The Role of the President’s Emergency Plan for AIDS Relief in Infant and Young Child Feeding Guideline Development and Program Implementation

The basic science and clinical research investigating the relationship between HIV and breastfeeding has provided much of the evidence base for the development of public health policies and practice guidelines aimed at preventing mother-to-child transmission (PMTCT) of HIV. Programmatically, however, translating the evidence into practice has been challenging. In 2003, President George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR) to “turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.” Through multiple US agencies, PEPFAR will have provided $63 billion between 2004 and 2013 in direct financial support and technical assistance for the implementation of HIV prevention, care, and treatment programs throughout the world. Focusing on PEPFAR’s role in infant feeding guideline modification and implementation, this chapter reviews the history of infant feeding guideline revisions based on evolving research and evaluation, highlights the successes and challenges of translating this rapidly changing evidence into practice, and concludes with a discussion of potential strategies for the adoption and implementation of 2010 WHO PMTCT and infant feeding guidelines.