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[pronut-hiv] WHO Satellite Session: PMTCT of the HIV in the era of HAART


  • From: "ProNut-HIV" <pronut-hiv@healthnet.org>
  • Date: Thu, 17 Aug 2006 22:04:32 -0400

WHO Satellite Session
PMTCT of the HIV in the era of HAART: Opportunities, challenges, and
experiences in implementing national programs

Dr Agnes Binagwaho (cnls@rwanda.1com), Secretaire Executif Commission
Nationale de Lutte contre le Sida, Kigali, Rwanda was one of the
presenters at the satellite session. The take-home messages from her
presentation were the following:

1. Rwanda is implementing a decentralized approach in the fight against
HIV/AIDS. The National AIDS Control Program has signed a contract with
each district/commune in the country to design and implement an action
plan for fighting HIV/AIDS in the district. The National AIDS Control
Program has developed a set of performance indicators to help monitor
the progress and reward the best performing district.

2. Infant feeding options
Replacement feeding is very expensive and not affordable to most HIV
positive women in Rwanda; therefore, the National guidelines recommends
safe breastfeeding for all children born to HIV+ women. The risk of
transmission of HIV through breastmilk exists, and HIV + mothers need
close follow up and guidance to successfully implement the abrupt
cessation of breastfeeding at 6 months. Optimal feeding for infants
after 6 months of age remains the most serious challenge. Malnutrition
is present in most infants who are not breastfed. Energy and nutrient
dense foods recommended for these children are not affordable. In
Rwanda, irrespective of HIV, malnutrition is a serious problem for
infants aged 6 months - 5 years. Rwanda is looking for solutions
to prevent malnutrition in all children under 5 and not
only in the HIV-infected ones. Rwanda believes in a family approach to
improve child survival. A familial approach looks at the household as a
unit and promotes good care for the mother and the father as well.

3. Sustainability for the activities of the HIV/AIDS program is another
serious challenge. There is a need for long term commitments and for a
gradual phasing out of the external support. Global Fund should continue
its support to projects which perform well and have great impacts on
communities. It may be very harmful to abruptly interrupt the support to
the program in the areas where the National AIDS Control Program is not
yet ready to take over.