Why water, sanitation and hygiene belong in the approach to HIV

4 min read
Image: WaterAid/Anna Kari

As we observe this World AIDS Day 2015, it is our conviction that ending AIDS by 2030 is achievable, with the right tools and practice. Percy Ngwerume, Senior Programme Officer, SAfAIDS and Mafupu Esther Mokoena, Team Leader, WaterAid Lesotho and Swaziland, discuss the importance of WASH in the push to end the epidemic.

“The world has delivered on halting and reversing the AIDS epidemic. Now we must commit to ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.” Ban Ki Moon, Secretary-General of the United Nations.

Part of the fight against AIDS is to keep those who live with HIV healthy and productive members of their communities, which requires access to clean water, basic toilets and the ability to keep clean with water and soap.

Tackling HIV in context

The response to any disease must be grounded in the context in which people live. Many of the world’s poorest countries are also those with the highest percentages of the population living with HIV – and places where water, basic toilets and good hygiene are hardest to reach, particularly for the poorest and most marginalised. That means the health and quality of life of people living with HIV are severely compromised.

For instance, Lesotho has one of the highest HIV/AIDS prevalence rates in not only Sub-Saharan Africa, but also in the world. Overall prevalence is estimated at 23%. The effects of HIV/AIDS on families in Lesotho are devastating. Today, young adults comprise the majority of new infections, leaving behind a generation of children who are growing up without the love and care of their parents. Grandparents and older children are left behind to pick up the responsibility, which causes financial, emotional and developmental problems.

But most attention focuses on medical aspects of HIV/AIDS, rather than issues of dignity and quality of life for people living with HIV/AIDS, and of those who care for them or who are left behind after their death. 

Nearly 70% of Lesotho’s people do not have access to safe, private toilets, and 18% don’t have access to clean water. Yet water, sanitation and hygiene are not often integrated into programmes aimed at improving the health of people living with HIV.

People living with HIV need two and a half times the amount of water required by a healthy person. Nine out of every ten people with HIV have diarrhoea mainly as a result of lack of access to WASH facilities and services, and safe water is needed for rehydration, for washing, for laundry and for general cleaning.

Life-threatening, opportunistic diseases and infections, including pneumonia, are caused and exacerbated by poor access to safe drinking water, sanitation and hygiene. And to take anti-retro viral medication (ARVs) safely, people living with HIV need approximately 1.5 litres of safe water is needed daily.

For mothers living with HIV, access to clean water and the ability to wash with soap can be a matter of survival for tiny newborns, who are themselves three times more likely than are other newborns to have diarrhoea. The consequential illnesses are increasingly severe as the lack of safe water and clean living conditions cuts their chances of survival.

And finally, imagine the burden and strain of fetching water from distant sources for people living with HIV with reduced energy levels, or side effects from medication, or symptoms of opportunistic infections.

How do we integrate WASH and HIV?

The question for us became what is missing in policy and programmes which might enable us to integrate work on WASH and HIV?

Last year WaterAid and SafAIDS analysed the needs and gaps between programming for WASH and for HIV in policies, guidelines and frameworks. We found limited links and very narrow coordination between the two sectors. There’s limited funding for integrated WASH and HIV activities, so programmes run in siloes.

In all four countries we studied – Lesotho, Swaziland, Mozambique and Zambia – our findings indicated that what was needed was a simple, yet comprehensive, guide to give practical support to integration of WASH and HIV programmes, including prevention, treatment and care.

So we wrote one – a field guide to integrating WASH and HIV programmes in Southern Africa. We call it a ‘bi-directional’ guide, which means it can be used by organisations working in both the WASH and HIV sectors.

This guide, based on evidence, extends the work of our 2014 gap and needs assessment and will help WaterAid and SafAIDS to work to mobilise government and other stakeholders to better integrate efforts on WASH and HIV. We now look to practitioners to use the guide, and improve it. 

We have a prime opportunity now to revive discourse on combining WASH and HIV programming for maximum impact, with the UN’s new Global Goals on sustainable development, including Goal 6 to reach everyone everywhere with water and sanitation and Goal 3 to achieve healthy lives, including an end to the AIDS epidemic by 2030. There is renewed focus on eradicating extreme poverty and creating a world that is healthier, fairer and more sustainable.

Ending the AIDS epidemic by 2030 is possible – and so is delivering access to water and sanitation to everyone everywhere. Achieving it will take political will, financing and cooperation.