An integrated approach to HIV and water, sanitation and hygiene in Southern Africa: A gap and needs assessment

WaterAid and SAfAIDS

Access to clean water and basic toilets is an essential but neglected part of managing living with HIV, new research by international development organisations WaterAid and SAfAIDS has found.

The new report, 'An integrated approach to HIV and water, sanitation and hygiene in Southern Africa: A gap and needs assessment,' shows that 70% of all people living with HIV in the world are in Sub-Saharan Africa, or about 25 million people. The report is being released just ahead of World AIDS Day, 1 December.

Clean water is critical to keeping people living with HIV healthy, for taking antiretroviral drugs and for the good hygiene required to minimise infections.

Yet 35% of people in Sub-Saharan Africa are without access to clean water and 70.4% are without basic sanitation, leaving many people living with HIV suffering from chronic diarrhoea and unable to care for themselves or their families.

Diarrhoea compromises the effectiveness of ARV drugs by reducing the body's ability to absorb nutrients from food and medicine.

Some 90% of people living with HIV in Southern Africa suffer from diarrhoea, and an overwhelming majority of these cases, 88%, are linked to unsafe drinking water, inadequate sanitation and poor hygiene. Nine of Southern Africa's ten countries have the highest HIV prevalence rates worldwide.

Barbara Frost, Chief Executive of WaterAid, said:

"In the last three decades, medical research has made great strides in turning HIV from a death sentence into a manageable condition. It defies logic that despite so much progress on education and in delivering anti-retroviral drugs, there has not been a focus on making sure people living with HIV also have clean water, basic toilets and the means to keep themselves and their surroundings clean.

These basic tools for preventing infection can mean more parents being well enough to work or to care for children, and healthier, more productive communities, even where HIV infection rates are high."

Robert Kampala, WaterAid Head of Region for Southern Africa, said:

"HIV and AIDS have taken a heavy toll in Southern Africa, straining healthcare resources, people's ability to care for themselves and their families, and national economies. As treatments for managing HIV advance, it is just as important to remember the basics and acknowledge the important role that clean water, basic sanitation and good hygiene play in helping people with HIV live healthier, happier lives."

The assessment focused on people living with HIV in Lesotho, Mozambique, Swaziland and Zambia. Swaziland has an HIV prevalence rate of 26.5%, one of the highest in the world; Lesotho's HIV prevalence rate remains at 23.1%, while Zambia's is 12.7% and Mozambique 11.1%.

Though rates of access to water and sanitation vary widely among these countries, in all four, research revealed many households with more than a kilometre to walk for water, and households without toilets where people including the sick and elderly have no choice but to defecate in the bush.

Just taking ARV drugs alone requires 1.5 litres of safe, clean water each day. A person living with HIV may require up to 100 litres a day to stay clean and healthy - taking into account basic needs for drinking, food preparation, laundry and washing, as well as formula feeding babies born to mothers with HIV, for watering gardens to improve nutrition, and for extra cleaning, washing and laundering during the bouts of diarrhoea common in people living with HIV.

In many parts of Sub-Saharan Africa, this is simply not possible.

This report recommends combining water, sanitation and hygiene into HIV services to recognise that without sufficient clean water, sanitation and proper hygiene, people living with HIV will be more ill more often, and less able to live healthy and productive lives.

Lois Chingandu, SAfAIDS Executive Director, said:

"If the world does not prioritize water and sanitation hygiene issues, all gains made in the HIV response will be reversed. Concerted efforts must be made to ensure the existing linkages are given the attention and prominence they deserve."

As the UN finalises its new Sustainable Development Goals next year, WaterAid and its partners are pushing to retain a stand-alone goal on water and sanitation for everyone, everywhere by 2030. Including water, sanitation and hygiene services in health-related goals as well will make people healthier, and work in healthcare and prevention more effective.

Proposals around universal health coverage should also include access to water, basic toilets and good hygiene education within households. In people living with HIV, this can prevent opportunistic infections and enable healthier, more productive lives.

December 9, 2014
Year of publication
Resource types
Reports and Fact sheets
HIV, water, sanitation, hygiene, diarrhoea, treatment, antiretroviral therapy, ARVs, ART, antiretroviral drugs

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