Jamii, social ties and networks: managing HIV and infant feeding in Central Tanzania

In Tanzania where HIV transmission is high, decisions to avoid or modify breastfeeding are crucial for infant survival yet difficult due to competing risks. This thesis explores the attitudes towards HIV and infant feeding of mothers and significant members of their social networks in Central Tanzania. It seeks to understand the perceived and potential role of social dynamics in infant feeding decisions to prevent HIV. Qualitative data was collected from in-depth interviews with twenty key informants, six HIV-positive mothers and four relatives of HIV-infected mothers. Thirteen focus group discussions were conducted in one urban and three village sites in the Dodoma region with mothers, fathers, grandparents, traditional midwives and healers, village leaders and people living with HIV. This process was adapted to benefit and maximise participation of respondents and people with HIV. Data was analysed using grounded theory and natural Swahili language.Cases of HIV-positive mothers and their close networks are used to explore the findings. Social graphs visually map and communicate the complex social context around infant feeding in new ways. Emerging themes based on Swahili categorisations provide original conceptualising of how social relations (jamii) are involved in decision-making. In the context of HIV, infant feeding is a moral issue of fear and safety (salama): decisions seek to maximise kinga (immunity). Social ties wield influence on infant feeding decisions by acting as kinga, and as gates or open paths for the flow of capacities (uwezo) into and within networks. Various kinds of capacities affect perceived possibilities for infant feeding and how social ties are involved. The embracing or rejecting of responsibilities within ties, especially after HIV status disclosure, affects mothers’ networks and choices. Networks of influence are constantly changing: resource availability and social support are dynamic. Original conceptualisations of infant-feeding, risk, trust and disclosure networks and their interaction and change explain these patterns of involvement.Swahili-based conceptualisations are used to explain how social ties manage HIV and infant feeding in complex, dynamic ways. This thesis helps reposition approaches to working with Tanzanian mothers, families and communities to enhance support for mothers’ choices by building on collective capacities and responsibilities