Exclusive breastfeeding is one of the infant feeding methods recommended by the World Health Organisation (WHO) in the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV), especially to HIV positive women of low socio economic status. The purpose of the study was to determine and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding in postnatal ward at a particular hospital in Limpopo Province, South Africa. Qualitative exploratory research design was used to explore and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding. A grand tour question in an unstructured interview was used to collect data, followed by probing questions according to participants’ responses. Data were collected from 15 HIV positive mothers aged 18 years and above. They opted for exclusive breastfeeding, and voice recorder and field notes were used to capture data. The seven steps of data analysis, adapted from Colaizzi were used. The findings: Although the benefits of exclusive breastfeeding was known by mothers, some participants had limited knowledge on the importance of exclusive breastfeeding. Some health care providers lack up-to-date information on exclusive breastfeeding. Religious and cultural practices interfere with exclusive breastfeeding. Coping strategies with the feeding options emerged as well. / Health Studies / M.A. (Nursing Science)

Magister Scientiae (Biodiversity and Conservation Biology) - MSc (Biodiv and Cons Biol) / W.H.O infant feeding options are presented as a package in the prevention of HIV transmission from mother to child. These infant feeding options are namely exclusive breastfeeding, replacement feeding and other options such as wet nursing by a tested HIV negative woman and heat treated breast milk. However, in Zambia, like many other poor countries, the cultural attitude towards breastfeeding is that the breastfeeding period generally goes up to two years. This traditional way of feeding is so much rooted in local culture that any cessation of breastfeeding or any introduction of alternative feeding would be a source of concern at community and family levels. In addition, it is a well known fact that stigma and discrimination are still high in the country. It is with this background that we decided to carry out a study in Mongu district which aimed at assessing HIV positive mothers’ knowledge of WHO infant feeding options and looking at the challenges they face vis-à-vis these recommended feeding options. DATA COLLECTION METHODS A total of 10 experienced nurses, who have been working in the HIV/AIDS programme for more than 15 years, were trained in data collection. During home visit, semistructured questionnaires were used during face- to- face interviews of each HIV positive mother who voluntarily took part in the study. SAMPLING AND SAMPLE SIZE Systematic sampling technique was used to constitute our study sample. With this technique, a complete list of 5317 HIV positive mothers was constituted by listing all HIV positive mothers whose names were in the registers of PMTCT at the selected health institutions, and who had infants whose ages ranged from 6 months to 2 years. 1636 HIV positive mothers had babies whose ages were ranging between 6 months and 2 years. Out of the 1636 we selected randomly the first participant from the complete list, and then we went on selecting every 8th HIV positive mother up to the time we constituted a sample of 200 participants. Thereafter, the selected HIV positive mothers were visited individually in their respective households for interview by trained interviewers. During home visit, 5 selected participants declined to take part in our study while 195 HIV mothers voluntarily accepted to be interviewed. RESULTS Analysis of data collected from 195 HIV positive mothers revealed that 144 study participants or 73.8 %( 95% C I 67.6-80%) of all participants knew their status through the PMTCT programme where the “opt out” approach was used to routinely screen pregnant women for HIV during ante natal visit or when admitted to labour wards. It was also established that the assessment of knowledge among study participants of exclusive breastfeeding period was good. 96.9 %( 95% CI 95.66-98.14%) of participants stated that 6 months was the recommended duration for exclusive breastfeeding when the mother is HIV positive while only 3.07 %( 95% CI 0.65-5.49%) said that exclusive breastfeeding should go beyond 6 months. It was discovered that the majority of HIV positive mothers or 166 participants representing 85.1%(95% CI 80.1-90.1%) who participated in our study considered mixed- feeding as not appropriate for infant born from HIV positive mothers while 29 participants or 14.8%(95% CI 9.8-19.8%) said that mixed feeding was recommendable. It was also found that 95 participants representing 48.7 %( 95% CI 41.6- 55.7%) opted for exclusive breastfeeding, 61 participants or 31.2% (95% CI 24.7-37.7%) participants opted for formula milk while 39 or 20 %( 95% CI 14.4- 25.6%) of participants were mixed-feeding. It was discovered that 118 participants had breastfed. Among them, 53.4 %( 95% CI 46.4-60.4%) participants said that they had breastfeed for up to 6 months while 46.6 %( 95% CI 43-50.2%) said they had breastfeed for more than 6 months. Among those who had breastfed for more than 6 months, 58.1 %( 95% CI 54.6-61.6%) said that they had done so because of financial constraints; 21.8 %( 95% CI 16-27.6%) for fear of discrimination and stigmatization; and 20 %( 95% CI 14.4-25.6%) for fear of discrimination and stigmatization and financial constraints. We also discovered during our research that for the majority of study participants or 81.5%, the decision to opt for one of the infant feeding options was a product of discussion between the HIV positive mothers and other persons such as the husband, friends, relatives and health care provider. CONCLUSION In our study we discovered that though the knowledge of PMTCT and WHO infant feeding options among study participants was good, fear of stigmatization, discrimination and abandonment was high among interviewees. This fear explains why the implementation of WHO infant feeding options is still a serious challenge amongst HIV positive mothers in Mongu, as many HIV positive mothers do not want to be seen in the community as people carrying the virus. It is also for the same reason that our study participants had to choose people to whom to talk to about their HIV positive status and with who to discuss their chosen infant feeding options. Further, due to the high level of poverty among Mongu residents, financial constraint was another major challenge in the implementation of WHO recommended infants feeding options.

