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  1. 1

    HIV and infant feeding. A policy statement developed collaboratively by UNAIDS, UNICEF and WHO.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF; World Health Organization [WHO]

    [Geneva, Switzerland], UNAIDS, [2005]. [5] p.

    The number of infants born with HIV infection is growing every day. The AIDS pandemic represents a tragic setback in the progress made on child welfare and survival. Given the vital importance of breast milk and breast-feeding for child health, the increasing prevalence of HIV infection around the world, and the evidence of a risk of HIV transmission through breast-feeding, it is now crucial that policies be developed on HIV infection and infant feeding. The following statement provides policy-makers with a number of key elements for the formulation of such policies. (excerpt)
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  2. 2

    WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.

    World Health Organization [WHO]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF

    Geneva, Switzerland, UNAIDS, 1998. [38] p.

    The Guidelines and Guide recognise that: HIV infection can be transmitted through breastfeeding. Appropriate alternatives to breastfeeding should be available and affordable in adequate amounts for women whom testing has shown to be HIV-positive. Breastfeeding is the ideal way to feed the majority of infants. Efforts to protect, promote and support breastfeeding by women who are HIV-negative or of unknown HIV status need to be strengthened; HIV-positive mothers should be enabled to make fully informed decisions about the best way to feed their infants in their particular circumstances. Whatever they decide, they should receive educational, psychosocial and material support to carry out their decision as safely as possible, including access to adequate alternatives to breastfeeding if they so choose; To make fully informed decisions about infant feeding, as well as about other aspects of HIV, mother-to-child transmission (MTCT) and reproductive life, women need to know and accept their HIV status. There is thus an urgent need to increase access to voluntary and confidential counselling and HIV testing (VCT), and to promote its use by women and when possible their partners, before making alternatives to breastfeeding available; An essential priority is primary prevention of HIV infection. Education for all adults of reproductive age, particularly for pregnant and lactating women and their sexual partners, and for young people, needs to be strengthened; Women who are HIV positive need to understand the particular importance of avoiding infection during pregnancy and lactation. (excerpt)
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  3. 3

    Unite for children, unite against AIDS.

    Bolton S

    UN Chronicle. 2005 Dec; [2] p..

    The new campaign of the United Nations Children's Fund (UNICEF), "Unite for Children, Unite against AIDS", hopes to focus global attention on the devastating impact that the HIV/AIDS pandemic has had on children. Ann Veneman, UNICEF Executive Director, in launching the campaign at UN Headquarters in New York on 25 October 2005, described what AIDS means to the youngest generation. "It is a disease that has redefined their childhoods, causing them to grow up too fast, or sadly not at all." In the worst-affected countries, where life expectancy has plummeted from the mid-60s to the early-30s, turning 18 no longer means reaching adulthood, but rather middle-age. A global campaign designed to strengthen the commitment to the fight against AIDS is crucial, explained Ms. Veneman, because "the scale of this problem is staggering, but the world has been largely unresponsive". "Unite for Children, Unite against AIDS" aims to prevent mother-to-child transmission, provide paediatric treatment, prevent infection among adolescents and young people, and protect and support children affected by HIV/AIDS. It also provides a platform for urgent and sustained programmes, advocacy and fund-raising to limit the impact of the disease on children and help halt its spread. (excerpt)
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  4. 4

    A call to action. Children: the missing face of AIDS.

    UNICEF; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    New York, New York, UNICEF, 2005. 25 p.

    The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
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  5. 5

    Guidelines on infant feeding and HIV.

    World Health Organization [WHO]; UNICEF; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    MCH News. 1998 Jul; (9):5, 9.

    This statement was released in Geneva on 1 May 1998: In a concerted effort to stop the mother-to-child transmission of HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its co-sponsors the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have developed a comprehensive set of guidelines that support the use of alternatives to breastfeeding for infants born to women infected with HIV, the virus that causes AIDS. The guidelines are intended to help governments devise national policies to reduce the risk of HIV transmission through breastfeeding and to assist health care managers in providing services and support to this end. The guidelines stress the importance of protecting, promoting and supporting breastfeeding as the best method of feeding for infants whose mothers are HIV-negative or who do not know their HIV status. But at the same time, they recognize the need to support alternatives to breastfeeding for mothers who test positive for the human immunodeficiency virus. (excerpt)
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  6. 6

    Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.

