Ndhiwa — Milka*, a 25-year-old HIV-positive mother-of-three, knew through prenatal visits to her local clinic in Ndhiwa District, western Kenya, that feeding her newborn daughter only with breast milk would increase the infant's chances of staying free of HIV.
For HIV-positive mothers, exclusive breastfeeding can lower the risk of HIV transmission to their infants three to four fold compared to mixed feeding, because, according to UNICEF, other liquids and foods given to the baby alongside the breast milk are thought to damage the already delicate and permeable gut wall of the small infant and allow the virus to be transmitted more easily.
But for most mothers pressure from relatives to introduce other foods before the baby reaches six months make this a delicate balancing act.
Milka told IRIN/PlusNews her story:
"Both my husband and I never knew I was HIV-positive until when I got pregnant and went to the clinic.
"When I got tested, as part of what the nurse had told me is mandatory for all mothers, she, after counselling me, revealed my status to me and that is how I knew I was positive.
"I was worried about my pregnancy but I was convinced by the nurse that I would give birth to a negative baby if I kept on going to the clinic and following their advice.
"When I gave birth, the nurse told me to choose between formula and breast milk as a way of feeding my baby and I chose breastfeeding because I knew I would not afford formula foods.
"When my baby got to three months, my husband, who hadn't known my status, and even some of my friends started saying the baby could now take porridge to grow up strong.
"That is where my problems started because I didn't know what to tell them. I kept on refusing their advice but all I was telling them was that I will do it [introduce porridge] later. The pressure kept on.
"I almost started giving other foods just to get the burden off me.
"Finally, I decided to tell my husband the reason I wasn't ready to give our child porridge. When I told him, he ran away from home and only came back after one week. We had a fight, but at last when we went to hospital and he also tested positive, he became very supportive.
"I couldn't keep the guilt of hiding my HIV status. I think making my husband know my HIV status was a good thing. It saved him, it saved our baby.
"At times, you have to let go hiding your HIV status and save your child.
"Now the pressure from relatives and neighbours don't bother me. I just feel I am relieved. It is not what they think, but what I chose to do that will affect my child in a good or bad way."
*not a real name