Ellen G. Piwoz ^1*, Jean H. Humphrey ², Naume Tavengwa ³, Peter J. Iliff ³, Edmore T. Marinda ⁴, Clare D. Zunguza ⁵, Kusum J. Nathoo ⁶, Kuda Mutasa ³, Lawrence H. Moulton ², Brian J. Ward ⁷

¹ Academy for Educational Development
² Johns Hopkins Bloomberg School of Public Health
³ ZVITAMBO Project
⁴ School of Public Health, Wits Medical School
⁵ Harare City Health Department
⁶ College of Health Sciences, University of Zimbabwe
⁷ McGill University - Montreal General Hospital Research Institute

^* To whom correspondence should be addressed. E-mail: ellen.piwoz{at}gatesfoundation.org.

	Abstract

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.

Key Words: Global Health, Health Promotion, HIV/AIDS, Nutrition/Food