    Rutenberg N; Baek C; Kalibala S; Rosen J

    New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)

    This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
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  7. 7

    Breastfeeding: foundation for a healthy future.


    New York, New York, UNICEF, 1999 Aug. [15] p.

    If every baby were exclusively breastfed from birth, an estimated 1.5 million lives would be saved each year. And not just saved, but enhanced, because breastmilk is the perfect food for a baby's first six months of life - no manufactured product can equal it. Virtually all children benefit from breastfeeding, regardless of where they live. Breastmilk has all the nutrients babies need to stay healthy and grow. It protects them from diarrhoea and acute respiratory infections - two leading causes of infant death. It stimulates their immune systems and response to vaccinations. It contains hundreds of health-enhancing antibodies and enzymes. It requires no mixing, sterilization or equipment. And it is always the right temperature. Children who are breastfed have lower rates of childhood cancers, including leukaemia and lymphoma. They are less susceptible to pneumonia, asthma, allergies, childhood diabetes, gastrointestinal illnesses and infections that can damage their hearing. Studies suggest that breastfeeding is good for neurological development. And breastfeeding offers a benefit that cannot be measured: a natural opportunity to communicate love at the very beginning of a child's life. Breastfeeding provides hours of closeness and nurturing every day, laying the foundation for a caring and trusting relationship between mother and child. (excerpt)
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  8. 8

    Global strategy for infant and young child feeding.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2003. vi, 30 p.

    The Executive Board of the World Health Organization, at its 101st session in January 1998, called for a revitalization of the global commitment to appropriate infant and young child nutrition, and in particular breastfeeding and complementary feeding. Subsequently, in close collaboration with the United Nations Children’s Fund, WHO organized a consultation (Geneva, 13–17 March 2000) to assess infant and young child feeding practices, review key interventions, and formulate a comprehensive strategy for the next decade. Following discussions at the Fifty-third World Health Assembly in May 2000 and the 107th session of the Executive Board in January 2001 of the outline and critical issues of the global strategy, the Fifty-fourth World Health Assembly (May 2001) reviewed progress and requested the Director-General to submit the strategy to the Executive Board at its 109th session and to the Fifty-fifth World Health Assembly, respectively in January and May 2002. During their discussion of the draft of the global strategy, members of the Executive Board commended the setting in motion of the consultative, science-based process that had led to its formulation as a guide for developing country-specific approaches to improving feeding practices. They also welcomed the strategy’s integrated and comprehensive approach. Several members made suggestions with regard to the exact wording of the draft strategy. These suggestions were taken carefully into account in preparing the strategy, as were comments from Member States following the Board’s 109th session and observations of other interested parties, including professional associations, nongovernmental organizations and the processed-food industry. Stressing the validity of a well-structured draft, the Executive Board recommended that the Health Assembly endorse the global strategy and that Member States implement it, as appropriate to national circumstances, in order to promote optimal feeding for all infants and young children. (excerpt)
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  9. 9
    Peer Reviewed

    Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?

    Papathakis PC; Rollins NC

    Bulletin of the World Health Organization. 2004 Mar; 82(3):164-171.

    Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/ UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8–60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. It took 21–25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30–35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. (author's)
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  10. 10

    HIV and infant feeding. A UNICEF fact sheet.


    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Approximately one third of infants born to HIV-infected mothers will contract the virus. Without preventive interventions, transmission of the virus occurs during a mother’s pregnancy or during childbirth or breastfeeding. Without interventions, about 15 to 30 per cent of children become infected during pregnancy or delivery; about 10 to 20 per cent contract the virus through breastmilk if breastfed for two years. An estimated 800,000 children under the age of 15 contracted HIV in 2001, about 90 per cent of them through mother-to-child transmission (MTCT). The risks of HIV infection have to be compared with the risks of illness and death faced by infants who are not breastfed. Breastfeeding provides protection from death due to diarrhoea and respiratory and other infections, particularly in the first months of life. During the first two months, a child receiving replacement feeding is nearly six times more likely to die from these infectious diseases, compared to a breastfed child. Breastfeeding also provides complete nutrition, immune factors and the stimulation necessary for good development, and it contributes to birth spacing. (excerpt)
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  11. 11

    Mother-to-child transmission of HIV. A UNICEF fact sheet.


