Integration of HIV/AIDS activities with food and nutrition support in ...

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individual treatment. Notwithstanding the vital importance of treatment, the profound consequences of HIV/AIDS are manifest in every sector: food security and nutrition, agricultural production, economic productivity, social networks, governance, human capital, and so on. Agency field staff working with refugee populations report that HIV/AIDS-affected families tend to receive uncoordinated services, with inadequate provision for family-level or longerterm (e.g., livelihood) support. Reduced resources and services (e.g., health, education, community, services, protection, food) Figure 1. Risk factors for HIV in conflicts and in displaced persons camps 1.4 What are “integrated programme strategies”? The term “integrated programme strategies” is used in this document to describe programmes that include aspects related to both HIV/AIDS and nutrition/food security. As a cross-cutting issue, HIV/AIDS should be considered in the design and implementation of virtually any intervention. The 1995 UNHCR/WHO/UNAIDS document, Guidelines for HIV interventions in emergency settings, placed HIV/AIDS squarely on the agenda of priorities for intervention in crises. The 2003 Inter-Agency Standing Committee on HIV/AIDS (IASC) document, Guidelines for HIV/AIDS interventions in emergency settings, clearly identified HIV/AIDS as an issue that cuts across all of the intervention areas in acute (immediate crisis) settings. 11 11 Inter-Agency Standing Committee (IASC). Guidelines for HIV/AIDS interventions in emergency settings. Geneva: IASC reference group, 2004. 19
The 2004 update however did not explore how HIV/AIDS should be “mainstreamed” into refugee programmes after the acute emergency phase has passed. The complex links between HIV/AIDS and food and nutrition are increasingly demonstrated in the scientific literature, but have not been sufficiently applied to programme implementation. Recognizing the vicious cycle between HIV risk, AIDS progression, poverty, food insecurity and individual nutritional status, this document identifies ways to address all these issues through integrated refugee health programmes, primarily in the post-acute phase. 1.5 The role of host communities in refugee programmes The decision to implement integrated programme strategies should be based on an epidemiological analysis of HIV/AIDS and malnutrition in both the host and the refugee communities, as explained in Section 2.5. Where possible and practical, extremely vulnerable host populations should be considered for all programmes provided to refugees that combine food and HIV/AIDS prevention, treatment, care and support. As with refugee programmes, the decision to provide external support to a host population should be based on a needs assessment. As noted above, host populations may have lower, equal or higher HIV prevalence rates, and often exhibit poorer health status than stable refugee populations. HIV/AIDS is frequently transmitted between refugee and host populations, and many opportunities can be taken to address the risks from both sides. Provision of services to refugee populations and not to host populations may spark tensions or hostility between the two groups. Working towards parity with the host community in service availability and quality is very important. For example, host community members living near Kala and Mwange camps in northern Zambia are eligible for free curative care, integrated maternal and child health (MCH) services, and voluntary counselling and testing (VCT) services for HIV at health clinics in the refugee camps. 1.6 How were the programme strategies in this document identified? Following a secondary literature review, mission teams undertook extensive primary research during two interagency field missions. The mission teams comprised thirteen staff of UNHCR, UNICEF and WFP, working at headquarters, regional and country programme levels, with an external team leader. In northern Zambia (September–October 2003), interviews were conducted with over 400 Congolese refugees, UN staff, coopering partner agency staff, government partners, and health facility staff. In western and northwestern Uganda (November–December 2003), the mission team conducted comparable research with Sudanese and Congolese refugees. The teams consulted closely with over sixteen implementing agencies, including international nongovernmental organizations (NGOs) (e.g., International Federation of the Red Cross (IFRC), Aktion Afrika Hilfe (AAH), and Agency for Cooperation and Research in Development (ACORD)), national NGOs (e.g., AIDS Information Centre (AIC), Traditional and Modern Health Practitioners Together against AIDS (THETA)) and local community-based organizations and groups of people living with HIV/AIDS (e.g., Meeting Point, Madi AIDS Heroes Association (MAHA)). Focus group interviews were conducted with a cross-section of refugees and members of the host community: • formal and traditional refugee and local leaders, e.g., refugee welfare committees, HIV/AIDS committees, food management committees, health management committees, sexual and gender-based violence committees; 20
Page 1 and 2: Integration of HIV/AIDS activities
Page 4 and 5: Contents Acknowledgements 5 Preface
Page 6 and 7: Acknowledgements The document was p
Page 8 and 9: Preface This document provides prac
Page 10 and 11: Executive Summary This document pro
Page 12 and 13: The integrated programme strategies
Page 14 and 15: Care and Support for HIV/AIDS-Affec
Page 16: Care and Support for HIV/AIDS-Affec
Page 19: to protect children’s welfare and
Page 23 and 24: food and nutrition components into
Page 25 and 26: 24 • Humanitarian charter and min
Page 27 and 28: families have important needs for s
Page 29 and 30: 28 5. Avoidance of stigma and discr
Page 31 and 32: Table 1. Epidemiological and situat
Page 33 and 34: Household Food and Livelihood Secur
Page 35 and 36: Box 2. The integrated programme str
Page 37 and 38: 36 3. A monitoring and evaluation s
Page 39 and 40: e gender-balanced, may elect an HIV
Page 41 and 42: sive opportunities existed for part
Page 43 and 44: pants. SFP staff should be trained
Page 45 and 46: Therapeutic feeding programmes (TFP
Page 47 and 48: How would this integrated programme
Page 51 and 52: and vegetables, dairy products, mea
Page 53 and 54: In populations that are highly affe
Page 55 and 56: practical experience exists at pres
Page 57 and 58: 56 Programme-level indicators Popul
Page 67 and 68: agriculture and horticulture, anima
Page 69 and 70: Palorinya Settlement, Uganda. AAH h
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How would this integrated programme
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How would this integrated programme
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Both types of programme should idea
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In medical inpatient settings, part
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78 Integrated Programme Strategy 14
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80 Integrated Programme Strategy 15
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Refugee participants enrolled in an
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Everyone involved in HIV/AIDS preve
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Emphasis on participatory and commu
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HIV/AIDS prevention programmes must
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expected to provide their services
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workers and community counsellors -
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Food and related resources are a po
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ment. The group Madi AIDS Heroes As
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