Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda.

Breastfeeding has been associated with a doubling of the risk of HIV transmission. In developed countries, it is recommended that HIV-positive women do not breastfeed, but this is not a feasible option in most of Africa. It is therefore important to know the extent to which breastfeeding practices are amenable to change. To study this, we carried out 24 focus group discussions with 208 women attending maternity clinics in three rural sites in rural south-west Uganda. Breastfeeding starts from a few minutes to a few days after delivery; most women reported starting after 2 days. The main reason for delay is lack of milk or that the breasts are 'blocked'. Most women thought that this delay was good for the baby, or at least not harmful. Almost all women reported giving the child a soup made of boiled mushrooms before starting to breastfeed. Once they have started breastfeeding, various supplementary foods are gradually introduced at 4-6 months. Women thought that ideally breastfeeding should last for 2-3 years, but in practice most stopped after 18 months. The father and his female relatives generally decide when the child should be weaned. The women thought that commercial milk formula foods were good but could not use them because they are too expensive and anyway unavailable in rural areas. Most women were unaware that HIV could be passed to the child through breastfeeding. Various practices identified as potentially risky are common in this population. Artificial feeding is not a viable option in this area, and although women were prepared to make sacrifices to prevent vertical transmission of HIV, practices are deeply ingrained in traditional culture and will need to be addressed in future interventions. Male partners will also need to be involved.