Breastfeeding among Somali mothers living in Norway: Attitudes, practices and challenges.

Background: Data from previous studies indicate a short duration of breastfeeding, especially exclusive breastfeeding, among infants of immigrant mothers living in Norway and other Western countries. Norway has a long tradition of supporting breastfeeding.

Aim: To explore infant feeding practices among Somali-born mothers in Norway, and the ways in which they navigate among different information sources.

The ARV roll out and the disability grant: a South African dilemma?

Background: Prior to the antiretroviral (ARV) drug roll out in 2004, people living with HIV (PLHIV) in South Africa received disability grants when they were defined as "AIDS-sick". In the absence of available and effective medication, a diagnosis of AIDS portended disability. The disability grant is a critical component of South Africa's social security system, and plays an important role in addressing poverty among PLHIV.

The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, northern Tanzania.

Background: In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines.

Methods: The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania.

"It is her responsibility": partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania.

Background: Partner involvement has been deemed fundamental in prevention of mother to child transmission (PMTCT) programmes, but is difficult to achieve. This study aimed to explore acceptability of the PMTCT programme components and to identify structural and cultural challenges to male involvement.

Methods: The study was conducted during 2007-2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania.

Ways ahead: protecting, promoting and supporting breastfeeding in the context of HIV.

The HIV epidemic coupled with the assumed benefits of infant formula for the children of all HIV-infected mothers have in complex ways changed public ideas about infant feeding and represents a threat to well established breastfeeding practices. In the wake of the confusion that postnatal prevention of mother to child transmission of HIV (PMTCT) interventions have created among HIV-infected mothers, infant feeding counsellors and the public at large, it is time to reinstate the principles of the Innocenti Declaration to protect, promote and support breastfeeding in the context of HIV. The challenge that lies ahead is a search for ways to restore the trust in breastfeeding as the normal and safest way to feed an infant.

Reflections on global policy documents and the WHO's infant feeding guidelines: lessons learnt.

As the papers in this thematic series have illustrated, the postnatal prevention of mother to child transmission of HIV (PMTCT) strategy has struggled with lack of local relevance. In an attempt to increase our understanding of the great dissonance between the policy intention and the experiences of the participants in concrete PMTCT programmes, we will in these concluding remarks draw upon writings in institutional ethnography. Through the concept of 'global texts' we reflect upon the scientific and ideological underpinnings of the WHO policy guidelines on HIV and infant feeding, and the influence that this policy has had across multiple local settings.

The difficulty with responding to policy changes for HIV and infant feeding in Malawi.

Background: When and how to wean breastfed infants exposed to HIV infection has provoked extensive debate, particularly in low-income countries where safe alternatives to breastfeeding are rarely available. Although there is global consensus on optimal infant-feeding practices in the form of guidelines, practices are sub-optimal in much of sub-Saharan Africa. Policy-makers and health workers face many challenges in adapting and implementing these guidelines.

Breastfeeding and HIV: experiences from a decade of prevention of postnatal HIV transmission in sub-Saharan Africa.

Infant feeding by HIV-infected mothers has been a major global public health dilemma and a highly controversial matter. The controversy is reflected in the different sets of WHO infant feeding guidelines that have been issued over the last two decades. This thematic series, 'Infant feeding and HIV: lessons learnt and ways ahead' highlights the multiple challenges that HIV-infected women, infant feeding counsellors and health systems have encountered trying to translate and implement the shifting infant feeding recommendations in different local contexts in sub-Saharan Africa.

Mothers' knowledge and utilization of prevention of mother to child transmission services in northern Tanzania.

Background: More than 90% of children living with HIV have been infected through mother to child transmission. The aims of our present study were to: (1) assess the utilization of the prevention of mother to child transmission (PMTCT) services in five reproductive and child health clinics in Moshi, northern Tanzania, after the implementation of routine counselling and testing; (2) explore the level of knowledge the postnatal mothers had about PMTCT; and (3) assess the quality of the counselling given.

Methods: This study was conducted in 2007 and 2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania.

Early cessation of breastfeeding to prevent postnatal transmission of HIV: a recommendation in need of guidance.

Aim: Early and rapid cessation of breastfeeding has been recommended by WHO to reduce mother-to-child transmission of HIV. This study assessed how HIV-infected mothers planned and experienced breastfeeding cessation as part of an HIV prevention strategy and how counsellors facilitated this process.

Methods: A qualitative study was conducted among HIV-infected mothers and counsellors from local clinics and an intervention research project in Durban, South Africa.

HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania.

Background: Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania.

Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania.

Background: This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania.

Methods: Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members.

Counsellors' perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania.

This study investigated the infant feeding advice that counsellors were giving HIV-infected pregnant women in Moshi, Tanzania, the factors they thought had an impact on women's infant feeding choices and their role in influencing these decisions. The data are drawn from in-depth interviews with 16 nurses working as counsellors in their spare time in an antenatal trial of prevention of mother-to-child transmission, five local HIV/AIDS counsellors and two medical doctors, whose counselling experience ranged from less than six months to nine years. Informed choice of infant feeding method by HIV-infected women, as recommended by UNAIDS/WHO/UNICEF Guidelines, was seriously compromised by the actual advice given, directive counselling, lack of time to cope with a positive HIV test result, and lack of follow-up support, regardless of socio-economic status.