Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A Scoping Review of counselling, socioeconomic and cultural factors

The World Health Organization (WHO) recommends exclusive breast-feeding (EBF) for HIV exposed infants for six months; this is considered best practice for reducing mother-to-child transmission of HIV in the postpartum period. This is a scoping review of the barriers affecting women's decision-making and choice to sustain the practice of EBF in sub-Saharan Africa (SSA). An online literature search via PubMed, Science Direct, Google Scholar, WHO and Joint United Nations Programme on HIV and AIDS (UNAIDS) websites identified research studies and reports that explored socio-economic, cultural and infant feeding counselling-related barriers to EBF among HIV-positive mothers in SSA. A total of 341 relevant articles were identified only 35 (23 qualitative, 3 quantitative and 9 mixed methods) met the inclusion criteria. Findings reveal that key barriers to choice and sustained practice of EBF are healthcare workers’ personal biases, inadequate counselling skills and guideline knowledge, a culture of mixed feeding norms, and maternal lack of decision-making power and fear of vertical transmission. Transmission of HIV programs in countries where major challenges persist should evaluate and address the identified healthcare worker and community-level factors impeding EBF.