Posts tagged ‘HIV/AIDS’

December 7, 2011

WASH Journalists handout on WASH and AIDS

AIDS patient in Nigeria

                                                                     By Babatope Babalobi

The challenges facing people living with HIV/AIDS (PLHIV) are numerous; lack of safe drinking water, appropriate sanitation and hygiene education are just a few. In countries where antiretroviral drug therapy is keeping PLHIV well enough to resist most other life-threatening opportunistic infections, they are still dying from diarrhea.

  • Every year over 2.8 million people die from AIDS. Over 33 million people live with HIV, most in low- and middle-income countries including West Africa.
  • Improved nutrition and food security reduces susceptibility to diseases, including HIV/AIDS.
  • Proper nutrition is a key aspect to maintain the health of PLHIV taking antiretroviral drug therapy.
  • Diarrhea blocks nutrient absorption creating a cycle of poor nutrition among PLHIV.
  • People living with HIV/AIDS and others with compromised immune systems, are more prone to common illnesses and diseases such as diarrhea. As such, access to improved sanitation and water supply is essential to the overall health of people living with HIV/AIDS.
  • Opportunistic infections, resulting from water and sanitation related diseases and immune suppression in people living with HIV can accelerate the progression of HIV to AIDS. The frequency of those infections is closely tied to the level of water and sanitation services available to households affected by HIV/AIDS as well as the hygiene practices of household members.
  • Diarrheal disease and various types of skin diseases are common secondary (or ‘opportunistic’) infections.[
  • Households caring for PLHIV with advanced illness may also require a greater quantity of water than other households for medicines, bathing and laundry. This adds to the existing burden on caregivers to collect water

Solutions that work

  • Improved water supply and sanitation reduces susceptibility to and severity of HIV/AIDS and other major diseases.
  • Providing access to a safe, reliable and sufficient water supply and basic sanitation is essential for both the people living with HIV/AIDS and their caretakers who are often relatives, friends and neighbors.
  • Improved access to a sustainable water supply lessens the risk of sexual violence, a risk factor for HIV, experienced during water collection.
  • One study of people living with HIV/AIDS in Uganda found that the presence of a latrine reduced the risk of diarrheal disease by 31%.
  • Water and sanitation services which are located in close proximity to HIV-affected households can have important labor saving effects, reducing the burden of caregiving and allowing more time for other activities, including school and income generation.
  • Potable drinking water is often used to soften foods, making them more palatable for the chronically ill
October 10, 2011

Water and Sanitation vital in fight against AIDS, says experts

                                                                                      By Babatope Babalobi

The United Nations views  that  access to improved water supply and sanitation will improve the quality of life of people living with HIV/AIDS

Although HIV/AIDS is not a water-related disease, the issues are closely linked, says the United Nations World Water Development Report titled : “Water, a shared responsibility”.

Many of the opportunistic infections that kill people living with HIV/AIDS are transmitted through contaminated water and unsanitary living conditions.  once people are sick, they frequently suffer from diarrhea and require access to safe, sanitary latrines and large quantities of water for keeping themselves and their surroundings clean.

Improved water supply and sanitation can reduce the frequency of diarrhea.  The incidence of malaria can also be reduced when mosquito breeding areas caused by insufficient drainage are eliminated.

The UN report argues that there is a lack of research on the role the water sector plays for people living with HIV/AIDS.  Thus far, the disease has been treated as an epidemic and not considered a chronic disease or socio-economic problem. The emphasis, therefore is heavily placed on treatment and prevention.

Neither international organizations nor country governments have looked closely at the implications and potential contributions of the water sector in combating the disease and a remarkably small amount of academic research has been done on the subject.

A nearby and reliable supply of water, including for small-scale production and sanitary latrines, allows those infected by HIV/AIDS to continue productive activities and reduces the workload for caregivers. Due to lack of access to safe water for preparing infant formula, many HIV positive women breastfeed even though this exposes their babies to HIV.

If a reliable source of safe water and infant formula can be provided until the baby starts to eat solid foods at six months of age, the generational spread of the virus can be reduced.

The World Bank supported Water Supply and Sanitation programme is one leading organization that has established the link between water supply and sanitation and HIV/AIDS.

WSP-Africa recently engaged with partners to discuss  the strategic role of water in the alleviation of HIV/AIDS and Poverty.  At the Pretoria, South Africa Think Tank Meeting on 26-29 November, Senior Specialist Barbara Mwila Kazimbaya-Senkwe asked, “How can the Water Sector Improve Service Delivery to people living with HIV/AIDS in Africa’s Low Income Peri-Urban Areas?”.

 “It is necessary for the global HIV/AIDS community to work with the global water community to develop a consensus list of prioritized research needed on water and sanitation and HIV/AIDS,” said Dr. Kate Tulenko, a public health specialist of the Water and Sanitation Program.

 “With combined efforts of the AIDS and water communities, WaSH services can be offered to people living with HIV/AIDS to improve their health, relieve the caregiving burden, preserve human dignity, and fulfill the call for every sector to participate in the fight against HIV/AIDS”. 

People affected by HIV/AIDS are often marginalized by society and face extraordinary difficulties in accessing safe water and sanitation, while both is vital to their health.

Another global body- the Water Supply and Sanitation Collaborative Council (WSSCC)  promotes close linkages of WASH and HIV/AIDS sectors to increase dignity and well-being of infected people as well as their families.

According to a 2008 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), 33.4 million people worldwide live with HIV and new infections now number 2.7 million annually. It is estimated that 2 million deaths occurred due to AIDS-related illnesses worldwide. Hundreds of millions more are affected through loss of parents, children, or colleagues.

Though a global pandemic, sub-Saharan Africa is most severely affected with 22.4 million HIV-positive people. South Asia and South-East Asia follow with 3.7 million infected. Poverty, including insufficient access to water supply and sanitation services, exacerbates the spread of HIV/AIDS; the highest burden of disease is found in regions with widespread poverty.

Diseases related to poverty, such as diarrhoeal and skin diseases, are the most common for people suffering from HIV/AIDS. Moreover, access to improved Water, Sanitation and Hygiene (WASH) services is also important for health and livelihoods in general, helping to prevent exposure to infection. These are clear reasons to facilitate the collaboration between the WASH and HIV/AIDS sectors.

Other cross-cutting issues include water quantity and quality and the training of family members, especially of caregivers, to support safe handling of water and maintaining hygienic conditions for those infected.

June 6, 2011

Report links improved Water and Sanitation services to effective AIDS treatment

                                                                                       By Babatope Babalobi

A Ventilated Improved Latrine

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.

Hand washing with Soap before kills germs

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.

Service delivery

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

Household filter..source of improved water supply

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 ( (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,).

Ways forward

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.