This project used ethnographic methods to explore in-depth the experiences of HIV-positive mothers and their infants, providing a full and careful description of the political, social, economic, cultural and moral context that affects the quality of their lives. The project aimed to inform policy and interventions made on behalf of such HIV-positive mothers and their infants.

South Africa’s high infant mortality rate is driven in part by the high rate of vertical transmission of HIV to children – an estimated 19% - 36% of children are born HIV positive. However, an understanding of infant health and survival in the presence of HIV and poverty is undermined by the lack of detailed analysis of HIV-infected women’s experiences of pregnancy and birth, and of the everyday experiences of infants born to HIV-positive mothers during the first year of life.

This research set out to address this gap, with the aim to deepen understanding of the intersections and disconnections between mothers’ and infants’ everyday lives, and the policies and services aimed at supporting and protecting them.

Ten HIV-positive women from a Cape Town township were recruited as participants. Using a range of ethnographic methods, the project tracked the women, their infants and other family members and caregivers from the first booking at an antenatal clinic, through birth, and until infants turned one year old.

Fieldwork concluded in 2010 and analyses of infant feeding practice and decision-making, HIV disclosure and fathers' involvement in prevention of mother-to-child transmission treatment were completed. 

The findings have suggested that improving adherence to exclusive feeding requires attending to this complex and dynamic interaction of social, psychological, cultural and economic factors through ongoing assessment and support. Promoting feeding practices that are beneficial regardless of HIV status, such as exclusive breastfeeding for six months and delaying the introduction of solid foods, among the general population would also help to mitigate the often unpredictable influence of others, especially important in the absence of disclosure or maternal acceptance of HIV status. The findings also suggested that new feeding guidelines that propose advocating for the single feeding option of exclusive breastfeeding with antiretroviral treatment may compromise infant HIV-free survival in new ways.

This project was funded by the Rockefeller Brothers Fund, Humanities Instituut voor Ontwikkelingssamewerking (HIVOS), and the Medical Research Council.

Further reading

Infant feeding in the context of HIV: Exploring practice and decision-making
Moses S 2012 
Unpublished honours thesis, Department of Psychology, University of Cape Town.

The fluidity of disclosure: A longitudinal exploration of women’s experience and understanding of HIV disclosure in the context of pregnancy and early motherhood.
Moses S 2011
Unpublished masters thesis, Department of Psychology, University of Stellenbosch.

Infants and HIV/AIDS in South Africa: The fragility of life
Moses S 2009
In: Child Rights in Focus, Issue 8, April 2009.