A qualitative study of maternal knowledge, perceptions and infant feeding practices among women living with HIV during the first six months of life

Appropriate infant feeding practices among mothers living with HIV (MLWHIV) are critical for preventing mother-to-child transmission (PMTCT) of HIV and promoting infant health. Knowledge gaps regarding infant feeding in the context of HIV, particularly related to breastfeeding duration as well as sub-optimal feeding practices have been reported in South Africa (SA) despite efforts to promote optimal infant feeding practices. Few studies have explored the situation qualitatively beyond 2018 among MLHIV with younger infants. We explored the knowledge, perceptions and practices of MLWHIV regarding infant feeding during the first 6 months of infant life in KwaZulu-Natal. This was an explorative-descriptive qualitative study. We conducted in-depth interviews with a purposive sample of 12 MLWHIV and infants aged 0 to 6 months. We obtained data using a semi-structured interview guide and analyzed them thematically. Themes were summarized and linked using relevant behaviour change theories/model. Three key themes emerged: mothers’ current infant feeding practices, perceptions of feeding infants less than six months, and knowledge of strategies for PMTCT of HIV in the context of infant feeding. Exclusive breastfeeding (EBF) was not the norm since only three participants were practicing it. Mixed feeding ( n = 5) and formula plus complementary foods ( n = 4) were the most common infant feeding methods. Knowledge on benefits of breastfeeding alongside trust in the education provided by healthcare workers (HCW) informed EBF choice. Poor understanding of infant feeding guidelines (recommended age for introducing complementary foods, the meaning of EBF, and mixed feeding) and the social environment (family, peers) influenced early complementary feeding. Participants portrayed positive attitudes towards breastfeeding irrespective of infant feeding method. Infant feeding practices were more appropriately explained by the behaviour change theories targeting the individual and the social environment including the socio-ecological model and socio-cognitive theory. Inappropriate infant feeding practices were common despite favourable perceptions about breastfeeding. Thus, interventions to enhance HCWs ability to support MLHIV to appropriately feed their infants and targeting the social environment to enhance normalising EBF in communities are needed.