Breastfeeding support for women with HIV: lactation consultant HIV-knowledge, attitudes, stigma, and tele-lactation...

To characterize lactation consultants' (LCs) HIV-related knowledge, attitudes, stigma, and tele-lactation experience relevant to supporting pregnant and postpartum people with HIV (PP-PWH).

Cross-sectional mixed-methods study of lactation consultants.

We conducted a mixed-methods survey of certified LCs in the United States and Canada. Quantitative measures assessed general HIV knowledge, HIV breastfeeding-specific knowledge, attitudes toward breastfeeding among PP-PWH, HIV-related stigma, and tele-lactation experience using validated instruments. Multivariable regression models examined associations between provider characteristics, knowledge, stigma, and attitudes. Qualitative free-text responses were analyzed thematically using the Health Stigma and Discrimination Framework, with findings integrated to contextualize quantitative results.

The sample included 207 internationally certified LCs, most of whom reported no or limited clinical experience supporting PP-PWH. General HIV knowledge was high, while HIV-specific breastfeeding knowledge was moderate. Higher HIV-specific knowledge was independently associated with prior experience supporting PP-PWH and awareness of updated infant-feeding recommendations, whereas years in practice and general HIV knowledge were not. HIV-related stigma levels were generally low; lower stigma was associated with greater support for patient autonomy but more cautious endorsement of breastfeeding in high-resource settings. Tele-lactation experience was common. Qualitative findings emphasized strong support for patient autonomy and nonjudgmental, informed counseling, alongside high willingness to learn and engage in additional training to better support PP-PWH.

LCs are motivated to support PP-PWH but face HIV-specific knowledge gaps and structural challenges shaping preparedness and counseling practices. Targeted education, clear guidance, and integration of tele-lactation within HIV care systems may strengthen equitable, person-centered lactation support.