Access to safe water is considered a basic human need and a basic human right (Kamminga 2006) for all people. Yet this basic right remains unrealized for a large majority of people in developing countries, especially in rural communities. The negative impact of low access to necessary quantities of water, to water of reasonable quality, to basic sanitation and hygiene are magnified for HIV-infected, immuno-compromised individuals. The added burden affects not only the HIV infected, but the entire affected family, increasing risk of diarrheal disease and lost productivity.
Therefore, people living with HIV/AIDS (PLWHA) and households affected by HIV and AIDS have a substantially greater need for WaSH services: more water; safe water; access to water and sanitation; proper hygiene. Evidence indicates that HIV affected households require far greater than the 20 liters of water per capita daily (WSP 2007). PLWHA experience periods of illness and relative weakness (Voss 2007) requiring close access to water and sanitation facilities. Studies have shown that those traveling great distances to collect water will reduce intake of water and use less safe water sources and those without easy access to latrines will often resort to open defecation methods (WSP 2007). Increased access to water also assists PLWHA and their families to maintain kitchen gardens or engage in income generating activities that will help ensure food security, improved nutrition, and provide additional income for the household.
In addition, the immuno-compromised status of PLWHA renders them more susceptible to opportunistic infections including those related to water, sanitation and hygiene—diarrhea and skin diseases.
In advanced stages of AIDS, PLWHA often have mouth sores which make eating difficult. Documented evidence has shown that softening food with water helps PLWHA ingest the food needed to maintain good nutrition (Kamminga 2006, WELL Briefing Note 5). Further, when infants are weaned from HIV positive mothers, a safe water source must be used to mix formula or the babies will be at greater risk for dying from diarrheal diseases. In the first two months, a child who receives replacement feeding is six times more likely to die than a breastfed child (UNICEF 2002).
Fourth, people on antiretroviral treatment (ART) require greater amounts of water for drinking (at least 1.5 liters per day). A great irony exists in giving advanced, costly life-saving ART to patients with a glass of water that could infect them with a life-threatening illness. It is important to maximize the effectiveness of these medicines by using safe water for ingesting them, since a side effect of many ARV drugs is diarrhea. Further, diarrheal illness in PLWHA can interfere with and compromise the absorption of these ARV drugs and can even contribute to developing HIV strains that are resistant to antiviral agents (Bushen 2004). Thus safe drinking water becomes that much more compulsory as ART becomes more pervasive in the developing world.
The evidence base: A small but growing body of literature has identified a series of linkages between water, sanitation and hygiene and HIV/AIDS: opportunistic infections negatively impact PLWHA quality of life and can speed the progression to AIDS and infection frequency is tied to water and sanitation services available to households and the hygiene practices of household members (Hillbrunner 2007). Individual studies address the impact of water quantity, quality, sanitation and feces management, handwashing and other aspects of wash can be found through the links below.
Programming experience and guidance: Ensuring proper WaSH practices benefits those infected with HIV and AIDS by keeping them stronger, well nourished, and able to contribute to the household. In addition, such good practices will also prevent the caregivers and other household members from contracting water-borne diarrheal diseases, which, in turn, helps to keep households economically viable and generally resilient for longer periods of time.
Catholic Relief Services and the USAID Hygiene Improvement Project conducted a Workshop on Integration of Water, Sanitation and Hygiene into HIV/AIDS Home-Based Care Strategies in Lilongwe, Malawi from October 29 – November 1, 2007. Links to the workshop reports are listed below:
- Background paper (pdf, 76.5KB)
- Working Groups Discussion Paper (pdf, 38KB). This paper presents key issues with respect to the Water, Sanitation and Hygiene (WSH) needs of PLWHA, particulary those who are in Home-Based Care (HBC) settings.
- Workshop Report: Integration of Water Sanitation and Hygiene into HIV/AIDS Home-Based Care Strategies, Oct 29-Nov 1, 2007. Catholic Relief Services, 2007. (pdf, 436KB
- Annotated Bibliography of Research and Resources Linking Water, Sanitation and Hygiene with HIV/AIDS Home-based Care. Hygiene Improvement Project October 2007.
- Complete Annotated Bibliography (pdf, 215KB) or by the sections below:
- Dignity for All: Sanitation, Hygiene and HIV/AIDS – A presentation at the AfricaSan 2008 Conference by Merri Weinger, USAID. (pdf 380KB) – This presentation:
- Highlights the linkages between WSH and PLWHA
- Describes the evidence base for integration
- Reviews global and country-based based implementation models
- Recommends key actions for implementers
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