Zimbabwe is working towards elimination of mother-to-child transmission of HIV. All pregnant and breastfeeding women who are HIV-infected are initiated on Option B+ treatment for prevention of mother-to-child transmission (PMTCT). Women on this regimen are encouraged to exclusively breastfeed for six months along with starting or continuing antiretroviral therapy (ART). Exclusive breastfeeding is not an easy feat, particularly for HIV-infected mothers.Our studyexplored the challenges faced by these women on the PMTCT program.

Challenges in implementing and studying PMTCT

Our study is premised on the assumption that the biomedical framework of ART initiation has informed most of the studies on PMTCT at the expense of the social model of health. The complex interactions of the biological, psychological and social processes that shape behavior have not been seriously considered. Mothers on PMTCT are not considered within the context of the broader environmental factors that influence their behavior. Policymakers often do not account for cultural factors when introducing interventions to address societal problems.

Although there are multiple advantages from the ‘test, treat, and breastfeed all infants’ strategy of PMTCT, a plethora of challenges can compromise and prevent the achievement of the desired health benefits for both the mother and her infant. These include HIV-related stigma, fear of transmitting HIV to the baby, and ART side effects.

妇女的斗争，用自己的话语

在我们的研究中，妇女在卫生专业人员和政策制定者促进的独家母乳喂养方面苦苦挣扎。妇女之间达成了共识，他们害怕通过母乳感染婴儿。一名妇女认为，护士坚持母乳喂养是残酷的：“If these nurses were HIV positive would they breastfeed”?

政策制定者应在引入解决社会问题的计划时认识到文化的重要性。

我们的定性研究表明，构成和感觉到的污名都是现实。一个女人觉得人们对她的艾滋病毒状况闲聊：“每当我接近人们时，他们都会改变主题，您可以告诉他们在谈论您。”while another felt that people did not want to be near her:“It is as if I have a stench.”卫生提供者，也许是无意间的，通过在特定时间对艾滋病毒感染的患者进行参与并将其标记为“those for tablets” (a local term used for people on ART).

This concern about stigma further challenged the women’s adherence to exclusive breastfeeding, fearing that it would be tantamount to giving away one’s HIV status, as it is against the community norms of infant feeding which involves giving water, traditional medicines and foods.

Disclosure of HIV status to family was also a major challenge which negatively impacted on the women’s ability to follow through with exclusive breastfeeding. The women, despite the knowledge received from the health workers, ended up mixed feeding their babies and not adhering to their ART medication due to fear that their families would find out their status. One of the women said,“When I was diagnosed HIV positive during antenatal care, I (hypothetically) asked my husband for his reaction … he became so livid … I hide my medication in the garden ….”

Implications

这项研究清楚地表明，PMTCT计划的成功不能仅通过吸收B+的吸收来衡量，该选项B+从2018年的65％上升到99％。认识到引入干预措施的上下文因素是关键。政策制定者应在引入解决社会问题的计划时认识到文化的重要性。有必要解决可能导致婴儿后婴儿感染的文化习俗，例如给婴儿传统药物和其他食物。程序应意识到“一种适合所有尺寸”方法不起作用。