Infant feeding and HIV

Mother-to-child HIV transmission is the main cause of HIV infection in children. About two thirds of children infected vertically are infected during pregnancy and around the time of delivery, while the remainder are infected during breast-feeding. Although breast-feeding tends to be the best way to feed infants, substituting breast-feeding can reduce the risk of mother-to-child HIV transmission when mothers are HIV-seropositive. However, when breast milk substitutes are used, infants are 5 times more likely to have bacterial infections than are breast-fed infants, even in the context of good hygiene. Where hygiene is poor, artificially fed infants may be 20 times more likely to die from diarrhea than are breast-fed infants. HIV-positive women need information on the risks and benefits of breast-feeding and of the various alternatives, and support in deciding which method is best. Infant feeding options are discussed.     

South African HIV surveillance

In (Africa Health), Nov 1994, you state that "AIDS specialist Alan Whiteside at the University of Natal says that one in five South Africans may be HIV positive." This is an inaccurate quote. South Africa is perhaps unique in African countries in that we have had very large sentinel surveys carried out on women attending ante-natal clinics for the past four years. These are done in October/November each year and have given us an accurate picture of the progress of the epidemic. The results from the 1994 survey are not yet available. However, the 1993 results were used to make predictions for 1994. In the worst affected area of South Africa, the prediction is that 19.78% of women attending the ante-natal clinics will be HIV positive. Full results by province are given in the following table. It would not, therefore, be accurate to say that one in five South Africans may be HIV positive, as clearly this is not the case country-wide and, even though one in five women in Natal/KwaZulu may be positive, they represent only the sexually active adult population.     

South African HIV surveillance [letter

In (Africa Health), Nov 1994, you state that "AIDS specialist Alan Whiteside at the University of Natal says that one in five South Africans may be HIV positive." This is an inaccurate quote. South Africa is perhaps unique in African countries in that we have had very large sentinel surveys carried out on women attending ante-natal clinics for the past four years. These are done in October/November each year and have given us an accurate picture of the progress of the epidemic. The results from the 1994 survey are not yet available. However, the 1993 results were used to make predictions for 1994. In the worst affected area of South Africa, the prediction is that 19.78% of women attending the ante-natal clinics will be HIV positive. Full results by province are given in the following table. It would not, therefore, be accurate to say that one in five South Africans may be HIV positive, as clearly this is not the case country-wide and, even though one in five women in Natal/KwaZulu may be positive, they represent only the sexually active adult population.     

Infant feeding practices and early flavor experiences in Mexican infants: an intra-cultural study

OBJECTIVES: The study explored the maternal beliefs and practices related to pregnancy, breastfeeding, and infant feeding among women living in several regions in Mexico. We hypothesized that, despite the culinary diversity within Mexico, there would be similar patterns in the types of flavors and foods eaten by mothers and fed to infants. DESIGN: A structured interview was conducted through personal interviews with mothers during routine visits to their local family medical units. The units were located in four regions in Mexico that represent the diversity of culinary practices characteristic of the country. SUBJECTS: A random sample of 101 women whose infants ranged in age from 6 days to 9 months. RESULTS: Although the vast majority of mothers knew of its benefits and nursed their infants, breastfeeding during the first week of life was not exclusive; approximately one third of the infants were also fed teas, water, and/or formula. The feeding of teas continued throughout infancy in three of the regions, but the flavor of the tea differed. There were also regional similarities in the foods chosen and avoided during pregnancy and lactation and the type of first foods offered to the infants. CONCLUSIONS: The similarities in the types of foods fed to infants and eaten more of by mothers during pregnancy suggest that these cultural and regional practices contribute to the development of strong preferences for regional cuisines. The foods eaten by the mother during pregnancy and lactation form the basis of the child's weaning patterns.     

Enhancing protective factors in South African adolescents affected by HIV/AIDS

This article explores the lived experiences of early adolescents orphaned by HIV/AIDS and seeks to identify the different factors that contribute to resilience at the individual, family or home and larger community levels. Ten early adolescents aged from 12 to 14 years living in Soweto, South Africa, participated in the study. Data were collected using photovoice, structured interviews and autobiographical essays and were analysed using thematic networks analysis. The analysis revealed individual assets, family variables, peer and teacher support alongside other community resources as being protective factors that cultivate resilience. Based on the findings, recommendations are made on how to increase protective factors for adolescents affected by HIV/AIDS.     

Collective Efficacy and HIV Prevention in South African Townships

South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.     

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.     

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.     

Infant survival, HIV infection, and feeding alternatives in less-developed countries.

OBJECTIVES: This study examines, in the context of the human immunodeficiency virus (HIV) epidemic, the effects of optimal breast-feeding, complete avoidance of breast-feeding, and early cessation of breast-feeding. METHODS: The three categories of breast-feeding were weighed in terms of HIV transmission and infant mortality. Estimates of the frequency of adverse outcomes were obtained by simulation. RESULTS: Avoidance of all breast-feeding by the whole population always produces the worst outcome. The lowest frequency of adverse outcomes occurs if no HIV-seropositive women breast-feed and all seronegative women breast-feed optimally, given infant mortality rates below 100 per 1000 and relative risks of dying set at 2.5 for non-breast-fed compared with optimally breast-fed infants. For known HIV-seropositive mothers, fewer adverse outcomes result from early cessation than from prolonged breast-feeding if the hazard of HIV transmission through breast-feeding after 3 months is 7% or more, even at high mortality rates, given relative risks of dying set at 1.5 for early cessation compared with optimal duration of breast-feeding. CONCLUSIONS: The risk of HIV transmission through breast-feeding at various ages needs to be more precisely quantified. The grave issues that may accompany a possible decline in breast-feeding in the less developed world demand evaluation.     

