AIDS (London, England) · 2026
Breastfeeding support for women with HIV: lactation consultant HIV-knowledge, attitudes, stigma, and tele-lactation experiences.
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Barr Emily Anne, Abuogi Lisa, Lingwall Mary, Qian Qian, Anthony Leah, Vennekotter Joanna, Lowenthal Elizabeth D, Wu Hulin, Zhang Tianheng, Tsusaki Rebecca, McKinney Jennifer R
Аннотация
OBJECTIVES: To characterize lactation consultants' (LCs) HIV-related knowledge, attitudes, stigma, and tele-lactation experience relevant to supporting pregnant and postpartum people with HIV (PP-PWH).
DESIGN: Cross-sectional mixed-methods study of lactation consultants.
METHODS: We conducted a mixed-methods survey of certified LCs in the United States and Canada. Quantitative measures assessed general HIV knowledge, HIV breastfeeding-specific knowledge, attitudes toward breastfeeding among PP-PWH, HIV-related stigma, and tele-lactation experience using validated instruments. Multivariable regression models examined associations between provider characteristics, knowledge, stigma, and attitudes. Qualitative free-text responses were analyzed thematically using the Health Stigma and Discrimination Framework, with findings integrated to contextualize quantitative results.
RESULTS: The sample included 207 internationally certified LCs, most of whom reported no or limited clinical experience supporting PP-PWH. General HIV knowledge was high, while HIV-specific breastfeeding knowledge was moderate. Higher HIV-specific knowledge was independently associated with prior experience supporting PP-PWH and awareness of updated infant-feeding recommendations, whereas years in practice and general HIV knowledge were not. HIV-related stigma levels were generally low; lower stigma was associated with greater support for patient autonomy but more cautious endorsement of breastfeeding in high-resource settings. Tele-lactation experience was common. Qualitative findings emphasized strong support for patient autonomy and nonjudgmental, informed counseling, alongside high willingness to learn and engage in additional training to better support PP-PWH.
CONCLUSIONS: LCs are motivated to support PP-PWH but face HIV-specific knowledge gaps and structural challenges shaping preparedness and counseling practices. Targeted education, clear guidance, and integration of tele-lactation within HIV care systems may strengthen equitable, person-centered lactation support.
DESIGN: Cross-sectional mixed-methods study of lactation consultants.
METHODS: We conducted a mixed-methods survey of certified LCs in the United States and Canada. Quantitative measures assessed general HIV knowledge, HIV breastfeeding-specific knowledge, attitudes toward breastfeeding among PP-PWH, HIV-related stigma, and tele-lactation experience using validated instruments. Multivariable regression models examined associations between provider characteristics, knowledge, stigma, and attitudes. Qualitative free-text responses were analyzed thematically using the Health Stigma and Discrimination Framework, with findings integrated to contextualize quantitative results.
RESULTS: The sample included 207 internationally certified LCs, most of whom reported no or limited clinical experience supporting PP-PWH. General HIV knowledge was high, while HIV-specific breastfeeding knowledge was moderate. Higher HIV-specific knowledge was independently associated with prior experience supporting PP-PWH and awareness of updated infant-feeding recommendations, whereas years in practice and general HIV knowledge were not. HIV-related stigma levels were generally low; lower stigma was associated with greater support for patient autonomy but more cautious endorsement of breastfeeding in high-resource settings. Tele-lactation experience was common. Qualitative findings emphasized strong support for patient autonomy and nonjudgmental, informed counseling, alongside high willingness to learn and engage in additional training to better support PP-PWH.
CONCLUSIONS: LCs are motivated to support PP-PWH but face HIV-specific knowledge gaps and structural challenges shaping preparedness and counseling practices. Targeted education, clear guidance, and integration of tele-lactation within HIV care systems may strengthen equitable, person-centered lactation support.