"Breastfeeding is difficult": a qualitative exploration of exclusive breastfeeding among HIV-positive mothers in Eldoret, Kenya.

BACKGROUND: The intersection of exclusive breastfeeding (EBF) and Human Immunodeficiency Virus (HIV) presents unique challenges for maternal and infant health, particularly in settings where safe feeding alternatives are limited. For HIV-exposed infants, EBF alongside maternal viral suppression significantly reduces the risk of HIV transmission and supports infant survival. However, infant feeding practices vary globally, and HIV introduces added social, medical, and cultural challenges. In Kenya, EBF rates are sub-optimal among HIV-positive mothers, with national rates estimated at around 61%. This study aimed to explore the breastfeeding experiences of HIV-positive mothers with HIV-exposed infants younger than six months at a hospital in Eldoret, Kenya. METHODS: This qualitative study was conducted at a mother-baby-friendly accredited hospital in Eldoret, Kenya in November 2023. In-depth interviews were conducted with 27 purposively selected HIV-positive mothers to explore their breastfeeding experiences. All interviews were conducted in Kiswahili, audio-recorded, transcribed, and translated into English. MAXQDA was used to manage the data, and thematic analysis guided the interpretation. RESULTS: Mothers acknowledged the importance of practising EBF. However, breastfeeding initiation was influenced by factors such as mode of delivery and parity. Mixed maternal attitudes toward EBF while living with HIV, conflicting information on EBF from biomedical, social, and personal sources, as well as social support, all influenced which feeding practices were considered normative. Tough economic realities and stigma associated with breastfeeding HIV-exposed infants complicated feeding decisions. Structurally, the clinic set-up played a crucial role in providing support to mothers, yet in some cases led to unintentional HIV disclosure. CONCLUSION: Creating an empathetic and supportive community for HIV-positive mothers opting to breastfeed is necessary to improve EBF uptake. Although progress has been made to implement EBF guidelines, building individual confidence and a supportive environment, both within health facilities and in communities, is paramount for these mothers. This includes dispelling community misconceptions about the risks of breastfeeding with HIV. This study serves as a call to action, highlighting structural barriers and urging collective efforts to foster a transformative environment for HIV-positive mothers and their infants.