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

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5. Avoidance of stigma and discrimination (and other unintended negative consequences)
should be considered at every step of programme development, implementation, monitoring
and evaluation.
Avoidance of stigma and discrimination should be considered in all aspects of programme
design, implementation and monitoring. In most cases, programmes that target HIV/AIDS-
affected families should not be implemented separately from programmes targeting the
community as a whole. Fear, ignorance and inadequate information about HIV/AIDS enhance
stigma and discrimination and every effort should be made to actively engage the community
in order to dispel fear and myths. HIV/AIDS-affected people can play a key role in deciding
how to address stigma and discrimination, with the support of families, communities, NGOs,
faith-based organizations and the media. Integration and coordination of refugee and host
community interventions could help reduce stigma and discrimination.
2.5 Developing a coherent approach to integrated programming
As Figure 4 illustrates, an emergency needs assessments should be conducted in stages, with a
very rapid initial assessment in the acute phase. Once programmes are in place to meet survival
needs and the situation allows for rapid population-level research, an expanded assessment can
be carried out. Protocols for meeting emergency food, nutrition and reproductive health needs
are articulated in international best practice documents, such as the SPHERE guidelines 19
and the Minimal Initial Services Package (MISP) guidelines24 . In the post-acute phase, more
detailed research is needed to expand interventions and tailor them more closely to local factors.
Food security and HIV/AIDS assessments provide additional information on epidemiology and
sources of health risks in the population.
In most cases, the integrated programme strategies described in this document must follow these
assessments, because they require epidemiological data on high-risk groups, as well as information
on factors such as relevant knowledge, attitudes and behaviour that affect health outcomes. Selection
of individual programme strategies should follow from the assessment findings, as shown
in Table 1. This table identifies key preconditions that should be in place before particular programme
types should be considered for implementation. Each detailed summary action sheet
provides further guidance about the conditions under which the activity may be appropriate.
Before any of these integrated programme strategies is implemented, assessment and analysis
are needed to determine whether food is an appropriate input in the local context. Food-based
programming may be unnecessary – or even harmful – where food security is established, such
as through provision of a universal full ration or local food production. Excess food distribution
can undermine local production and disrupt food markets. Generally, food is an appropriate
input only if research demonstrates that the food is needed and valued by recipients; and that
the receipt of food will have the intended effect (i.e., improve nutritional status among the
HIV/AIDS-affected, or increase participation in public health programmes). With all foodbased
programmes, food as an external input should be phased out for more sustainable solutions
as quickly as possible.
24 United Nations High Commissioner for Refugees. Reproductive Health in Refugee Situations: An Inter-Agency
Field Manual. Geneva: United Nations High Commissioner for Refugees, 1999.