Although recent policies have sought to increase the rates of exclusive breastfeeding (EBF) and continued breastfeeding for HIV exposed infants, few programs have considered the multiple social and cultural barriers to the practice. Therefore, to generate evidence for exclusive and continued breastfeeding policies in Kenya, we examined community perspectives on the facilitators and barriers in adherence to EBF for the HIV positive mothers. Qualitative research was conducted in Koibatek, a sub-County in Baringo County Kenya, in August 2014 among 205 respondents. A total of 14 focus group discussions (n = 177), 14 In-depth Interviews and 16 key informant interviews were conducted. Transcribed data was analyzed thematically. NVivo version 10.0 computer qualitative software program was used to manage and facilitate the analysis. Facilitators to exclusive breastfeeding were perceived to include counselling at the health facility, desire to have a healthy baby, use of antiretroviral drugs and health benefits associated with breastmilk. Barriers to EBF included poor dissemination of policies, knowledge gap, misinterpretation of EBF, inadequate counselling, attitude of mother and health workers due to fear of vertical HIV transmission, stigma related to misconception and misinformation that EBF is only compulsory for HIV positive mothers, stigma related to HIV and disclosure, social pressure, lack of male involvement, cultural practices and traditions, employment, food insecurity. There are multiple facilitators and barriers of optimal breastfeeding that needs a holistic approach to interventions aimed at achieving elimination of mother to child transmission. Extension of infant feeding support in the context of HIV to the community while building on existing interventions such as the Baby Friendly Community Initiative is key to providing confidential support services for the additional needs faced by HIV positive mothers.

中文翻译：

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HIV 背景下母乳喂养政策的现实和挑战：关于社区对肯尼亚巴林戈县 HIV 阳性母亲母乳喂养相关促进因素和障碍的看法的定性研究

尽管最近的政策试图提高 HIV 暴露婴儿的纯母乳喂养 (EBF) 和继续母乳喂养率，但很少有计划考虑到这种做法的多重社会和文化障碍。因此，为了为肯尼亚的纯母乳喂养和持续母乳喂养政策提供证据，我们研究了社区对 HIV 阳性母亲坚持母乳喂养的促进因素和障碍的看法。2014 年 8 月在肯尼亚巴林戈县的一个子县 Koibatek 对 205 名受访者进行了定性研究。共进行了 14 次焦点小组讨论（n = 177）、14 次深度访谈和 16 次关键知情人访谈。对转录的数据进行了专题分析。NVivo 10.0 版计算机定性软件程序用于管理和促进分析。人们认为纯母乳喂养的促进者包括在卫生机构提供咨询、希望拥有一个健康的婴儿、使用抗逆转录病毒药物以及与母乳相关的健康益处。EBF 的障碍包括政策传播不力、知识差距、对 EBF 的误解、咨询不足、母亲和卫生工作者因害怕 HIV 垂直传播而产生的态度、与误解相关的污名以及错误信息认为 EBF 仅对 HIV 阳性母亲是强制性的、污名化与艾滋病毒和披露、社会压力、缺乏男性参与、文化习俗和传统、就业、粮食不安全有关。最佳母乳喂养有多种促进因素和障碍，需要采取整体方法进行干预，以消除母婴传播。