© WFP/Laura Melo Key Challenges Regarding Infant Feeding and HIV in UNHCR Operations IYCF in Emergencies Bali, Indonesia · March 2008

Operationalizing WHO Guidelines WHO scientific/technical guidance  UNHCR Policy Related to the Acceptance, Distribution and Use of Milk Products in Refugee Settings UNHCR Guidance on Infant Feeding and HIV in Emergencies for Refugees and Displaced Populations among others…

Milk Policy UNHCR will actively discourage the inappropriate use and distribution of breast milk substitutes in refugee settings and will promote the provisions of the International Code of Marketing of Breast Milk Substitutes UNHCR will accept, source, and distribute only Vitamin A fortified dry milk products and only if they can be used under strict control and hygienic conditions UNHCR will not accept unsolicited donations of BMS, bottles, teats, or commercial baby foods When donations of DSM are supplied, UNHCR will advocate for donor funding to implement projects that will ensure their safe use

Guidance on Infant Feeding and HIV in Emergencies Being prepared by IFE Core Group Members on behalf of UNHCR and in consultation with WHO and UNHCR Nutrition and HIV Advisors Aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in emergency situations Provides an overview of the technical and programmatic consensus on IYCF and HIV Provides guidance for program implementation to prevent malnutrition, improve the nutritional status of infants and young children, reduce post-partum mother-to-child HIV transmission

Considerations regarding IF and HIV Program implementation is heavily influenced by the emergency phase Programming needs to be responsive to changing situation Any provision of infant formula or milk product should be in accordance with the UNHCR Milk Policy and the Operational Guidance on IFE Protection and support of breastfeeding should be an integral part of all infant feeding and HIV programs UNHCR and partners are responsible for addressing all five elements of the AFASS set of conditions

Principles governing IF and HIV Assessments of the local situation are needed to: Ensure an understanding of existing feeding practices, beliefs, and capacities of the community Support the optimal decision on IF and HIV practices Identify the necessary assistance Women should know their HIV status to receive appropriate counselling to help them make and carry out informed infant feeding decisions

More principles... All HIV positive pregnant women should be provided with routine, periodic counselling and the support needed to ensure that they are able to make safe and appropriate infant feeding decisions and carry them out effectively All HIV positive mothers should receive follow-up and full support to practice their chosen option Voluntary and Confidential HIV counselling and testing (VCT) of women and their partners should be encouraged

Key Challenges Messages regarding infant feeding are not harmonized across all actors Misconceptions about mother-to-child HIV transmission Difficulties in implementing AFASS conditions Need for careful monitoring and control of the use of breast milk substitutes in the field Nature/quality of the product itself (Codex Alimentarius) Necessity for the provision of a full package of care Need for extensive training and logistical organization Livelihood activities and related risks