“I love my baby more than they do”: infant feeding decision-making among mothers living with HIV in the United States

In the US and other high-income countries, national guidelines traditionally recommended against breastfeeding infants born to women living with HIV (WLHIV), due to the risk of HIV transmission to the infant. In 2023, US guidelines were changed to recommend collaborative decision-making and support for WLHIV who choose to breastfeed. Little is known regarding how WLHIV make the decision of how to feed their babies, leaving clinicians lacking guidance on how to provide effective counseling. We therefore conducted a semi-structured interview study of pregnant and recently postpartum WLHIV in the US. A diverse cohort of 19 WLHIV described weighing multiple considerations against one another based on their preferences and beliefs, with risk of HIV transmission being just one of many interconnected and often conflicting motivations. While some considerations were always associated with a specific feeding choice, others, such as fear of HIV disclosure, influenced some mothers to breastfeed and others to formula feed. In the context of both breastfeeding and formula-feeding, mothers were faced with a continuum of additional feeding-related choices throughout the child's infancy. WLHIV stressed the importance of receiving personalized infant feeding counseling that acknowledges that their priorities and beliefs may be different from those of their health providers.