HIV AND INFANT FEEDING

A FRAMEWORK FOR PRIORITY ACTIONS

Estimated deaths in children (<15 years) from HIV/AIDS during 2001

Total deaths: 580,000 North America < 100 Caribbean 5 000 Latin America 8 000 Western Europe < 100 North Africa & Middle East 6 000 sub-Saharan Africa 500 000 Eastern Europe & Central Asia < 100 South East Asia & Pacific & South-East Asia 40 000 1 500 Australia & New Zealand < 100 New infections: 800,000

Source: UNAIDS, 2001

Timing and risks of HIV transmission

Source: de Cock, JAMA 2000

During pregnancy During labour and delivery During breastfeeding Overall without breastfeeding Overall with breastfeeding till 6 months Overall with breastfeeding till 18 to 24 months

5-10% 10-20% 5-20% 15-30% 25-35% 30-45%

Relative risk of infectious disease mortality among non-breastfed infants 5.8

4.1

2.6

1.8

1.4

1.6

<2

WHO, Lancet 2000

2 to 3 4 to 5 6 to 8 age group (months) 9 to 11 12 to 23

WHO/UNAIDS/UNICEF Guidelines on HIV&IF

•

HIV - or status unknown

Exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for 2 years or beyond

• •

HIV+

When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding is recommended. Otherwise EBF is recommended for the first months of life Access to information, follow up care and support including family planning and nutritional support

CONTEXT

International Goals

UNGASS for Children - reductions of child mortality and malnutrition by at least one third by 2015 UNGASS on HIV/AIDS - reductions in the proportion of HIV infected infants by 20% by 2005 and 50% by 2010

Strategies

UN strategic approach to the prevention of transmission of HIV to infants and young children Global strategy on Infant and Young Child Feeding

Purpose

To propose priority actions to be considered by governments in the context of the special circumstances of HIV/AIDS to ensure an environment that encourages appropriate infant and young child feeding while reducing mother to child transmission of HIV

Audience

National policy-makers, regional advisory bodies, public health authorities, UN staff, professional bodies, NGOs and other interested stake-holders

Priority Action Areas for Governments

• • • •

Develop a comprehensive national IYCF policy, including HIV and Infant Feeding Implement the Code of Marketing

•

Protect, promote and support appropriate IYCF practices in context of HIV Provide support to HIV+ women in their chosen Infant Feeding method Promote research on HIV and Infant Feeding, monitoring and evaluation

Priority Action Areas for Governments Develop a comprehensive national IYCF policy, including HIV and Infant Feeding

• • •

Draft or revise existing policy to reflect current knowledge on appropriate feeding practices in general and in relation to HIV Build consensus among stake-holders Promote consistency with other policies

Priority Action Areas for Governments Implement the Code of Marketing

• • •

Implement the Code at the national level Monitor compliance If the country has decided to provide replacement feeding, establish appropriate supplies/logistics systems and mechanisms in accordance with the Code and subsequent relevant WHA resolutions

Priority Action Areas for Governments Protect, promote and support appropriate IYCF practices in context of HIV

• • • • •

Increase the priority given to IYCF issues in national planning within and outside of health sector Develop and implement guidelines on IYCF Strengthen capacity at all levels for the promotion of improved IYCF Revitalise and scale-up BFHI Facilitate coordinated implementation of existing programmes on issues around IYCF

Priority Action Areas for Governments Provide support to HIV+ women in their chosen Infant Feeding method

• • • • • •

Expand access and demand for improved ANC and VCT Integrate counselling into MCH services Support the orientation of managers and capacity development of counsellors and health workers on breastfeeding counselling and HIV and infant feeding Provide follow-up of mothers and infants, including nutritional support to mothers Strengthen follow-up and supervision of health workers Develop and implement a comprehensive communications strategy

Priority Action Areas for Governments Promote research on HIV and Infant Feeding, monitoring and evaluation

• • • •

Carry out formative research on local feeding options Promote assessment and evaluation of programmes related to HIV and Infant Feeding Disseminate results and other information Revise national guidelines in response to new knowledge

Role of WHO, UNICEF, UNAIDS

• • • •

Advocacy for priority actions Convening technical consultations and providing guidance Resource mobilisation Capacity development

REMAINING CHALLENGES

• • •

Communicating evidence clearly to all levels and maintaining consensus on the way to proceed in a rapidly changing environment Dealing with limitations of existing evidence base on appropriate feeding for infants of HIV+ mothers: answers for some key issues will take time Moving rapidly with priority actions in a context of limited resources and weak health systems