Sociocultural factors influencing infant-feeding choices among African immigrant women living with HIV: A synthesis of the literature Josephine Etowa, PhD, RN, RM, FWACN (Full Professor of Nursing) 1 , Shannan MacDonald, PhDc (Assistant Professor of Nursing) 1 , Jean Hannan, ARNP, PhD (Associate Professor of Nursing) 2 , J. Craig Phillips, LLM, PhD, RN, ARNP, ACRN, FAAN (Associate Professor of Nursing) 1 , Nana Yaa Boadu, PhD (Faculty) 1 , & Seye Babatunde, MD (Medical Doctor) 3 ABSTRACT Background and purpose: The World Health Organizations (WHO) strategy is to eliminate pediatric HIV. HIV pre- vention guidelines in high-income countries recommend mothers living with HIV avoid breastfeeding. Yet, breast- feeding is promoted as the normal and unequalled method of feeding infants. This creates a paradox for mothers coming from cultures where breastfeeding is an expectation and formula feeding suggests illness. Therefore, the purpose of this literature review is to examine the context influencing infant feeding among African immigrant women living with HIV to develop interventions to reduce the risk of HIV mother-to-child transmission. Methods: Using the PEN-3 cultural model as a guide, we selected 45 empirical studies between 2001 and 2016 using 5 electronic databases on the sociocultural factors influencing infant-feeding choices and practices among African women from HIV endemic countries. Conclusions: Findings are congruent with the importance of culture when developing guidelines. Our review provides support that culture-centered interventions are crucial toward achieving the WHO’s strategy to eliminate pediatric HIV. Implications for practice: Understanding the sociocultural determinants of infant-feeding choices is critical to the development of prevention initiatives to eliminate pediatric HIV. Keywords: African Canadian immigrant women; HIV; infant feeding; PEN-3 cultural model; PMTCT; sociocultural determinants. Journal of the American Association of Nurse Practitioners 30 (2018) 208–235, © 2018 American Association of Nurse Practitioners DOI# 10.1097/JXX.0000000000000014 HIV infection among women of childbearing age and mother-to-child transmission (MTCT) of HIV remain major global health issues. Globally, 36.7 million (34.0 million–39.8 million) persons are living with HIV, half of whom are women of childbearing age (United Nations AIDS [UNAIDS], 2016a). It is estimated that 1700 infants become infected with HIV daily, 91% of whom have acquired HIV through MTCT during pregnancy, childbirth, or breast- feeding (Avert, 2015; Morgan, Masaba, Nyikuri, & Thomas, 2010; World Health Organization [WHO], 2015). In the ab- sence of interventions, the probability of MTCT of HIV among infants is estimated to be 5%–10% during preg- nancy, 10%–15% during labor, and 15%–20% during pro- longed breastfeeding (De Cock et al., 2000; United Nations Children’s Emergency Fund [UNICEF], 2016; WHO, UNICEF, & UNAIDS, 2013). Consequently, breastfeeding may be re- sponsible for one-third to one-half of HIV infections in settings where interventions are not available. Recognizing that mothers are the main source of pe- diatric HIV infection, global stakeholders have called for the increased prevention of mother-to-child trans- mission (PMTCT) of HIV over recent years (WHO, UNICEF, UNFPA, & UNAIDS, 2007, 2008; Horvath et al., 2009; 1 Department of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada, 2 Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida, 3 Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria Correspondence: Jean Hannan, ARNP, PhD, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, Miami, FL 33199. Tel: 305-348-0227; E-mail: jhann001@ fiu.edu Submitted: 28 June 2017; revised: 3 November 2017; accepted: 28 November 2017 208 April 2018 · Volume 30 · Number 4 Journal of the American Association of Nurse Practitioners Review - Systematic Ó 2018 American Association of Nurse Practitioners. Unauthorized reproduction of this article is prohibited.