By Babatope Babalobi
Improved access to WASH Though AIDS is the most devastating global epidemic. However, a report has revealed that many secondary diseases from which AIDS patients suffer are preventable through better hygiene.
Authored by Christine van Wijk for the Loughborough University, UK, the report argues that those infected by AIDS can stay healthy longer and able to continue work if they have access to a nearby and reliable supply of water and improved sanitary latrines.
HIV/AIDS, the most devastating global epidemic ever, with Sub-Saharan Africa having the highest number of HIV positive individuals (29.4 million people), followed by South and South-East Asia (6 million). Yet, there is no cure for HIV/AIDS and governments cannot prevent transmission through vaccination. Prevention depends on people’s own sexual behaviour and that of others.
Arguing that there is a strong nexus between HIV/AIDs and access to improved water supply and sanitation services, the report states that
“men, women and children with HIV/AIDS infection are highly susceptible to other diseases; Most of these are related to poor water supply, sanitation and hygiene. Diarrhoeas and various types of skin diseases are common secondary (or ‘opportunistic’) infections. The risk of getting malaria is also greater, and is worsened by poor drainage creating extra mosquito breeding places in and around communities.”
During their years of illness, AIDS patients are mainly cared for by relatives, friends and neighbours (home-based care). Easy access to a safe, reliable and sufficient water supply and basic sanitation in this stage is essential.
For the caregivers, it greatly reduces the extra burdens which they already carry. For the patients, it means human dignity and basic access to personal hygiene. For example, over half of patients suffering from HIV/AIDS have chronic diarrhoea. Having a latrine nearby is then crucial. For mothers who are HIV positive, the risk of transmitting the virus through breast milk is 1:3. Irrespective of whether they can, or for various reasons cannot replace breastfeeding by bottle feeding, clean water is important for the babies’ care.
Within households, water is also needed for productive uses, to increase food security and maintain nutrition levels. This helps patients to stay healthy for a longer time and keeps the household’s income from falling so rapidly and deeply. Access to a plot and water for staple crops, vegetables and fruit for home consumption and marketing are especially crucial for poor families.
So far, HIV/AIDS has been treated as an epidemic rather than as (also) a chronic disease. The emphasis is on the medical aspects – treatment and prevention – and, to a very limited degree, on the socio-economic impacts. Neither the UN organizations nor country governments have looked at the implications for the water sector. Yet, the need for, and impact on, water supply and sanitation are great. Over one billion people lack a minimum supply of safe water and 2.4 billion people have no proper sanitation and many of them suffer from HIV/AIDS.
Service delivery is affected by situations within water and sanitation service organisations and by conditions on the ground. Within high prevalence countries, staff infection rates can be as high as 30%.
Eng. Samuel Wambua, the Executive Director of NETWAS International said at the 13th Regional Water and Sanitation Seminar in Nairobi in September 2001 that “…a scenario may arise when we will have few customers to provide water for, few effective service
providers, few to provide labour, few experts to provide management and technical support in the sector.
The basic principles of developing sustainable community water supply and sanitation are eroded, when those with the disease and their caretakers are not able to participate in planning, decision making and implementation and cannot apply pressure to ensure that their special needs are met”
Christine van Wijk in the report said that “More robust water supplies, water treatment and sanitation systems requiring less (and less complex) maintenance and repairs, and more attention to home systems, including home treatment of drinking water, would make communities and households less dependent on outside support. Basic sanitation and enough water nearby for personal hygiene is crucial as 50% of patients suffer from chronic diarrhoea.
Where households have no safe water, or the supply is intermittent and breakdowns are long, SODIS, or solar disinfection of less safe water, is suitable for household use.
A transparent container such as a plastic bottle is filled with water from a nearby source with a lower water quality and closed. The caretaker places the container in strong sunlight. This will kill most bacteria when the water is exposed for a period of 4-6 hours in full sunlight, or an entire day when the sky is overcast.
The water is disinfected by UV rays, and in addition reaches a temperature of up to 50-60 degrees so it needs to cool down before use (http://www.sodis.ch/) (WHO)
Recognizing hygiene in health education
Although some material exists health education is not yet addressing the chronic disease effects of HIV/AIDS infections. A case study in Limpopo province, South Africa, showed a lack of adjustment not only of water supply and sanitation services, but also of hygiene education.
The participating focus groups of caregivers and people living with HIV/AIDS identified good food and exercise as important ways of staying healthy longer. There were, however, no concerted efforts from the departments of water, health, agriculture and the communities to address production around homes and/or waterpoints for better nutrition. Poor sanitation was another problem that was insufficiently addressed.
The households in the case study saw drinking river water as a potential risk for catching cholera, but there was little awareness of the importance of personal and domestic hygiene behaviour for the patients’ health. The local health educators focused on the prevention of HIV/AIDS but did not address secondary diseases stemming from poor quality or inadequate water supply, hygiene and sanitation. (Kgalushi et al,).
Safe water, sanitation and hygiene are basic needs and human rights. They help those affected by HIV/AIDS to remain in good health for longer, facilitate care for ill patients and increase their dignity. Programmes and policy makers can give higher priority for water supply, sanitation and hygiene promotion to areas with a high incidence of the disease.
Hygiene education needs to be integrated in the training given to home care volunteers and their trainers in order to ensure safe water handling practices.
As most caregivers are women, their influence on planning and implementation of service provision is more necessary than ever. Because often very young and very old women take over much of the water and sanitation related tasks, both hygiene education and technology selection may have to be adapted to suit their requirements.
Community based approaches are known to enhance sustainability and use. They can at the same time function as an entrance to promote community–based prevention and mitigation activities. The principles are the same, the issue at hand more sensitive. It requires well-trained, motivated and non-stigmatising facilitators. Experience with participatory methods exists and can be built on.
Water agencies are affected by the disease. This necessitates the development of policies and strategies within the agencies and for the sector. Agencies need an internal HIV/AIDS policy and strategy to mitigate impact on the agency and the development of a strategy to integrate HIV/AIDS in service provision.
In the sector, facilities are needed that require less frequent maintenance and repairs by outsiders and limited time and money from households to keep them going. Development of low-cost home treatment is an alternative.
A poverty alleviation framework can ensure that the socio-economic and equity aspects that play a role in water, sanitation and HIV/AIDS are addressed. As treatment becomes cheaper and more available, HIV becomes a chronic disease requiring a multi-pronged strategy for keeping those infected in good health and able to work. This includes more attention to personal hygiene and the means for hygiene preservation: access to adequate and safe water, good sanitation and hygiene education.
The report therefore called on Policy makers, programme planners and managers, donors and field workers to treat HIV as a chronic disease and plan for better water supply, sanitation and hygiene to counteract the cruel impacts on people’s day-to-day health, work, income and dignity.