An estimated 160,000 women of childbearing age in Lesotho are HIV positive (UN Children's Fund [UNICEF] 2010). To prevent the transmission of HIV from mother to child (PMTCT), antenatal care clinics test pregnant women for HIV and provide prevention counseling. PMTCT counseling includes information about medication in pregnancy, delivery procedures, and safe infant feeding. Regarding infant feeding, the WHO recommends either exclusive replacement feeding or exclusive breastfeeding; while the culturally normative practice is to combine breast milk with other food for the infant. Mixed feeding, however, increases the likelihood of HIV infection through breast milk. Women must balance the recommendations of healthcare workers with society's norms and the advice of their family, as well as cost and availability. Exclusive replacement feeding is too expensive for most families and against the cultural norm, while exclusive breastfeeding proves difficult to implement because of a lack of understanding of PMTCT recommendations among an infant's multiple caretakers. Collective child care is an important part of social integration and respect for elders makes it difficult for young women to risk conflict by rejecting familial advice for that of healthcare workers. Given these concerns, the authors examine safe infant feeding in the context of Lesotho's HIV epidemic.
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