It’s hard to pick up a newspaper these days and not come across an article about the global food crisis — soaring food prices, riots over rice and bread, and looming famines are dominating the headlines worldwide.

It’s being called “the perfect storm” by many: a combination of the high cost of fuel, increased consumption, increasing production of biofuels, bad harvests and climate change. UN Secretary-General Ban Ki-moon presided over the Rome Summit, a 3-day forum hosted by the UN Food and Agriculture Organization (FAO) that brought together leaders from around the globe to tackle the current food crisis. At the meeting, participants recognized the important and unique role UN family plays in responding to the crisis. The Rome Summit follows an earlier meeting the Secretary-General called of UN agency heads. Then, the Secretary-General spoke of solidarity of the UN system, noted that there was a short-, medium- and long-term plan of action and called for full funding of the World Food Programme (WFP) so that people could be fed. Otherwise, he said, “we risk again the specter of widespread hunger, malnutrition and social unrest on an unprecedented scale.” There seems to be consensus that things will get worse before they get better, so an urgent meeting mobilizing all UN agencies is welcome. So too is the UNAIDS policy brief on HIV, food security and nutrition.

Considering what we know about HIV/AIDS and food insecurity – that poor nutrition undermines the response of ARV treatment; that HIV/AIDS undermines food security by reducing a household’s and society’s capacity to produce food; and that the lack of food can lead to increased risk of HIV for poor women as they may be forced to engage in transactional sex to meet their basic needs – the UNAIDS policy brief couldn’t be more timely.

The Policy Brief is just that – short and to the point with a list of actions for governments, international partners and civil society. For many, especially those in the field, it’ll be an essential source of information. No doubt heads of National AIDS Councils and officials in Ministries of Health have already printed it off, and poured over every sentence and footnote. Guidance from the UN is always welcome in the field. In fact, it’s often the spark that ignites national debate and encourages the development of internal policy. Last year, many government officials in Africa waited for the WHO (World Health Organization) policy guidelines on circumcision before developing their own policies on the issue. So, it is more than a little disappointing to read the following about women, food security and HIV: “Some 90% of HIV-positive children contract the virus from their mother during pregnancy, delivery or breastfeeding. Inadequate nutritional status may increase the risk of vertical HIV transmission by influencing maternal and child factors related to transmission. HIV-positive mothers also need access to appropriate information and replacement feeding options, in order to minimize the risk of transmission during breastfeeding.”

It’s puzzling that the UN would be recommending replacement feeding to prevent transmission of HIV from mother to child instead of exclusive breastfeeding, when we know that there’s scientific evidence supported by countless studies that show that exclusive breastfeeding protects against HIV transmission. What’s more is that replacement or artificial feeding carries risks of diarrhoeal disease, respiratory illness, malnutrition and possibly death if clean water isn’t available. Providing information to HIV-positive pregnant women, as the Policy Brief does, is essential – after all, the decision on whether to breastfeed or not is up to the woman and she should be supported in carrying out her decision safely. But to not acknowledge the mounting evidence that shows that exclusive breastfeeding is best, to not mention that replacement feeding is costly and not feasible for many, many women, and to not point policymakers to the heaps of data on the issue is irresponsible. Even UNICEF, which hasn’t taken the lead on the issue in way that one might expect, has started talking about breastfeeding. In last week’s the State of Africa’s Children 2008, exclusive breastfeeding features strongly. And the recently released Children and AIDS: Second Stocktaking Report notes that a consensus statement on HIV and infant feeding has been adopted by all relevant UN departments and agencies and that the statement “…recommends exclusive breastfeeding for HIV-infected women for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.”

So why the confused messages from the UN and the lack of coherence? For one thing, the UNAIDS policy brief was a collaboration with WFP and WHO, two co-sponsors of UNAIDS. On the surface, that makes perfect sense – both WFP and WHO have clear mandates around the issues of food security and HIV. But the question then is, why hasn’t the consensus statement on HIV and infant feeding been embraced and internalized by every single UN agency, including WHO and WFP?  It should be known so well that it can be quoted by heart by every UN official concerned with the health and well-being of women and children.

But a policy brief on HIV, food security and nutrition without the contribution of the Population Fund, UNFPA (which has expressed concerned about the impact of the current food crisis on pregnant women and nursing mothers), the World Bank (which has funded studies on prevention of vertical transmission), or UNICEF doesn’t make sense. (UNICEF executive director Ann Veneman recently warned that increase in food prices could slow down progress toward achieving the Millennium Development Goals and that rising prices “will most affect the most vulnerable, including people depending on humanitarian assistance, orphans, those affected by HIV/AIDS, refugees and poor urban families.”) What about UNHCR, the agency that oversees the protection and well-being of refugees? Surely, they have a vested interest in a policy on HIV and food security. Refugee camps are likely one of the most difficult and dangerous places in the world to formula feed your baby when you consider the limited access to clean water, sanitized bottles, and indeed, even the formula. The absence of the UN Development Programme, which houses the Millennium Development Goals and administers UNIFEM, the UN women’s fund, is equally baffling. But what’s most bizarre is the absence of FAO, the Food and Agriculture Organisation of the UN. In the field, it’s often FAO that promotes school gardens and efforts to improve livelihoods of households affected by HIV. The agency’s main activities include bringing knowledge to the field and sharing policy expertise. So to not see their mark on such an important Policy Brief is odd. (Or maybe that’s not the odd part at all:  unlike the other agencies noted, FAO isn’t even a co-sponsor of UNAIDS!)

Convening the 10 UNAIDS co-sponsors, plus other relevant agencies to develop a policy brief must be a bit like herding cats. But the mandate of UNAIDS, the Joint United Nations Programme on HIV/AIDS, is “bringing together the efforts and resources of ten UN system organizations in the AIDS response ….” Coordinating, convening, consulting – these words are at the core of UNAIDS’ work and mandate. Why, then, when it comes to an issue as important and timely as food, nutrition and HIV, was a truly joint response not sought? Secretary-General Ban Ki-moon seems to be taking the food crisis very seriously – it’s hard not to; there are simply too many people affected by it. But if a UN response is going to be effective, the world needs clarity and direction from the agencies on the issue, not confusion and misinformation.

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