AIDS and Behavior

, Volume 22, Supplement 1, pp 114–120 | Cite as

Early Breastfeeding Cessation Among HIV-Infected and HIV-Uninfected Women in Western Cape Province, South Africa

  • Moleen ZunzaEmail author
  • Monika Esser
  • Amy Slogrove
  • Julie A. Bettinger
  • Rhoderick Machekano
  • Mark F. Cotton
  • the Mother-Infant Health Study (MIHS) Project Steering Committee
Original Paper


As part of the Mother-Infant Health Study, we describe infant feeding practices among HIV-infected and HIV-uninfected mothers over a 12-month period when the Western Cape Province prevention of mother-to-child transmission (PMTCT) program was transitioning from a policy of exclusive formula feeding to one of exclusive breastfeeding. Two hundred pairs of mother and HIV-uninfected infant were included in the analysis, among whom 81 women were HIV uninfected and breastfeeding. Of the 119 HIV-infected mothers, 50 (42%) were breastfeeding and 69 (58%) were formula feeding. HIV-infected mothers predominantly breastfed for 8.14 (7.71–15.86) weeks; HIV-uninfected mothers predominantly breastfed for 8.29 (8.0–16.0) weeks; and HIV-infected mothers predominantly formula fed for 50.29 (36.43–51.43) weeks. A woman’s HIV status had no influence on the time to stopping predominant breastfeeding (P = 0.20). Our findings suggest suboptimal duration of breastfeeding among both HIV-infected and HIV-uninfected mothers. Providing support for all mothers postdelivery, regardless of their HIV status, may improve breastfeeding practices.


Early breastfeeding cessation HIV/AIDS Prevention of mother-to-child transmission 



This work was supported in part by the Major Thematic Grant from the Peter Wall Institute for Advanced Studies, University of British Columbia (F0906208) and the Canadian Institutes of Health Research Canada-HOPE Scholarship Program (Grant Number CH1-106949); The United States President’s Emergency Plan for AIDS Relief (PEPFAR) through HRSA under the terms of T84HA21652; Stellenbosch University Faculty of Medicine and Health Sciences Clinical Research Grant; South Africa Medical Research Council Self-Initiated Grant; Harry Crossley Foundation Project Funding; and Stellenbosch University Temporary Research Assistant Grant. We wish to acknowledge the support and training Dr Moleen Zunza received from the University of California, San Francisco, International Traineeships in AIDS Prevention Studies (ITAPS), US NIMH, R25 MH064712. Dr Amy Slogrove was supported by research fellowships from the Canadian Institutes of Health Research Canada-HOPE Scholarship Program, the Canadian HIV Trials Network International Fellowship, and the South African National Health Scholarship Programme. Dr Julie Bettinger is a Michael Smith Foundation for Health Research scholar. We thank the mothers and infants who generously donated their time to the MIHS study and without whose participation the study would not have been possible. We gratefully acknowledge the expert assistance provided by the staff at Family Clinical Research Unit, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa; and the Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada. We thank Dr Krysia Lindan for her mentorship during the drafting of the manuscript. The funders had no role in the study design, data collection and analysis, preparation of the manuscript, or decision to submit the manuscript for publication. Mother-Infant Health Study Project Steering Committee: David Speert, University of British Columbia, Vancouver, Canada. Monika Esser, Stellenbosch University, Cape Town, South Africa. Julie A. Bettinger, University of British Columbia, Vancouver, Canada. Mark F. Cotton, Stellenbosch University, Cape Town, South Africa.

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants in the study.