    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Without preventive interventions, approximately 35 per cent of infants born to HIV-positive mothers contract the virus through mother-to-child transmission. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission. Infants can become infected during pregnancy, childbirth or breastfeeding. Some 15-20 per cent of infant infections occur in pregnancy, 50 per cent occur during labour and delivery, while breastfeeding accounts for a further 33 per cent of infant infections. Sub-Saharan Africa is home to 90 per cent of the world’s HIV infected children. Most of the 580,000 children under the age of 15 who died of HIV/AIDS in 2001 were African. For mothers living with HIV/AIDS, especially in developing countries, the decision on whether or not to breastfeed is a frightening dilemma. Infants not infected during pregnancy and childbirth, whose mothers are HIV positive, face a 10-15 per cent chance of acquiring HIV through breastfeeding, depending on how long they are breastfed. The use of breastmilk substitutes reduces this risk, but can expose them to other dangerous health risks, including diarrhoea. Many mothers in developing countries cannot afford breastmilk substitutes and lack access to clean water, which is essential for their safe preparation and use. A mother living with HIV/AIDS therefore faces many grave difficulties: worries about her own health and survival; the risk of infecting her baby through breastmilk; and the danger that her baby will develop other health problems if she does not breastfeed. (excerpt)
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  12. 12
    Peer Reviewed

    HIV-positive mothers in Uganda resort to breastfeeding.

    Wendo C

    Lancet. 2003 Aug 16; 362(9383):542.

    An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)
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  13. 13

    Cooperative project helps to prevent AIDS spread in Henan province.

    China Population Today. 2001 Dec; 18(6):13.

    To prevent more children from falling victims to AIDS, a project will soon be implemented by UN International Children's Emergency Fund in collaboration with the Ministry of Health of China and Henan Provincial Health Division, in Shihe District of Xinyang City and Shangcai County of Zhumadian City, Henan Province. The project is focused on intervention of AIDS transmission from mother to baby. Mother-to-baby is one of the major channels for AIDS transmission. In the early 1990s, driven by profits, some organizations and individuals began to engage in illegal and tainted collection and trade in blood and blood products, which gave rise to the rapid proliferation of AIDS among blood donors. According to the Ministry of Health, since 1995, local health departments have conducted seven special surveys and identified Wenlou Village of Shangcai County as the village worst struck by AIDS. This project will provide counseling among target groups about HIV antibiotic tests, provide drug therapy to women tested positive to HIV during antenatal, childbirth and postnatal periods, and follow up with babies born to women tested positive to HIV. Breast-feeding is not recommended for such women. (full text)
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  14. 14

    A changing emphasis for feeding choices for HIV seropositive mothers in East, Central and Southern Africa.

    Pillay K

    SOCIETES D'AFRIQUE ET SIDA. 1997 Jul-Oct; (17-18):12-4.

    Since the first descriptions that HIV-1 can be transmitted from mother to infant by breast-feeding, infant feeding practices in HIV-1 seropositive mothers had to be re-evaluated. In developed countries, public health policies recommend artificial feeding. A workshop sponsored by the South African Department of Health and the World Bank in collaboration with the Department of Pediatrics & Child Health, University of Natal and the Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa was held in Durban, South Africa (May 20-21, 1996) to address the question on breast-feeding infants with seropositive mothers. The presentations of the program included the epidemiology of mother to infant transmission of HIV with special emphasis on breast-feeding, the biological aspects of HIV transmission through breastmilk, a review of international studies on breast-feeding and mother to infant transmission of HIV and an exploration of the potential impact of breast-feeding on interventions against mother to child transmission of HIV by antiretrovirals. Thus, a shift in emphasis on the question of feeding choices for HIV seropositive women in developing and intermediate income countries has occurred. However, this statement has yet to be converted into policy.
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  15. 15

    Breastfeeding and complementary feeding. Summary.

    United Nations. Administrative Committee on Coordination. Sub-Committee on Nutrition. Working Group on Breastfeeding and Complementary Feeding

    SCN NEWS. 1999 Jul; (18):7.

