In resource-limited settings, exclusive breastfeeding among HIV-infected mothers reduces infant
morbidity and mortality from all causes, including HIV. Although breastfeeding by HIVinfected
mothers carries a risk of HIV transmission from mother-to-child, that risk decreases
from 45% to less than 5% with the practice of exclusive breastfeeding and appropriate
antiretroviral therapy. The World Health Organization recommends women living with HIV
exclusively breastfeed for the first 6 months of their infants life in recourse-limited settings.
However, exclusive breastfeeding rates remain low. This dissertation highlights infant feeding
experiences among HIV-infected women in recourse-limited settings and investigates a pilot
intervention promoting exclusive breastfeeding in South Africa. Three distinct projects were
conducted in completion of the dissertation and include, 1) a metasynthesis exploring HIVinfected
women’s infant feeding experience, 2) a review of existing breastfeeding self-efficacy
instruments, and 3) an original study testing an Information-Motivation- and Behavioral skillsmodel
based pilot intervention promoting exclusive breastfeeding among HIV-infected women
in South Africa. Together, these three studies provide an in-depth understanding of determinants
impacting HIV-infected women’s ability to execute exclusive breastfeeding behavior and an
innovative approach to support its practice. The overarching aim of this dissertation is to
investigate innovative and practical approaches to support HIV-infected women exclusively
breastfeeding behavior and increase understanding of both barriers and strategies that inhibit or
enhance its practice.