV/AIDS National Program recommends that HIV positive mothers should not breastfeed their infants, providing them with artificial milk formula. Despite the positive impact this policy has had in decreasing HIV Mother to Child Transmission, little is known about its emotional effects on mothers.
Methods: Using qualitative research methods, this study was conducted at a Center for Pediatric AIDS Care (CEADIPE), in order to document mothers´ experiences when advised not to breastfeed, and how health services address their needs and provide them with adequate support. Open-ended interviews of 24 HIV positive mothers were conducted and interpreted in light of mothers´ social and cultural context, including women with and without previous breastfeeding experience.
Results: Although mothers felt non- breastfeeding as a difficult topic, different patterns of reaction and coping strategies were identified in the analysis of the interviews. Mothers´ frustrations and acceptance varied according to their age and previous motherhood and infant feeding experiences, but in general they were more assured if they felt they had enough information and support from health staff to deal with artificial feeding, which for this cohort wasn´t a problem since they had easy access to formula. The prescription of breast milk cessation through mechanical methods was often described as painful and discriminating. Stigma represented an important challenge to mothers not breastfeeding since it could represent the disclosure of their HIV status. Fear was commonly mentioned regarding babies health status especially when deprived of maternal milk.
Conclusions: Factors that influence mothers´ well being and how they experience artificial feeding were identified, which can illuminate the points of intervention where improvement of services could be most productive. The role of the public sector in order to support mothers with formula milk and specialized services proved to be crucial.