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

This research was conducted as part of the formative evaluation of a mother-child interaction intervention, which was incorporated into the Kgolo Mmogo pilot study at the Kalafong Hospital in Tshwane (South Africa). The purpose of the intervention was to encourage the development of parenting skills and to improve mother-child relationships within an HIV context over a six-month period. By promoting more effective interaction between mother and child, child resilience could be enhanced and children could learn the necessary coping skills that would help them deal with the challenges posed by HIV and other life events. The aim of the study was to generate a systemic understanding of families affected by HIV/AIDS. The study explored (1) the effect of HIV on family interaction and (2) the effect of the mother-child interaction intervention on family interaction from the perspective of HIV-infected mothers. The theoretical framework chosen for the study was of a systemic nature and the standpoints, as set out by the Milan family therapy team, were implemented. Ten months after the intervention, four of the HIV-positive mothers who had participated in the intervention were interviewed and encouraged to share their experiences. Circular questions were employed in the interviews as a means of gathering data. A qualitative design was therefore the best option for this study. The research findings of this study coincide with previous literature and research findings; thus, the findings of this study have been consolidated. The current study findings support the importance of bridging the distance that is created by HIV in family relations, particularly between mother and child. Newly-diagnosed mothers often become stuck in their own processes and distance themselves from others in order to make sense of their situation. The broader social stigmas associated with HIV/AIDS contribute further to the sense of isolation that HIV-positive women experience. Often, women perceive HIV to be a disruptive force in their relationships with their partners and children, which creates tension, secrets and uncertainty within the family. HIV-infected mothers generally feel that keeping secrets from their children protects them from being traumatized by the social stigmas surrounding HIV/AIDS. Some HIV-positive mothers also feel that an emotional distance will shield their children from the pain of losing their mother. Because they are grappling with many negative feelings, such as anger and frustration, many HIV-positive mothers resort to strict disciplinary measures and avoid spending time with their children. The children misinterpret their mother’s behaviour and react in a manner that the mother perceives to be both disrespectful and disobedient, thus creating a recurring cycle in which both mothers and children become stuck. The participating mothers perceived the mother-child interaction intervention to focus on their emotional, physical, cognitive and behavioural needs as well as the needs of their children. The mothers experienced the intervention as having been particularly helpful to them and their children. They perceived themselves to be warmer, more supportive, more accepting and to have found meaning in their lives. In addition they felt that their children had begun to behave themselves and were also less avoidant of them. It enhanced their understanding of one another, and strengthened their bond so that they can depend on each other in times of difficulty. Copyright / Dissertation (MA)--University of Pretoria, 2009. / Psychology / unrestricted