Psychosocial distress and associated factors among pneumoconiosis patients: a cross-sectional study.

Since the start of the global HIV epidemic in the 1980s, nearly 10 million cases of perinatal HIV transmission have occurred globally (), and about 3,000 people living with HIV (PLWH) give birth each year (, ). Before antiretroviral therapy (ART) was available, the rate of HIV transmission through breastfeeding/chestfeeding during the first two years of life was approximately 16% (, ). Preventive measures, including universal HIV screening and increased ART use during pregnancy, have effectively reduced perinatal HIV transmission. More recent research shows that the perinatal HIV transmission rate with breastfeeding/chestfeeding in the United States has fallen to less than 1%, with fewer than 150 cases reported annually since 2013 (, , ). This update also reflects a shift toward patient-centered counseling and shared decision-making in HIV care. Prior to 2023, breastfeeding/chestfeeding was generally considered contraindicated for birthing people living with HIV (BPLWH) in the United States, with organizations such as the Department of Health and Human Services (DHHS), the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC) advising against this feeding method (–). Instead, formula feeding was strongly recommended as a safer alternative to breastfeeding/chestfeeding because it eliminated the risk of vertical transmission of HIV through breastfeeding/chestfeeding and was considered relatively accessible and affordable in a U.S. context (, ). In contrast, breastfeeding/chestfeeding has been recommended for BPLWH in many African regions due to limited access to clean water, the high cost of formula milk, and the fact that chestfeeding/breastfeeding improves morbidity and mortality rates, making it a more viable option in resource-constrained settings (, ). However, in January 2023 DHHS updated the U.S. national guidelines, titled this update encouraged shared decision-making about infant feeding, including support for considering breastfeeding/chestfeeding for BPLWH who have sustained an undetectable viral load (). The recommendations also highlighted how to manage cases of detectable viral load during breastfeeding/chestfeeding and offering additional avenues for support for BPLWH and their infants (). This change aimed to recognize the benefits of breastfeeding/chestfeeding and the importance of individual choice, cultural considerations, and equity through the shared decision-making process between patients and healthcare workers (HCWs). Despite this policy change, breastfeeding/chestfeeding guidelines are not always understood or consistently followed across clinical settings. Sociocultural, clinical, and logistical barriers contribute to disparities in care and leave both HCWs and patients uncertain about decision-making practices (). For BPLWH, these challenges are compounded by stigma, bias, and unequal power dynamics among HCWs (). Addressing these gaps in guideline implementation is therefore critical; therefore, to understand how breastfeeding/chestfeeding guidelines are adopted and sustained in practice, we must first identify the factors that shape their integration into clinical settings. This study aims to begin addressing these gaps in guideline implementation by understanding how HCWs interpret, engage with, and apply updated national guidelines; this knowledge can inform targeted strategies to overcome barriers and support consistent implementation.