Lactation consultant support for breastfeeding people with HIV: HIV-knowledge, attitudes, stigma, and tele-lactation experiences in the United States and Canada
Bibliographic record
Abstract
Abstract Background As infant feeding guidelines in the United States evolve to include shared decision-making approaches for pregnant and postpartum people with HIV (PP-PWH), lactation consultants (LCs) play an increasingly critical role in providing informed, compassionate support for breastfeeding/chestfeeding. However, limited knowledge and persistent stigma may hinder their preparedness and willingness to support PP-PWH in achieving their feeding goals. Methods We conducted a cross-sectional mixed-methods survey among 207 certified LCs in the United States and Canada. Quantitative data assessed HIV-related knowledge, stigma, and willingness to support breastfeeding in PP-PWH using adapted and validated instruments. Qualitative data from open-ended responses were thematically analyzed using the Health Stigma and Discrimination Framework. Results Participants demonstrated high general HIV knowledge (Mean = 9.29/10) but only moderate HIV breastfeeding knowledge (Mean = 10.8/21). Those with recent experience supporting PP-PWH in breastfeeding had significantly higher HIV breastfeeding knowledge (p < 0.001). Stigma levels were generally low, but stigma was significantly associated with more restrictive attitudes toward breastfeeding (p < 0.001). Qualitative findings revealed that LC willingness to support PP-PWH was shaped by perceived risks, personal comfort levels, professional ethics, understanding of transmission prevention, and systemic supports. Many emphasized respect for parental autonomy, nonjudgmental care, and the need for updated education and policy clarity. Conclusion LCs are motivated to support PP-PWH but face knowledge gaps and institutional barriers that must be addressed. Integrating targeted education, stigma reduction strategies, and peer-supported tele-lactation models may enhance LC confidence and improve equitable, person-centered care for families affected by HIV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.009 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".