Would you like to breastfeed your child?
T1 (n=21)
“I get frustrated. I don't like to think about it, because I have always dreamt of breastfeeding my baby” (ID 13, para 2)
“It's only now that I'm pregnant and I want to breastfeed that I think about it. If I didn't have this disease then I would breastfeed my kids but now it's impossible” (ID 3, nulliparous)
“Of course, I would like to breastfeed. But if I don't have the opportunity, it is okay.” (ID 20, para 2)
T3 (n=17)
“In the beginning, I thought that I would really like to breastfeed, but now I have just accepted it. Also, I can see that the baby is so fat and doing fine” (ID 21, nulliparous)
“I accepted that I wasn't going to breastfeed before I delivered. So, after I gave birth it was okay. It was just normal; I just gave her the bottle and it was fine”. (ID 11, nulliparous) Would you like to breastfeed your child?
T1 (n=10)
“It wasn't a surprise to me, but it's definitely something that has been the biggest part of HIV and pregnancy for me…not being able to… even to try to breastfeed.” (ID 2, para 2)
“I wish that I could breastfeed, that everything was normal…but that is just not the situation.” (ID 19, para 2)
“I am losing something by not being able to breastfeed…I would like to breastfeed. But obviously it is not an option.” (ID 31, nulliparous)
T3 (n=9)
“I've gotten used to it. And it's not that relevant anymore. I think it was a bigger issue just after the delivery, I thought about it quite a lot and felt sad, but it's normal now.” (ID 31, nulliparous)
“I felt guilty for not breastfeeding. It made me very sad in the beginning.” (ID 19, para 2) The QUAL data EXPAND on the QUAN data, highlighting that most women would like to breastfeed and that although there is a high acceptance of not being able to breastfeed while living with HIV, breastfeeding avoidance is an emotional burden and a reminder of HIV. Not being able to breastfeed gets easier over time.

The QUAL data COMPLEMENT the QUAN data. Not breastfeeding is experienced as a loss, not only because of the health and bonding benefits of breastfeeding but also for their own experience as a woman/mother. Over time this became less important as the women focused on the benefits of bottle feeding.

What are your reasons for wanting to breastfeed*?

*Only women who responded that they would like to BF while living with HIV. Multiple responses possible. T1 (n=21)
“I feel bad, because I think breastfeeding creates a bond with the baby, and I feel like something is lost. I know there are other ways of bonding, but breastfeeding is really a big part of it. (ID 5, para 2)
“They say I am not supposed to breastfeed, but I would have liked to breastfeed, to have that bonding with the baby. Also, they say breast milk is good for their immune system” (ID 9, nulliparous)
“Someone like me, who has been hiding this from everybody…. this baby…there is an exposure. To give the bottle when everybody is giving breast…Not only do you feel guilty. You feel that they are judging you” (ID 28, para 2)
T3 (n=17)
“At the end of it all, I realize…it's not such a big deal. I was sad before I had the baby. I was very sad …at some point, I just accepted the situation”. (ID 22, nulliparous)
“I want to experience it. To feel like a real woman, a real mother. It is important to me” (ID 1, para 4)
“If you are African and not breastfeeding, it is because of HIV” (ID 13, para 2) What are your reasons for wanting to breastfeed*?

*Only women who responded that they would like to BF while living with HIV. Multiple responses possible. T1 (n=10)
“It feels like people think that… if you're going to be the best mom you must breastfeed… I think it's ridiculous. I don't agree with that, it's just that for my own personal experience I would have loved to try it” (ID 2, para 2)
“I felt like something was taken away from me….that bonding with your child” (ID 30, para 2)
“I really want to try for the sake of the baby, but also…that motherly experience and bonding” (ID 24, nulliparous)
T3 (n=9)
“For my own sake…I would really have wanted to breastfeed. But this time, I have had a lot of positive experience… it's so easy to just give the bottle. it's very flexible” (ID 2, para 2)
“If I could I probably would have breastfed. Mostly for the baby's sake. But I have tried to turn it around. Now the dad can help and there is a lot of good formula available”. (ID 25, nulliparous)
“It was hard that I couldn't breastfeed because I hear that you have a very special bond with the child” (ID 23, nulliparous) What are your reasons for not wanting to breastfeed*?

*Only women who responded that they would not like BF while living with HIV. Multiple responses possible. T1 (n=20)
“I know the baby will be fine. Rather than doing it and then you don't know what will happen. What if you infect the baby?” (ID 27, para 3)
“I know breastfeeding is good, but in my case…I don't want to put my baby in danger. So, I will not do it. I have accepted it and I'm ready for it”. (ID 12, nulliparous)
“I feel like it gives me more freedom, that I am not going to breastfeed. That someone else can take over and give the bottle. So maybe I get to be myself sometimes.” (ID 8, nulliparous)
T3 (n=17)
“Now the baby is 7 months and doing well, so I'm like babies can do well without being breastfed.” (ID 11, nulliparous)
“You simply cannot breastfeed when living with HIV” (ID 13, para 2)
“It was much easier even from the start because then I didn't have to do all the work. Anybody could feed the baby” (ID 22, nulliparous) What are your reasons for not wanting to breastfeed*?

*Only women who responded that they would not like to BF while living with HIV. Multiple responses possible. T1 (n=10)
“It is annoying…but I haven't had any desire to try when you cannot be 100% sure that there is no risk of transmission” (ID 30, para 2)
“If they had told me that there was an opportunity…because the risk is very small, I still don't think that I would breastfeed”. (ID 7, nulliparous)
“It would be best, but I think it is okay for me not to breastfeed. There are a lot of benefits to bottle feeding.” (ID 25, nulliparous)
T3 (n=9)
“It has been a little easier with the bottle. Anyone could help.” (ID 24, nulliparous)
“If I had another child, I don't think that I would breastfeed. I have been very happy with the bottle. It is so easy” (ID 7, nulliparous)
“If I was to become pregnant again would I want to take the risk? Probably not. There would be this little fear, even if I am well treated” (ID 19, para 2) There is CONCORDANCE between the QUAN and QUAL data, showing that the risk of transmission is the main reason for not wanting to breastfeed, but also trying to focus on the benefits of formula feeding. Meta-inferences: The QUAL data EXPAND the QUAN data, highlighting that most women living with HIV of non-Nordic origin would like to breastfeed, but that over time not breastfeeding is less of an issue. The women also highlight the stigma associated with not breastfeeding, especially in the African culture. Meta-inferences: The QUAL data EXPAND on the QUAN data, highlighting that although most women living with HIV of Nordic origin would have liked to breastfeed, this is simply not an option when living with HIV, focusing on the benefits of bottle feeding. Both groups would like to breastfeed; there is a higher acceptance among women of Nordic origin and more stigma associated with not breastfeeding among women of non-Nordic origin.