Infant feeding: a review of weaning

Current advice on mixed feeding for the infant is reviewed, with reference to recent reports in the UK. Changes in practice are illustrated and the relevance to the infant of current advice for a prudent diet in adulthood is discussed. It is suggested that future reports on infant feeding may need to be more fully extended to the pre-school child.     

Factors related to HIV disclosure in 2 South African communities

Disclosure of HIV status is an essential part of behavior modification and access and adherence to treatment in people infected with HIV. We conducted interviews in 2 South African communities of similar ethnic mix but with very different rates of disclosure of HIV status and found that disclosure was the catalyst for access to a variety of important and often essential resources. In the community with high rates of disclosure of HIV infection, disclosure led to greater access to formal institutional support and opportunities to take positive leadership roles in the community. Our findings highlight the prominence of wider sociopolitical contexts for disclosure decisionmaking and the need for HIV interventions to increase levels of disclosure of HIV infection.     

Breast and bottle feeding in rural and urban South African children

We studied breast and bottle feeding in 1264 children aged 1–4 years from five South African communities using a questionnaire on feeding habits completed by trained interviewers. The proportion of infants breast feeding ranged from 73% to 94% for mean periods of 9–16 months. The group with the most consistent and prolonged breast feeding habits were rural black children. Different bottle feeding practices were used within the various communities. At the ages studied the types of infant feeding practice varied little within the groups although each group differed significantly from the others for the preferred feeding method.     

Becoming a mother: perspectives and experiences of young women in a South African Township

There has been growing interest in the high levels of pregnancy among young women in South Africa. This study aimed to explore a range of perspectives and experiences of early motherhood among young women in a township in KwaZulu-Natal, South Africa. This was done using in-depth interviews from a small sample of young mothers aged 18–24 years. All the young mothers reported that they had had their first child while still at school. None of them had intended or planned to have a child, and were therefore not ready for motherhood. Limited information on pregnancy prevention methods plays a key role in influencing early childbearing. Young mothers in the study wanted to assume financial responsibility for their children but they were finding it difficult to do so. Many faced numerous obstacles as they were no longer in a relationship with the father of their child and depended on their own parents for support. Participants described how the difficulties they faced in their daily lives and their new roles as mothers impacted negatively on their education and career aspirations. The study recommends greater involvement of schools and community in addressing the challenges of early childbearing.     

Menstruation experiences of South African women belonging to the ama-Xhosa ethnic group

A growing body of research has emphasised the salience of cultural beliefs and traditional practices to women’s experiences of menstruation. Relatively less research has, however, been undertaken in South Africa. This study explored the experience of menstruation among women from the ama-Xhosa ethnic group, one of the largest ethnic groups in the country. Among the ama-Xhosa, there are distinct cultural practices associated with menstruation, including the female rite of passage (intonjane) and virginity testing (inkciyo). However, few studies have explored the experience of menstruation for women from this cultural group. This study involved the synthesis of data from individual interviews and focus group discussions conducted among a sample of ama-Xhosa women. The data were analysed using thematic analysis. Distinctive findings included women’s participation in traditional cultural practices of intonjane and inkciyo and the presence of cultural taboos associated with menstruation. Women’s narratives revealed strong ambivalence regarding these practices. On the one hand, they wanted to adhere to traditional practices but experienced these customs as evoking discomfort and shame. The study confirmed the prevalence of negative constructions of menstruation. Positive appraisals of menstruation as evoking joy and happiness were also encountered.     

Peer education,gender and the development of critical consciousness: participatory HIV prevention by South African youth

Despite the growing popularity of participatory peer education as an HIV-prevention strategy worldwide, our understandings of the processes underlying its impact on sexual norms are still in their infancy. Starting from the assumption that gender inequalities play a key role in driving the epidemic amongst young people, we outline a framework for conceptualizing the processes underlying successful peer education. We draw on the inter-locking concepts of social identity, empowerment (with particular emphasis on Freire's account of critical consciousness) and social capital. Thereafter we provide a critical case study of a school-based peer education programme in a South African township school, drawing on a longitudinal case study of the programme, and interviews and focus groups with young people in the township. Our research highlights a number of features of the programme itself, as well as the broader context within which it was implemented, which are likely to undermine'the development of the critical thinking and empowerment which we argue are key preconditions for programme success. In relation to the programme itself, these include peer educators' preference for didactic methods and biomedical frameworks, unequal gender dynamics amongst the peer educators, the highly regulated and teacher-driven nature of the school environment and negative learner attitudes to the programme. In relation to the broader context of the programme, we point to factors such as limited opportunities for communication about sex outside of the peer educational setting, poor adult role models of sexual relationships, poverty and unemployment, low levels of social capital and poor community facilities. We discuss the implications of our findings for the design of peer educational activities, and point to a number of broader social and community development initiatives that would maximize the likelihood of programme success.