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

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;
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