BACKGROUND: Prior to 2010, the World Health Organization recommended that HIV-positive mothers exclusively breastfeed for the first 6 months of life unless replacement feeding was acceptable, feasible, affordable, sustainable, and safe. Community pressure to practice mixed feeding, lack of knowledge on safe feeding, and shame regarding HIV status discourage mothers from breastfeeding exclusively and contribute to South Africa's low exclusive breastfeeding prevalence of 7% for infants under 6 months. OBJECTIVE: This pilot study explored the feasibility of implementing a feeding buddy system to provide a mother with support to achieve her infant feeding goal. METHODS: A convenience sample of 14 HIV-positive mothers and their buddies was recruited from the Butterworth Gateway Clinic in South Africa. HIV-positive mothers selected a buddy who accompanied them on clinic visits and counseling sessions on safe infant feeding. The research team conducted in-depth interviews to gather qualitative information on participants' experiences at 3 points in time. RESULTS: Buddy selection was influenced by the mother's relationship to the buddy, trust, and previous disclosure of HIV status. The 3 most cited forms of support were the buddy's accountability, teaching, and help in feeding the infant correctly. CONCLUSIONS: Buddies were successfully integrated into routine Prevention of Maternal-to-Child Transmission visits. Study participants confirmed that having a buddy was a helpful support for HIV-positive mothers.