This article assesses the infant feeding components of prevention of mother-to-child HIV transmission (PMTCT) programs in Botswana, Kenya, Malawi, and Uganda. The study found that infant feeding counseling was infrequently discussed in any depth, and often rated poor when it was. National HIV managers are unsure about the infant feeding policy in the context of HIV, and there is an almost universal belief that an HIV positive mother will always infect the child via breastfeeding. The authors conclude that there is a need to scale up PTMTC programs and infant feeding policies.