{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:52:57Z","timestamp":1792248777567,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T00:00:00Z","timestamp":1547769600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007880","name":"Johns Hopkins University","doi-asserted-by":"publisher","award":["P30AI094189"],"award-info":[{"award-number":["P30AI094189"]}],"id":[{"id":"10.13039\/100007880","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["T32NR007081"],"award-info":[{"award-number":["T32NR007081"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1K23MH116807\u201001A1"],"award-info":[{"award-number":["1K23MH116807\u201001A1"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005595","name":"University of California","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,1]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n \n Currently, the United States (U.S.) recommends that infants born to women living with\n HIV<\/jats:styled-content>\n (\n WLHIV<\/jats:styled-content>\n ) be fed formula, whereas many low\u2010resource settings follow the World Health Organization's recommendation to exclusively breastfeed with ongoing antiretroviral therapy. Evidence on infant feeding among\n WLHIV<\/jats:styled-content>\n in high\u2010resource countries suggest that these contrasting recommendations create challenges for providers and patients. Our study used multiple methods to understand providers\u2019 infant feeding perspectives on caring for their pregnant and post\u2010partum\n WLHIV<\/jats:styled-content>\n in the U.S.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We sent a survey (n\u00a0=\u00a093) to providers across the U.S. who have cared for\n WLHIV<\/jats:styled-content>\n . A subset of survey participants opted into a follow\u2010up qualitative interview (n\u00a0=\u00a021). These methods allowed us to capture a broad understanding of provider attitudes via the survey and more nuanced qualitative interviews. The study was completed prior to an updated breastfeeding section of the U.S. Perinatal Guidelines.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The majority of providers (66.7%) discussed infant feeding intent with their patients using open\u2010ended questions. Many also discussed alternative feeding methods (37.6%) and disclosure avoidance strategies (34.4%). Over 75% (95% confidence interval (\n CI<\/jats:styled-content>\n ): 65.1 to 84.2) of participants reported that a\n WLHIV<\/jats:styled-content>\n asked if she could breastfeed her child, and 29% (95%\n CI<\/jats:styled-content>\n 20 to 40.3) reported caring for a patient who breastfed despite recommendations against breastfeeding. Providers reported that their patients\u2019 primary concern was stigma associated with not breastfeeding (58%), while providers were primarily concerned about medication adherence during breastfeeding (70%). Through qualitative analysis, four overarching categories emerged that reflect providers\u2019 sentiments, including (1) U.S. guidelines inadequately addressing\n WLHIV<\/jats:styled-content>\n 's desire to breastfeed; (2) negotiating patient autonomy amidst complex feeding situations; (3) harm reduction approaches to supporting\n WLHIV<\/jats:styled-content>\n in breastfeeding; and (4) providers anticipating multilayered patient stigmatization.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The majority of provider respondents cared for a\n WLHIV<\/jats:styled-content>\n who desired to breastfeed, and a third had\n WLHIV<\/jats:styled-content>\n who breastfed despite recommendations against it. Providers found that the status of U.S. guidelines and their incongruity with\n WHO<\/jats:styled-content>\n guidelines left them without adequate resources to support\n WLHIV<\/jats:styled-content>\n 's infant feeding decisions. Our findings provide important insight to inform professional associations\u2019 discussions about public health policy as they consider future directions for infant feeding guidelines among\n WLHIV<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25224","type":"journal-article","created":{"date-parts":[[2019,1,18]],"date-time":"2019-01-18T11:16:57Z","timestamp":1547810217000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["\u201cIn the United States, we say, \u2018No breastfeeding,\u2019 but that is no longer realistic\n \u201d<\/i>\n : provider perspectives towards infant feeding among women living with HIV in the United States"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6729-4101","authenticated-orcid":false,"given":"Emily L","family":"Tuthill","sequence":"first","affiliation":[{"name":"Department of Community Health Systems School of Nursing University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Tomori","sequence":"additional","affiliation":[{"name":"Department of Anthropology Durham University Durham UK"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Van Natta","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenell S","family":"Coleman","sequence":"additional","affiliation":[{"name":"Department of Gynecology\/Obstetrics Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,18]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"391\u2014396","article-title":"Policy statement: infant feeding and transmission of human immunodeficiency virus in the United States","volume":"131","author":"American Academy of Pediatrics (AAP)","year":"2013","journal-title":"Pediatrics"},{"key":"e_1_2_10_3_1","unstructured":"U.S. Department of Health and Human Services Panel\u00a0on Treatment of HIV\u2010Infected Pregnant Women and Prevention of Perinatal Transmission.Recommendations for Use of Antiretroviral Drugs in Pregnant HIV\u20101\u2010Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States.2017[cited 2018 March 26]. Available from:http:\/\/aidsinfo.nih.gov\/contentfiles\/lvguidelines\/PerinatalGL.pdf"},{"key":"e_1_2_10_4_1","unstructured":"U.S. Department of Health and Human Services AIDSinfo.Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.2018[Cited 2018 Sept 16]. Available from:https:\/\/aidsinfo.nih.gov\/guidelines\/html\/3\/perinatal\/513\/guidance-for-counseling-and-managing-women-living-with-hiv-in-the-united-states-who-desire-to-breastfeed"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0911486"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001612"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181bdf65a"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31816e395c"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181b323ff"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181950c56"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832ec20d"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000279708.09180.f5"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907736"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001015"},{"key":"e_1_2_10_15_1","volume-title":"Guideline updates on HIV and infant feeding: the duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV","author":"World Health Organization (WHO)","year":"2016"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60283-9"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0001363"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2011.00918.x"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnn.2012.07.013"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2013.01.008"},{"issue":"5","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/sextrans-2015-052224","article-title":"\u2018It pains me because as a woman you have to breastfeed your baby\u2019: decision\u2010making about infant feeding among African women living with HIV in the UK","volume":"92","author":"Tariq S","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"10","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1093\/cid\/ciw587","article-title":"Should providers discuss breastfeeding with women living with HIV in high\u2010income countries? An ethical analysis","volume":"63","author":"Johnson G","year":"2016","journal-title":"Clin Infect Dis"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2016.1140885"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2014.888720"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu272"},{"key":"e_1_2_10_26_1","unstructured":"British HIV Association (BHIVA).British HIV Association guidelines for the management of HIV infection in pregnant women 2018.2018[cited 2018 Sept 29]. Available from:https:\/\/www.bhiva.org\/file\/WrhwAPoKvRmeV\/BHIVA-Pregnancy-guidelines-consultation-draft-final.pdf"},{"key":"e_1_2_10_27_1","volume-title":"Content analysis: an introduction to its methodology","author":"Krippendorff K","year":"2013"},{"key":"e_1_2_10_28_1","volume-title":"Qualitative content analysis: theoretical foundation, basic procedures and software solution","author":"Mayring P","year":"2014"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ678"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0160775"},{"issue":"2","key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/QAD.0000000000001707","article-title":"Improving postpartum retention in care for women living with HIV in the United States","volume":"32","author":"Momplaisir FM","year":"2018","journal-title":"AIDS"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2744-2"},{"issue":"2018","key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.1016\/S2352-3018(18)30098-5","article-title":"Does U=U for breastfeeding mothers and infants? 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