Psychological Outcomes of Current Infant Feeding Dilemma for HIV-Infected Mothers

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