Exclusively breastfed infants in developing countries are at lower risk of HIV transmission than mixed-fed infants. Ethno-graphic research was conducted in eleven low-resource settings across South Africa, Namibia and Swaziland to understand how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling. Despite prevention of mother-to-child transmission (PMTCT) programmes, very early mixed-feeding remains the norm; traditional conceptualisations of 'water as life' and 'milk as a fluid' are holding up against current PMTCT education, with milk considered liquid 'drink' rather than 'real food'. This aggravates an 'insufficient milk syndrome' where disempowered mothers perceive their breastmilk, and themselves, as deficient - 'not good enough'. Infant feeding is embedded within traditional relationships of intimacy; both relatives and breadwinner have influence and even authority over options and modes of infant feeding. In patriarchal and violent societies, traditional power differentials prohibit easy or complete HIV disclosure or condom negotiation; HIV status remains hidden from most partners and relatives. This context of secrecy means that the traditional advice and authority, which the mothers feel they dare not disregard, is often blind to the mother and her infant's HIV status and survival needs.

Ethnographic research was conducted in eleven low-resource settings across Swaziland, Namibia and South Africa to explore how the perceptions and experiences of counselling health workers, pregnant women and recent mothers could be used to improve infant feeding counselling in the context of mother to child transmission (MTCT) of HIV. We found many counselling encounters to be demotivating. Mothers often reported feeling judged, stigmatised and shamed. Counsellors complained of mothers' poor compliance and passive resistance and reported suffering from stress, depression and burnout. We observed a rift between the mothers and counselling nurses, with both parties holding opposing agendas grounded in conflicting realities, expectations, experiences and needs. While the clients framed the visit as a consultation, counsellors framed it as health education, towards one exclusive purpose; to save the baby. Two communication modes prevailed in the counselling encounter: in theory, the counselling format was non-directive and client-centred but, in practice, most encounters reverted to information-based health education. Neither counselling format enabled the counsellors to acknowledge the reality of the two opposing agendas in the conversation and manage its dynamics. In order to achieve success - which, for the health service, is framed as persuading mothers to test for HIV and disclose the result - counsellors often felt compelled to be prescriptive and authoritative and reverted at times to confronting, judging and shaming mothers. Yet to adhere to their feeding choice consistently, mothers need to be motivated towards the significant behaviour change that this implies: to change their traditional roles and identities as women. For infant feeding counselling in the context of HIV/AIDS to become effective in southern Africa, a different format is therefore required; one that can acknowledge and manage these opposing agendas and conflicting realities and also enable counsellors to motivate mothers to make significant behaviour change.

This article explains a conceptual tool that was used in the Gender Research in Africa and the Middle East into ICT for Empowerment (GRACE) Network, to map journeys of personal and social change toward a self-determined purpose of transformation. Named the Personal Trajectory Map, it was initially intended as a self-management tool for the GRACE members to help clarify thinking, manage emotions and stay focused on project purposes, but its use got extended over time. This article is a moment in the ongoing theorization of this conceptual tool and the approach it was an intricate part of. Its usefulness can be theoretically explained through the interlinkages between the concepts of agency, intent, conation, and the capacity to aspire. Illustrating how it was used in some of the participatory action research processes, this article argues that it is worthwhile to open the black box of the female-self-in-transformation since it will clarify for female participants as well as for their researchers, what they are up against when they want to empower themselves in a male dominated world. Furthermore, offering women a deeper understanding and more guidance in their processes of personal and social change, will not only support female participants, it will enhance research quality and the chances for project success.

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