Breast milk provides all the nutrient needs of the infant especially in
the first six months of life and also protects the growing infant from
pneumonia, diarrhoea, and malnutrition, which are the major causes of
morbidity and mortality in the African Region. However breastfeeding is
also known to transmit the Human Immuno- deficiency Virus (HIV) from
mother to the child. Several guidelines have been developed to guide
policy makers, health workers and mothers on the most appropriate
methods to feed HIV exposed infants. Previous HIV and infant feeding
guidelines emphasized on preventing infants from becoming infected with
HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over
the period, programme implementers and researchers have reported
difficulties in implementing earlier recommendations and guidelines on
HIV and infant feeding within health-care systems. New evidence now
shows that giving Anti-Retroviral therapy (ARVs) to either the
HIV-infected mother or HIV-exposed infant can significantly reduce the
risk of transmitting HIV through breastfeeding. Thus, in 2010 World
Health Organization (WHO) issued the latest guidelines on HIV and
infant feeding entitled Principles and recommendations for infant
feeding in the context of HIV and a summary of evidence. The 2010 WHO
guidelines have changed the recommendations on how HIV infected mothers
should feed their infants, and how health workers should support them.
National authorities in each country can decide which infant feeding
practice will be primarily promoted and supported by Maternal and Child
Health services, i.e. breastfeeding with an antiretroviral intervention
to reduce transmission or avoidance of all breastfeeding. Previous
guidelines and recommendations on infant feeding in the context of HIV
have undergone frequent changes over the past decade. The adaptation
and implementation of previous and current guidelines at national level
have met challenges. These include lack of consensus among key
stakeholders, inadequate funding for the additional cost of providing
ARVs to the mother or the child and difficulties in communicating the
recommendations in the new guidelines clearly to mothers, health
workers and policy makers. To address these challenges a number of
proposals have been suggested such as coordinated consensus building
process, costing of interventions and a phased implementation approach
to ensure successful scale up over time. This paper describes the
process of adapting global HIV and infant feeding recommendations and
guidelines at national level. It also reviews the challenges
encountered in implementation and proposes the way forward in
addressing them