Lactation consultant support for breastfeeding people with HIV: HIV-knowledge, attitudes, stigma, and tele-lactation experiences in the United States and Canada

BackgroundAs 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. MethodsWe 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. ResultsParticipants 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. ConclusionLCs 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.