Paper long abstract:

International guidelines have been developed by the World Health Organisation (WHO) and other international organisations for women who wish to breastfeed and are HIV positive. These guidelines and their recommendations are directed at national and local health planners and health professionals in low-income countries. They draw on quality-graded evidence to calculate the relative risks of breastfeeding and its alternatives for women in these countries. Consideration is given in the most recent WHO (2009) guidelines to 'cultures' and context, but these considerations lose their meaningfulness against the implicit and stark socio-political injustices underpinning the recommendations (for example, continued limited access to anti retro viral medication). The evolution of the content and the language of these guidelines, will be explored. In particular, the cultural issues embedded in breastfeeding practices, HIV testing and disclosure of HIV status will be highlighted. This paper will also draw on my experiences and reflections from working within a global health networking project, currently taking place with partners in Malawi.