Barriers in the implementation of home-based peer counselling to promote exclusive breastfeeding (EBF) among HIV positive women in the rural Malawi

Background
The use of home-based peer counselling has widely
resulted in significant increase in the rate of EBF in both developed and developing countries. Unfortunately barriers to implementation of interventions rarely prioritized the needs of HIV positive women
during the design and conduct of the interventions even in countries with high rates of HIV among pregnant women.

Method
We conducted qualitative in-depth interviews between January to August 2012 targeting HIV positive women, peer counsellors and health professionals who were directly involved in the community based intervention conducted by MaiMwana Project in the rural Malawi between 2005 to 2010. A total of 39 respondents were purposively selected and interviewed once using a pre-designed interview guide.

Results
Lack of time because of household chores and farming, poverty, transportation and non-disclosure of HIV status were seen as main barriers to effectively visit and counsel women in their homes. In fact the presence of other family members during the visit and fear of stigma made many HIV positive women not to disclose their HIV status to the counsellors which made it difficult for the counsellors to effectively counsel the woman. The needs of HIV positive women need to be considered when developing these community based interventions.