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

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Preface This document provides practical guidance on the integration of food and nutrition programmes with support activities for people with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) among refugees and host populations. It has been written principally for United Nations agencies, their cooperating partners, and other organizations working with populations affected by an emergency. While the guidelines focus mainly on refugees, internally displaced populations and asylum-seekers, they are also applicable to host communities and other populations affected by emergencies. This initiative – to identify opportunities to address both malnutrition and HIV/AIDS through combined programmes – grew out of the recognition of the many complex interactions between HIV infection, nutritional status and livelihood resilience. In populations with a high prevalence of HIV/AIDS, such as in southern Africa, profound changes are likely to occur in the demographic, social, economic and political environments in which people make a living. HIV/AIDS can cause hunger and malnutrition in households stricken by illness, where family members are unable to continue working for food or income. HIV/AIDS can also be a consequence of hunger, as when women and girls resort to high-risk sex to earn food or income. Refugee protection programmes often include a range of health (including HIV/AIDS) and food and nutrition activities. Refugee food and nutrition programmes offer unique, and often relatively straightforward, opportunities for HIV/AIDS prevention and mitigation; at the same time, HIV/AIDS programmes present vital entry points for activities to prevent and reduce food insecurity and malnutrition. This document focuses on how to gain the most benefit from working at this intersection between food and nutrition and HIV/AIDS activities, by asking two key questions: 1. How can emergency food and nutrition programmes incorporate HIV/AIDS-related activities, in support of HIV/AIDS prevention efforts or to increase care, treatment and support for affected households? 2. How can HIV/AIDS prevention, care, treatment and support programmes in refugee settings better utilize food and related resources to improve nutritional outcomes for people living with HIV/AIDS, as well as to build local capacity to provide HIV/AIDSrelated services? A document of this length cannot possibly give detailed attention to all aspects of HIV/AIDS and food security/nutrition interactions. Nonetheless, it seeks to expand our capacity as an international community to engender and support HIV prevention, care, treatment and support and good nutrition in refugee settings. An epidemic as vast and complex as HIV/AIDS demands that we commit ourselves, fully and with humility, to honest dialogue and continual learning about how to lessen the effects of the disease across the globe. With this in mind, we expect that this document will continue to evolve to reflect lessons learned. 1 Harvey P. HIV/AIDS and humanitarian action. London: Overseas Development Institute, 2004 (Humanitarian Policy Group Report 16). 2 Loevinsohn M, Gillespie S. HIV/AIDS, food security, and rural livelihoods: understanding and responding Washington, DC: International Food Policy Research Institute, 2003 (Discussion Paper 157). 3 De Waal A. HIV/AIDS and emergencies: challenges of measurement and modelling. Johannesburg: United Nations Regional Inter-Agency Coordination and Support Office (RIACSO), 2003. 1 2 3 7
Acronyms used in this document AAH Aktion Afrika Hilfe ACORD Agency for Cooperation and Research in Development ADEO African Development and Emergency Organization AIC AIDS Information Centre ANC antenatal care ART antiretroviral therapy ARV antiretroviral (medication/drug) AVSI Association of Volunteers in International Service CBO community-based organization CCA community counselling aide CP cooperating partner CSB corn–soya blend CTC community therapeutic care FFW food-for-work GFD general food distribution HAP Health of Adolescents Programme HBC home-based care HEPS high energy and protein supplement HIV/AIDS human immunodeficiency virus/ acquired immunodeficiency syndrome IASC United Nations Inter-Agency Standing Committee IDP internally displaced person IFRC International Federation of the Red Cross IGA income-generating activity MAHA Madi AIDS Heroes Association MCH maternal and child health NGO nongovernmental organization 8 PLWHA people living with HIV and AIDS PMTCT prevention of mother-to-child transmission [prevention of parent-to-child transmission] PPPD per person per day RDA recommended dietary allowance RTP Right to Play SFP supplementary feeding programme SGBV sexual and gender-based violence TB tuberculosis TBA traditional birth attendant TFP therapeutic feeding programme THETA Traditional and Modern Health Practitioners Together Against AIDS UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNGASS United Nations General Assembly Special Session HIV/AIDS UNICEF United Nations Children’s Fund UNHCHR United Nations High Commissioner for Human Rights UNHCR United Nations High Commissioner for Refugees VCT voluntary counselling and testing WFP United Nations World Food Programme WHO World Health Organization WVI World Vision International YASSA Youth Anti-AIDS Services Association ZRCS Zambia Red Cross Society
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 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 and 20: to protect children’s welfare and
Page 21 and 22: The 2004 update however did not exp
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 49 and 50: 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
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How would this integrated programme
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agriculture and horticulture, anima
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Palorinya Settlement, Uganda. AAH h
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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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