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Disclosure of HIV status in infants is a special case which does not correspond to general recommendations for counseling as defined for adults, and few norms exist. Whereas preventing mother to child transmission (PMTCT) programs should result in 700,000 annual disclosures regarding infants born to HIV-positive mothers in Africa, the actual figures are much lower and the conditions for disclosure implementation and its social dimensions in the field are not precisely documented. The aims of this article are to describe and analyze the experience of HIV status disclosure for infants and children on the basis of interviews held with mothers and PMTCT teams in Burkina Faso. The method was based on repeated interviews with 37 mothers and with health workers. Their discourses show the complexity of disclosure in a context characterized by uncertainty. They show delays due to difficulties in venipuncture and in methods for laboratory diagnosis and information management in health services. HIV disclosure is implemented by PMTCT physicians and also other professionals, sometimes in other services. The mother plays a key role, sometimes by requesting disclosure; the father is generally informed only secondarily, in spite of his legal responsibility for the child. Interactions analysis reveals some ambiguities of disclosure, regarding information that doctors keep secret, reciprocal expectations of communication between doctors and mothers, mothers' interpretation of apparent signs regarding their child's health, and uncertain information being given. The information often contains guilt-inducing elements for mothers; communication about follow-up does not reduce this effect. These results encourage the elaboration of a model for specific counseling that should provide mothers with general information, and personalized interaction and support that they need in order to receive and manage disclosure of their child's HIV status.

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.