Exploring the complexities of infant feeding decisions for immigrant pregnant people living with HIV in Ontario, Canada: a qualitative study

North American societies recommend that Pregnant People Living with Human Immunodeficiency Virus (PLWHIV) use formula to feed their infants to eliminate the risk of perinatal HIV transmission. However, many Canadian PLWHIV have migrated from HIV-endemic countries, where the World Health Organization recommends exclusive breastfeeding. These opposing recommendations, along with the complex interplay of social, cultural, and personal factors, create tension when making decisions regarding infant feeding. This study describes the experiences of PLWHIV in making decisions to inform healthcare providers and enhance guidelines for the use of breast milk. In-depth interviews were conducted with patients (<i>n</i> = 10) from a tertiary hospital in Toronto, Ontario. All participants were immigrants to Canada, with the majority (<i>n</i> = 8) self-identifying as African or Caribbean. Regarding their most recent pregnancy, 6 exclusively formula-fed, three exclusively used breast milk, and one used a combination of both feeding methods. The thematic analysis revealed four key themes: values and facilitators in the decision-making process, challenges experienced with infant feeding choices, reflections on these decisions, and recommendations for enhanced care. The findings highlight the need for socially and culturally inclusive evidence-based counseling, a safe environment, multidisciplinary care, and access to information that supports the best possible outcomes for both mothers and babies through informed decision-making.