Nutrition and HIV/AIDS: A Training Manual - Linkages Project

Breastfeeding techniquesIt is especially important for PMTCT programming that staff members are trained inlactation management skills. The risk of cracked nipples may be reduced byimproving positioning and attachment (i.e., latching onto the areola rather thannipple). The use of abrasive creams and soaps, which may result in cracked nipples,should be discouraged by counselors and health workers. The pain of cracked nipplesmay cause the mother to avoid emptying her breasts, resulting in engorgement andeventually leading to mastitis. Gentle expression techniques may be required toassist the mother with emptying her breasts.Role-plays and practical sessions on lactation management are recommended forinstructing or reviewing good breastfeeding techniques with students. Refer toSession 3 on nutrition actions for people living with HIV/AIDS for more information.Voluntary and confidential counseling and testing (slide 29)Voluntary counseling and testing (VCT) has been shown to be a cost-effectiveapproach to reducing HIV-related risk behaviors. Stigma is an important issue toconsider for this intervention. Sensitivity counseling, community education, andinvolvement of partners in the VCT process may help alleviate the stresses caused bythe stigma of HIV. Work is ongoing in Kenya and other countries to examine theeffectiveness of VCT on PMTCT. The following lessons have been learned from theseand other VCT programs:• Systems should be in place to ensure confidentiality of VCT services.• Men and communities need to be sensitized about MTCT.• Health workers must be properly trained in MTCT.• Counseling programs should be offered to support HIV-infected women andmen. Peer counselors, service providers, and social workers must be properlytrained.197