Date of Completion


Embargo Period



Mother-to-child transmission, vertical transmission, breastfeeding, HIV, infant feeding

Major Advisor

Dr. Regina Cusson

Associate Advisor

Dr. Jeffrey Fisher

Associate Advisor

Dr. Jacqueline McGrath

Field of Study



Doctor of Philosophy

Open Access

Open Access


In resource-limited settings, exclusive breastfeeding among HIV-infected mothers reduces infant morbidity and mortality from all causes, including HIV. Although breastfeeding by HIV- infected 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 HIV-infected 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 skills-model 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.