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AIDS 2016 – integration for HIV and WASH

Posted 3 Aug 2016 by Sakhile Khaweka

The AIDS 2016 Conference in Durban, South Africa, was an important chance to promote integration of HIV and water, sanitation and hygiene (WASH) programmes. Sakhile Khaweka, WaterAid’s Regional Support Officer for Southern Africa, introduces WaterAid and SAfAIDS’ field guide for integration, and looks at how WaterAid can continue to advocate for the importance of WASH in a busy HIV sector.

A vibrant and buzzing atmosphere filled the convention centre in Durban, South Africa, as African and international organisations, INGOs, HIV activists, pharmaceutical companies, celebrities, politicians, sex workers, and gay rights activists gathered together for July’s AIDS 2016 Conference. Many came with different agendas to be heard in the numerous sessions planned for the week.

Nurse Elenura tests a child for HIV and malaria at a paediatric clinic in Dar es Salaam City, Tanzania.
Experienced Nurse Elenura tests a child for HIV and malaria at a paediatric clinic in Dar es Salaam City, Tanzania.

AIDS 2016 was a useful platform for raising awareness around the critical links between WASH and HIV prevention, treatment, and care and support responses. WaterAid and SAfAIDS advocated for HIV to existing networks and partners, which focused organisations on considering WASH issues when designing HIV-related programmes and policies within their constituencies. The current buzzwords in the sector are ‘prevention’ and ‘treatment’, and we wanted to highlight the importance of WASH in both of these.

Integrating WASH and HIV programmes

With pharmaceutical giants competing for centre stage in showcasing their latest treatment drugs, and gay rights activists and sex workers stealing the show with parades and demonstrations demanding recognition and decriminalisation, how does one draw attention to the relevance of the WASH agenda to the HIV sector?

In addition to housing a WaterAid and SAfAIDS side-event workshop, which served as a platform for discussions around how to take WASH and HIV integration forward, the conference provided an opportunity for WaterAid, in collaboration with SAfAIDS, to launch a bi-directional field guide for integrating WASH and HIV programmes in Southern Africa. This guide contributes to WaterAid’s commitment to promoting equity and inclusion, and aims to ensure that underserved and marginalised sections of society are included in efforts to reach everyone with WASH services.

The overall goal of the field guide is to promote access to and control of WASH resources by people living with HIV, and equal access by women, men, girls, and boys. The aim is to achieve this through application of a set of minimum standards for integrating HIV into WASH programme and policy design, implementation, tracking, evaluation and reporting, rolled out by WaterAid in southern Africa.

HIV and WASH in southern Africa

Some 70% of all people living with HIV are in sub-Saharan Africa – about 25.8 million people. Nine of Southern Africa’s ten countries have the highest HIV prevalence rates worldwide. Clean water is crucial to keeping them healthy, for taking antiretroviral drugs, and for the good hygiene required to minimise the risk of infections.

Yet 32% of people in the region live without access to clean water, and 70% do not have 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 antiretroviral drugs by reducing the body’s ability to absorb nutrients from food and medicine. Some 90% of people living with HIV in sub-Saharan Africa suffer from diarrhoea, and 88% of these cases are linked to unsafe water, inadequate sanitation and poor hygiene.

During the side event hosted by WaterAid and SAfAIDS, a handful of participants joined in the roundtable discussions on taking forward integration of WASH into the HIV agenda. One of the concerns raised during the discussion was that WASH interventions that directly target households including people living with HIV can create stigma, and that pushing for WASH and HIV-integrated programmes without buy-in and ownership of people living with HIV would be futile.

The way forward – integrating WASH and HIV programmes

Over and above disseminating our bi-directional guide, we need to generate more evidence on which to base advocacy for WASH and HIV integration, to inform policy and build a case for integration of WASH and HIV programmes. This evidence needs to be around topics including:

  • Building the capacity of and empowering people living with HIV to demand their rights to WASH 
  • Getting buy-in of people living with HIV 
  • Creating synergies, and coordination from different players and sectors to secure joint funding and integrated programmes
  • Documenting working models that can be used by other stakeholders 
  • Conducting strategic advocacy with relevant stakeholders 
  • Focusing on water resource management 
  • Making greater use of the opportunity provided by the growing focus on nutrition 
  • Engaging ICASA (the International Conference for AIDS and STIs in Africa) and other regional and international conferences to include WASH in their agenda

WaterAid will continue to promote and advocate the vital role of safe WASH in HIV prevention and treatment in our work in southern Africa. We can leverage our presence in Lesotho and Swaziland, which are among the countries with the highest HIV prevalence. The global focus and attention on these two countries in terms of funding, treatment and prevention provides opportunities to give prominence to the role of water and sanitation in these processes.

Despite prevention, treatment and research being the stated priorities of HIV practitioners, WaterAid can contribute to building a strong case for greater investment and attention to the WASH and HIV nexus by further engaging HIV partners, especially people living with HIV and health workers.

Leadership too has an important role in the development of evidence and advocacy to achieve the necessary buy-in from the HIV sector and other health actors to gain focus on WASH. Leadership can ensure commitment of resources and effort in promoting the WASH agenda in the HIV sector.

Ultimately, the integration of WASH and HIV programmes is about meeting the needs of people living with HIV. If they are unable to participate in planning, decision making and implementation, consideration of their specific water and sanitation needs will be limited, and we will have missed the point.

Sakhile Khaweka is WaterAid’s Regional Support Officer for Southern Africa. She tweets as @sakhilek

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