| dc.description.abstract | Infant feeding (IF) in the context of HIV is challenged by the potential and cumulative
risk of MTCT of HIV through breastfeeding (BF), and the risks associated with
replacement feeding (RF). The human rights approach and promotion of exclusivity of
feeding modality adopted by expert guidelines are both new concepts. Currently, mixedfeeding
is the norm in Kenya. Focus on HIV and IF has not included an evaluation of the
psychological challenges faced by women in the process.
The objective of the study was to determine the psychological states of HIV-infected
women faced with the need to make IF choices using anxiety, curiosity, anger, and
depression as indicators; and determine it impact on infant feeding practice.
A comparative study was carried out on two cohorts in different sites within Nairobi.
HIV-positive (N=101) and -negative (N=69) mothers aged 17-38 years, were recruited to
the study and followed for 6 weeks postpartum (PP). Mathare North and Kangemi clinics
and Pumwani Maternity Hospital (PMH) were purposively selected because of their high
HIV prevalence, and a PMTCT program that provided free infant formula at PMH. The
principal tools of investigation were a structured questionnaire for socio-demographic
data; and the State-Trait Personality Inventory (STPI), to assess psychological states.
Study respondents were similar in their socio-demographic characteristics. Overall, 71%
(N=170) had received IF counselling. First week PP interview was the baseline (N=166)
for IF practices and psychological states. At PMH, more HIV-positive mothers (60%)
opted for RF. A higher attrition from the study was noted among BF HIV-positive
mothers. Prevalence of non-exclusive IF at Week 1, 2, and 6 was 26%, 42%, and 76%
respectively, among HIV-positive BF women; 21%, 76%, and 89% respectively, among
HIV-positive RF women; and 36%, 47%, and 95% respectively, among HIV-negative BF
women. HIV-positive BF women had a higher likelihood of exclusive BF at 6 weeks (R.R
= 2.29; 95% CI =1.33, 3.94; P (MH) = 0.045) compared to HIV-negative women.
The STPI’s discriminatory power was noted with regard to its ability to detect differences
between study groups’ test performance. Study results showed that there was a
relationship between elevated maternal emotions, serostatus, and infant feeding options.
HIV-positive mothers obtained higher anxiety, anger, and depression scores over the six
weeks. A significant difference was also noted with regard to ‘emotional re-adjustment’ as
evident from individual change-with-time differentials. By Week 6, HIV-positive mothers
‘re-adjusted’ significantly only in State-anxiety, -anger, and -depression, compared to
HIV-negative mothers’ significant ‘re-adjustment’ in all above, including State-curiosity
and Trait-anxiety. Between Week 1 and 6, HIV-positive RF mothers had no significant
change in any scale, compared to BF mothers’ significant changes in State/Trait-anxiety,
and State/Trait depression.
Key factors when making IF options and practices were cited as: “exclusivity of IF in
relation to HIV” (90%); “fear of (HIV status) disclosure” (87%), “lack of privacy” (85%),
and “view of BF as the norm” (65%). This study recommends a critical review of the
current PMTCT guidelines to make them more sensitive to local situations, and strengthen
existing PMTCT programs through mainstreaming the assessment of maternal emotions to
make counselling for HIV-infected women more empowering | en |
