“I beg you…breastfeed the baby, things changed”: Infant feeding experiences among Ugandan mothers living with HIV in the context of evolving PMTCT guidelines

For women living with HIV (WLWH) in low- and middle-income countries, breastfeedingrepresents both an HIV transmission risk and the best way to ensure infant survival. The 2013 World Health Organization (WHO)-led strategy for the Prevention of Mother to Child Transmission (PMTCT) recommends exclusive and continued breastfeeding alongside lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women to optimize maternal and infant health while reducing perinatal HIV transmission risk. There have been four major changes to WHO’s infant feeding guidelines since 1992, but few studies have explored how these evolving recommendations affect the pregnancy and postpartum experiences of WLWH. To address this gap, this study explores infant feeding experiences of twenty WLWH on ART in Uganda navigating new PMTCT guidelines. Findings reveal that women are making choices about infant feeding that run counter to current guidelines amid uncertainty about optimal infant feeding practices, fear of HIV transmission through breastfeeding, privileging of infant formula alongside fears about child survival and failure to-thrive while exclusively breastfeeding, and maternal stress related to breastfeeding duration. Results highlight an urgent need for clearer communication about guideline changes and supportive infant feeding care for WLWH, including training for healthcare providers.