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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.085704v1 97/7/1249    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Piwoz, E. G. Articles by Ward, B. J. Search for Related Content PubMed PubMed Citation Articles by Piwoz, E. G. Articles by Ward, B. J. Related Collections Global Health Health Promotion HIV/AIDS Nutrition/Food

Ellen G. Piwoz, ScD, Jean H. Humphrey, ScD, Naume V. Tavengwa, MSW, Peter J. Iliff, MRCPCH, Edmore T. Marinda, MSc, Clare D. Zunguza, BSc, Kusum J. Nathoo, FRCP, Kuda Mutasa, BSc, Lawrence H. Moulton, PhD and Brian J. Ward, MD

Ellen G. Piwoz is with the Center for Nutrition, Academy for Educational Development, Washington, DC. Jean H. Humphrey, Naume V. Tavengwa, Peter J. Iliff, and Kuda Mutasa are with the ZVITAMBO Project, Harare, Zimbabwe. Ellen G. Piwoz, Jean H. Humphrey, and Lawrence H. Moulton are with the Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md. Edmore T. Marinda is with the School of Public Health, University of Witswatersrand, Johannesburg, South Africa. Clare D. Zunguza is with the Harare City Health Department, Harare. Kusum J. Nathoo is with the College of Health Sciences, University of Zimbabwe, Harare. Brian J. Ward is with the Montreal General Hospital Research Institute, McGill University, Montreal, Quebec.

Correspondence: Requests for reprints should be sent to Jean Humphrey, ScD, ZVITAMBO Project, #1 Borrowdale Rd, Borrowdale, Harare, Zimbabwe (e-mail: jhumphrey{at}zvitambo.co.zw).

Objectives. We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status.

Methods. Mothers were tested for HIV and were encouraged—but not required—to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission.

Results. Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status.

Conclusions. The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice.