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"Peer but not peer": considering the context of infant feeding peer counseling in a high HIV prevalence area
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. (Internationell kvinno- & mödrahälsovård/Essen)
Visa övriga samt affilieringar
2009 (Engelska)Ingår i: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 25, nr 4, s. 427-434Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Postnatal transmission of HIV through breastfeeding remains an unsolved problem in resource poor settings, where refraining from breastfeeding is neither feasible nor safe. This study describes how women experienced infant-feeding peer counseling within a community-based intervention trial in 3 settings in South Africa. In total, 17 interviews and 10 observations were done with HIV-infected and uninfected women. The findings raise questions on the concept of "peer." Some women feared the peer counselor visits and questioned their intentions. Others, especially HIV-infected women, valued peer counseling for the emotional support provided. Being HIV infected with limited or no network of support appeared stressful for most women. The effects of data collection on the delivery and uptake of peer counseling are discussed. The findings underline the contextual barriers facing peer counselors and show that these challenges could have important implications for the effectiveness of infant-feeding counseling in high HIV prevalence countries.

Ort, förlag, år, upplaga, sidor
2009. Vol. 25, nr 4, s. 427-434
Nyckelord [en]
HIV, exclusive breastfeeding, exclusive formula feeding, peer counseling, interventions, South Africa
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-124187DOI: 10.1177/0890334409341050ISI: 000271223200009PubMedID: 19622755OAI: oai:DiVA.org:uu-124187DiVA, id: diva2:317205
Tillgänglig från: 2010-05-03 Skapad: 2010-05-03 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
Ingår i avhandling
1. Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
Öppna denna publikation i ny flik eller fönster >>Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Despite global efforts, exclusive breastfeeding is rarely practiced in South Africa where infants are at risk of diarrheal infections, malnutrition and HIV transmission. The present study was conceptualized within the context of a multi-country, cluster randomized community-based behavioural intervention known as PROMISE-EBF in South Africa, Burkina Faso, Zambia and Uganda (www.clinicaltrials.gov, no: NCT00397150). The aim of this thesis was to identify and describe contextual factors that are important for the effectiveness of community-based peer counselling with a special focus on the promotion of exclusive breast and formula feeding. This thesis identifies the paradoxes and discrepancies embedded in the notion of community-based “peer” counselling approach, especially in the South African context of poverty, HIV and social distrust. Peer counselling, while perceived useful, was associated with social distrust which might have resulted in reduced effectiveness of the intervention. The thesis further illustrates that, while there is strong support for breast feeding, there was a general openness for early introduction of commercial foods and liquids. Mothers’ perceptions on infant feeding and peer counselling varied substantially according to HIV-status and geographical area. Nevertheless, the infant feeding peer counselling approach neither modified the mothers’ perceptions on feeding nor its associated barriers. Thus, several important barriers to exclusive breastfeeding including the risk for HIV stigmatization still remain. The results of this thesis highlight the need to rethink current approaches to the promotion of exclusive breastfeeding. It further draws attention to the gap between theoretical assumptions inherent in health interventions and the actual dynamic processes and realties of women in low-income high HIV settings.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2010. s. 72
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 619
Nyckelord
Promotion, Exclusive Breastfeeding, Formula Feeding, Peer Counselling, HIV, South Africa
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:uu:diva-133199 (URN)978-91-554-7939-8 (ISBN)
Disputation
2010-12-15, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 13:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2010-11-24 Skapad: 2010-11-02 Senast uppdaterad: 2011-01-13Bibliografiskt granskad

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