  1. 1.
    National Department of Health. The National Antenatal Sentinel HIV Prevalence Survey, South Africa. 2013.Google Scholar
  2. 2.
    Ziegler JB, Cooper DA, Johnson RO, Gold J. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet. 1985;1(8434):896–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Lepage P, Van de Perre P, Carael M, et al. Postnatal transmission of HIV from mother to child. Lancet. 1987;330:400.CrossRefGoogle Scholar
  4. 4.
    Weinbreck P, Loustaud V, Denis F, Vidal B, Mounier M, de Lumley L. Postnatal transmission of HIV infection. Lancet. 1988;331:482.Google Scholar
  5. 5.
    World Health Organization. Department of Reproductive Health Research. New data on the prevention of mother-to-child transmission of HIV and their policy implications: conclusions and recommendations. Geneva. 2001. Accessed November 22, 2014.
  6. 6.
    Bahl R, Frost C, Kirkwood BR, et al. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull World Health Organ. 2005;83(6):418–26.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Kuhn L, Aldrovandi G. Pendulum swings in HIV-1 and infant feeding policies: now halfway back. Adv Exp Med Biol. 2012;743:273–87.CrossRefPubMedGoogle Scholar
  8. 8.
    Bhandari N, Bahl R, Mazumdar S. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet. 2003;361(9367):1418–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Coovadia HM, Rollins NC, Bland RM, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369(9567):1107–16.CrossRefPubMedGoogle Scholar
  10. 10.
    Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia H. Influence of infantfeeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet. 1999;354(471):476.Google Scholar
  12. 12.
    Kumwenda NI, Hoover DR, Mofenson LM, et al. Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med. 2008;359(2):119–29.CrossRefPubMedGoogle Scholar
  13. 13.
    Kesho Bora Study Group. Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding vs zidovudine/singledose nevirapine prophylaxis): the Kesho Bora randomized controlled trial. Clin Infect Dis. 2012;55:449–60.CrossRefGoogle Scholar
  14. 14.
    Mofenson LM. Antiretroviral drugs to prevent breastfeeding HIV transmission. Antivir Ther. 2010;15(4):537–53.CrossRefPubMedGoogle Scholar
  15. 15.
    World Health Organisation/Joint United Nations Programme on HIV/AIDS/United Nations Children’s Fund). Guidelines on HIV and infant feeding. Principals and recommendations for infant feeding in the context of HIV and a summary of evidence. Geneva. 2010.Google Scholar
  16. 16.
    World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. 2013. Accessed July 26, 2013.
  17. 17.
    National Department of Health, South Africa, South African National AIDS Council. Clinical Guidelines: Prevention of Mother-of-to Child Transmission (PMTCT). Pretoria 2010.Google Scholar
  18. 18.
    Department of Health. South African infant and young child feeding policy. 2013. Accessed March 13, 2017.
  19. 19.
    KwaZulu-Natal Department of Health. Guidelines on infant feeding and young child feeding in the context of HIV. 2010. Accessed March 13, 2016.
  20. 20.
    Slogrove A, Esser M, Cotton M, et al. A prospective cohort study of common childhood infections in South African HIV-exposed uninfected and HIV-unexposed infant. Pediatr Infect Dis J. 2017;36(2):e38–44.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    World Health Organization. Breastfeeding and replacement feeding practices in the context of mother-to-child transmission of HIV: an assessment tool for research and programs. 2001. Accessed February 8, 2010.
  22. 22.
    Tylleskar T, Jackson D, Meda N. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet. 2011;378:420–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Shapiro RL, Hughes MD, Ogwu A, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010;362(24):2282–94.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Coetzee B, Tomlinson M, Osawe S, Amibiku A, Kagee A. INFANT Study Team. Barriers to and facilitators of adherence to exclusive breastfeeding practices among HIV infected and non-infected women in Jos, Nigeria. Matern Child Health J. 2017;21:953–60.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Nabwera HM, Jepkosgei J, Muraya KW, et al. What influences feeding decisions for HIV-exposed infants in rural Kenya? Int Breastfeed J. 2017;12:31.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chinkonde JR, Sundby J, de Paoli M, Thorsen VC. The difficulty with responding to policy changes for HIV and infant feeding in Malawi. Int Breastfeed J. 2010;5:11.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Cattaneo A. Academy of breastfeeding medicine founder’s lecture 2011: inequalities and inequities in breastfeeding: an international perspective. Breastfeed Med. 2012;7(1):3–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Labbok MTE. Achieving exclusive breastfeeding in the United States: findings and recommendations. 2008. Accessed June 11, 2016.
  29. 29.
    Leviniene G, Petrauskiene A, Tamuleviciene E, Kudzyte J, Labanauskas L. The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding. Medicina (Kaunas). 2009;45(3):238–47.CrossRefPubMedGoogle Scholar
  30. 30.
    Chinkonde JR, Sundby J, de Paoli M, Thorsen VC. The difficulty with responding to policy changes for HIV and infant feeding in Malawi. Int Breastfeed J. 2010;5:11.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sint TT, Lovich R, Hammond W, et al. Challenges in infant and young child nutrition in the context of HIV. AIDS. 2013;27(2):S169–77.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Coutsoudis A. Infant feeding dilemmas created by HIV: South African experience. J Nutr. 2005;135(4):956–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001;285(4):413–20.CrossRefPubMedGoogle Scholar
  34. 34.
    Santos I, Victora C, Martines J, et al. Nutrition counseling increases weight gain among Brazilian children. J Nutr. 2001;131(11):2866–73.CrossRefPubMedGoogle Scholar
  35. 35.
    Morrow AL, Guerrero ML, Shults J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999;353:1226–31.CrossRefPubMedGoogle Scholar
  36. 36.
    Chapman DJ, Morel K, Anderson AK, Damio G, Perez-Escamilla R. Breastfeeding peer counseling: from efficacy through scale-up. J Hum Lact. 2010;26(3):314–26.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. Breastfeeding promotion interventions and breastfeeding practices: a systematic review. BMC Public Health. 2013;13(suppl 3):S20.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Moleen Zunza
    • 1
    • 2
    Email author
  • Monika Esser
    • 3
  • Amy Slogrove
    • 1
    • 4
  • Julie A. Bettinger
    • 5
  • Rhoderick Machekano
    • 6
  • Mark F. Cotton
    • 1
  • the Mother-Infant Health Study (MIHS) Project Steering Committee
  1. 1.Department of Paediatrics & Child HealthStellenbosch UniversityCape TownSouth Africa
  2. 2.Division of Epidemiology and Biostatistics, Department of Global HealthStellenbosch UniversityCape TownSouth Africa
  3. 3.Department of Pathology, Immunology Unit, National Health Laboratory ServiceStellenbosch UniversityCape TownSouth Africa
  4. 4.School of Population & Public HealthUniversity of British ColumbiaVancouverCanada
  5. 5.Vaccine Evaluation Center, BC Children’s HospitalUniversity of British ColumbiaVancouverCanada
  6. 6.Elizabeth Glaser Pediatric AIDS FoundationWashingtonUSA

Personalised recommendations