Determinants of Adherence to National Infant Feeding Guidelines by Black Mothers Living with HIV

Objective: Worldwide, 160,000 children were newly infected with HIV in 2018; half of these were infected through breastfeeding. Infant feeding guidelines are distinct depending on each country’s resources and national or sub-national guidelines. Because of divergent guidelines, the best infant feeding approach to prevent mother-to- child transmission can become unclear. The purpose of this study was to examine the sociocultural and psychosocial factors related to adherence to infant feeding guidelines through a city-level, North-South comparison of Black mothers living with HIV in Nigeria, Canada, and the United States. Design: Using a cross-sectional multi-country survey, a convenience sample of 690 mothers were recruited from June 2016 – December 2019. Socio-cultural and psychosocial factors influencing infant feed- ing practices were measured. Results: Using binary logistic regression, infant feeding attitudes (OR = 1.10), motherhood experiences (OR = 1.08), low hyper-vigilance score (OR = .93), paternal support (OR = 1.10) and perception that the health care provider supported adherence to infant feeding guidelines (OR = 2.43) were associated with guideline adherence. Mothers who had cultural beliefs that were inconsistent with infant feeding guidelines and mothers with low incomes (OR = 2.62) were less likely adherent to their country’s guidelines. Conclusion: City-level factors were not found to influence adherence to infant feeding guidelines; however, socio-cultural and psychosocial factors at community,family and individual levels were significant. Policy formulation and targeted interventions must be cognizant of cultural expectations of motherhood and mindful of psycho-social determinants of adherence to infant feeding guidelines.