Key messages and communications
Q.39 How to change the stigmatization of breastfeeding as dangerous or exclusive breastfeeding and formula feeding as meaning only HIV?
Changing health workers’ and the public’s perceptions about the best way to feed a baby, whether HIV-exposed or not, is extremely important and takes sustained effort, linked with other communication strategies and policy initiatives (e.g. the Baby-friendly Hospital Initiative and the Code). It remains essential to convey that avoiding HIV Infection is not enough, but that health services must also aim to reduce other causes of child mortality. This concept is known as HIV-free survival (see Q.40). If health workers only consider the importance of avoiding HIV infection, then interventions such as formula feeding may be inappropriately recommended in circumstances where formula feeding would be unsafe and increase the child's risk of dying. In order for health workers to understand these issues, they need accurate information about the outcomes for babies with different feeding methods. They themselves need to be confident in the advantages and feasibility of breastfeeding with ARVs before they can provide accurate information and support.
The public can be reached through awareness campaigns and educational materials. Families of HIV-infected women who have disclosed their status can be invited to discuss feeding methods and the importance of supporting women while feeding their infants. Local formative research and assessments of communication approaches will help.
National and local leaders need to be consistent when communicating the national recommendations and provide the justification (evidence) in easily understood language, so that other opinion leaders in civil society can give their backing and support.