    Eight issues were discussed by this Working group and recommendations included in the following. All implementing agencies should adopt a rights-based approach to all of their infant feeding programs; and an intersectoral rights-based approach to child survival growth and development should be adopted by all implementing bodies. Regarding maternity legislation, it was requested that the Sub-Committee on Nutrition (SCN) Secretariat use its good offices to approach the new Director General of International Labor Organization and express concern over the process towards the re-negotiation of the Maternity Protection Convention. The Benefits of Breastfeeding Model (BOB) for assessing the economic value of breastfeeding should be used more widely to advocate for the introduction and strengthening of breastfeeding policies and programs. The Breastfeeding Counseling training course and its complementary feeding component needs to be more widely implemented, particularly in countries affected by the HIV epidemic to counter the tendency to abandon breastfeeding protection, promotion and support. In the context of mother-to-child transmission (MTCT) of HIV, global implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly resolutions needs to be accelerated and strengthened. UN Children's Fund should prepare a briefing note explaining the continued relevance of the Code in the context of prevention of MTCT of HIV, explaining particularly the provisions concerning free and low cost supplies. It was recommended that additional research is needed on the relative safety of exclusive breastfeeding, on the effects of the alternative feeding options proposed in connection with MTCT of HIV on children's health and family well-being, and specifically on how mothers cope in practice using various feeding options. In all preventive MTCT initiatives, infant feeding practices and their effects on children's health need to be more closely monitored. (full text)
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  16. 16

    The milk of human kindness. How to make a simple morality tale out of a complex public health issue.

    Yamey G

    BMJ. British Medical Journal. 2001 Jan 6; 322(7277):57-8.

    On December 5, 2000, the Wall Street Journal ran a lead news story and an accompanying editorial claiming that donations from baby food manufacturers would stop the mother-to-child transmission of HIV. The article contended that the UN Children's Fund's (UNICEF) feud against the formula industry was to be blamed for allowing AIDS to spread, especially in sub-Saharan Africa, and for killing millions of children. In 6 days, the American dailies had taken a highly contentious health issue and turned it into a battle between the corporations and the international health agency. Despite assaults from the media, as well as from several UN officials, UNICEF remains firm in its stance against accepting donations. Carole Bellamy, executive director of UNICEF, explained that a rush to promote formula feeding could lead to the spread of other infectious diseases. Bellamy notes that if formula is to be used, it needs to be done in a targeted manner. Moreover, Bellamy argued that the paper failed to acknowledge that UNICEF is leading the way in addressing mother-to-child transmission. WHO officials also expressed frustration at the paper for implying that formula donations were the easy answer to the difficult HIV/AIDS crisis. However, the Wall Street Journal rejected the powerful criticisms it has received from the international community and has made no apologies for the story and the hard-hitting editorial.
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  17. 17

    Zidovudine to prevent mother-to-infant HIV transmission in developing countries: any questions? [editorial]

    Van der Stuyft P; Boelaert M; Temmerman M

    Tropical Medicine and International Health. 1998 Sep; 3(9):689-90.

    The 12th World AIDS Conference in Geneva, Switzerland, held last June 28 to July 3, 1998, pursued the noble aim of bridging the HIV control/AIDS care gap between the developing and developed world. The collaboration of three organizations, namely, the Joint UN Program on AIDS/HIV, the UN Children's Fund, and the WHO, took an initiative to reduce mother-to-child perinatal HIV transmission in developing countries. It will seek support to provide a short zidovudine regimen to 30,000 HIV-infected pregnant women living in 30 project areas in 11 pilot countries. The cost of drugs under the proposed short regimen seems promising, some US$50 per treatment course. However, for the short zidovudine regimen to be effective, at least one antenatal visit is needed before 34-36 weeks of gestation. At that moment pregnant women should have access to voluntary and nonstigmatizing HIV testing. In less developed countries unjust distribution of global health services is prominent. Thus, several ethical problems concerning equity, sustainability, development, and women's and patients' rights remained to be considered in developing countries.
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  18. 18

    Effect of zidovudine on perinatal HIV-1 transmission and maternal viral load [letter]

    Golden B; Cooper E; Cundall D; Moy R

    Lancet. 1999 Jul 10; 354(9173):158-9.

    The International Child Health Group of the Royal College of Pediatrics and Child Health is displeased with the UNAIDS, UNICEF, and WHO policy statement endorsing the artificial feeding of infants. The statement holds that with nutritionally adequate breast milk substitutes safely prepared and fed to the infants of mothers with HIV infection, the infants are at less risk of morbidity and mortality than if they were breast-fed. This global policy has more potential to harm than help, for women in extremely poor and unsuitable settings may wrongly decide to adopt bottlefeeding. The better strategy is to promote exclusive breast-feeding for 4-6 months. Efforts should also be made to reduce the vertical transmission of HIV by increasing the use of short-course zidovudine wherever feasible. Further efforts should be made to address the factors which contribute to HIV infection and prevent social and economic development.
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