uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
"Peer but not peer": considering the context of infant feeding peer counseling in a high HIV prevalence area
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essen)
Show others and affiliations
2009 (English)In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 25, no 4, 427-434 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2009. Vol. 25, no 4, 427-434 p.
Keyword [en]
HIV, exclusive breastfeeding, exclusive formula feeding, peer counseling, interventions, South Africa
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-124187DOI: 10.1177/0890334409341050ISI: 000271223200009PubMedID: 19622755OAI: oai:DiVA.org:uu-124187DiVA: diva2:317205
Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2011-01-13Bibliographically approved
In thesis
1. Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
Open this publication in new window or tab >>Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 72 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 619
Promotion, Exclusive Breastfeeding, Formula Feeding, Peer Counselling, HIV, South Africa
National Category
Medical and Health Sciences
Research subject
urn:nbn:se:uu:diva-133199 (URN)978-91-554-7939-8 (ISBN)
Public defence
2010-12-15, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 13:15 (English)
Available from: 2010-11-24 Created: 2010-11-02 Last updated: 2011-01-13Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed
By organisation
Department of Women's and Children's Health
In the same journal
Journal of Human Lactation
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 171 hits
ReferencesLink to record
Permanent link

Direct link