Results: Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour
change remained. We found that information promoting exclusive breastfeeding may have been understood by
mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than
as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of
breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after
breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of
breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child
transmission of HIV.