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Post a reply: Should you recommend wet nursing in HIV prevalent areas where replacement feeding is not safe but there is no HIV testing available?

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Current WHO guidance on infant feeding and HIV (2010) emphasises a public health approach to infant feeding choice in the HIV context. It emphasises that feeding recommendations decided at national and sub-national level consider what is likely to give the greatest chance of HIV-free child survival. This involves a balancing of risks of different feeding options. The ENN has been working with UNHCR to develop Standardised Operating Procedures (SOP) for handling BMS in refugee settings. There are different interpretations of the WHO guidance emerging from our internal UNHCR review of the SOP. Specifically, in contexts where a wet nurse is available but HIV testing is not and replacement feeding is not a viable safe option, some feel that wet nursing can and should be supported (based on a balance of risks to child survival). Others point out that the WHO guidance (2010) advises HIV testing of wet nurses and find it ethically difficult to recommend wet nursing in the absence of testing. To emphasise, UNHCR advocates for and promotes the availability of HIV testing and ARV treatment in its operations. The reality is that these services are not always available and it is in the context of these very challenged environments that this question is posed. It is 'real life' dilemmas in programmes that have led to this question. We would really value the wider communities experience, evidence and opinion on this and I'd like to thank UNHCR for their openness in sharing this challenge.
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