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

eason that many HIV-infected mothers continue to breastfeed their children after 6months, thereby increasing the risk of mother-to-child transmission, is their inabilityto afford replacement feeding options.To facilitate a successful transition from exclusive breastfeeding to replacementfeeding and to complementary feeding (see below), service providers must supportmothers in addressing the food security constraints impeding their transition.Specifically, priority must be placed on access to breastmilk substitutes for childrenunder 6 months and access to breastmilk substitutes and adequate sources ofcomplementary foods for children over 6 months. This may involve providing linkagesto safety net services or food aid or helping to plan reallocation of householdexpenditures to afford these items.Complementary feeding and food security (slide 24)Practicing proper complementary feeding of children between the ages of 6-24months and obtaining adequate nutritious foods for complementary feeding arechallenges to many poor households, even outside the context of HIV/AIDS. Thedisease exacerbates this challenge by diminishing household resources and maycreate the need for complementary foods with higher levels of micronutrients (e.g.,iron, zinc, vitamin A, vitamin C, and folic acid) than are contained in somebreastmilk substitutes. Complementary foods need to be protein-calorie dense andcontain sufficient levels of macronutrients. Because it is recommended that HIVinfectedmothers not breastfeed their children past 6 months of age and becausesome breastmilk substitutes such as cow’s and goat’s milk lack key nutrientscontained in breastmilk, accessing complementary foods containing these nutrientsis critical.To support appropriate complementary feeding of children of HIV-infected women,merely providing information to mothers and caregivers about nutritionalrequirements and food types may be insufficient. In addition to understanding theknowledge and behavior constraints, counselors and service providers need tounderstand the food security constraints that inhibit proper complementary feeding.Based on this information, they can help mothers identify feasible options withinthese constraints. Such options may include seeking fortified foods where possible,providing referrals for food assistance or other safety net services, and helping toidentify which available foods are optimal for complementary feeding.80