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Preventing mother-to-child HIV transmission in South Africa

20th Anniversary of Global Health Fellows and Scholars

Photo of Dr. Joan Matji with a UNICEF banner behind her

Dr. Joan Matji conducted her doctoral research through a joint partnership with Yale University and University of Pretoria, South Africa. She focused on the nutritional status of HIV positive mothers and an assessment of infant feeding practices. She observed that, more often than not, the mothers' needs were neglected by the research.

"I often found that we were not asking, 'How is mum doing? How is she coping with her status? How is she doing nutritionally?" These questions are what motivated Matji's 2005-2006 Fogarty project that investigated associations among postnatal maternal nutritional status, maternal HIV disease progression, and infant feeding practices. Matji's team focused on what was happening to the new mothers after they'd delivered. They explored the influence of each mother's psychosocial well-being on how she fed her child and the health implications of these choices.

At that time in South Africa, the general recommendation for prevention of mother-to-child transmission suggested clinicians assess whether formula feeding was affordable, safe, and sustainable for each mother. Women who did not meet the criteria were advised to breastfeed exclusively, while the government provided free infant formula for mothers living with HIV. "It perpetuated discrimination and stigma around mothers with HIV in the region because everyone knew that, if you had [the government supplied] orange-colored tin or formula, you were HIV positive," said Matji.

To better understand women's childcare choices, she and her team recruited 317 pregnant women with HIV at 28 weeks of pregnancy and a comparative group of about 53 HIV-negative women at the same stage of pregnancy. Most of the pregnant women living with HIV planned to formula-feed basing their choice on the shame around breastfeeding when HIV-positive. But later, after giving birth, they changed their minds due to the societal stigma around formula feeding. Matji's team found that the women living with HIV who ultimately decided to follow through with formula feeding had only done so because they had either been incentivized by free formula or encouraged to do so by their physicians.

The data also showed that about 65% of the mothers were overweight or obese at the end of the study. "This was an interesting finding because, at that time, most people assumed somebody who is HIV positive would be malnourished, even emaciated, but this was not the case among these women." From these findings, Matji and her colleagues began formulating recommendations for holistic interventions to address the stigma around HIV disclosure and infant feeding practices for mothers.

"My training helped me fine-tune the methodologies and approaches that I could use for this research, which was somewhat clinical in nature," said Matji. "It was a great refresher and I also learned new terminologies."

Today, Matji serves as UNICEF's Country Representative to Botswana as part of the United Nations Children Fund. In this role, she manages a staff of 22 focused on developing informed nutritional recommendations and health policies for mothers and children under age 5. The team is developing guidelines to ensure adolescents living with HIV adhere to their treatment regimens and working to prevent violence against children, among many other initiatives. Mostly, their efforts center around providing technical advice to the government, which is responsible for implementing the programs. "Because of my Fogarty training, I feel better positioned to critique research findings presented to the organization," said Matji. "I often ask, 'What are the implications for public policy?'"

In the future, she plans to continue advocating for the mothers and children in Botswana and, one day, to get back into research and academia, potentially as a mentor for up-and-coming researchers. Matji advises those entering Fogarty's LAUNCH program: "Keep an open mind and take advantage of the networking opportunities afforded to you. The bonds I formed in this program and the work I did as part of it were so beneficial to my career."

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Updated March 18, 2024

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