Clean water and sanitation are the ‘missing pieces’ in treatment for people living with HIV

Access to clean water and basic toilets is an essential but neglected part of the management and treatment of human immunodeficiency virus (HIV), new research by international development organisations WaterAid and SAfAIDS has found.


28 Nov 2014

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 reside in Sub-Saharan Africa. This equates to approximately 25 million people. The report is being released just ahead of World AIDS Day on 1 December.

Clean water is critical to keeping people living with HIV healthy, for taking antiretroviral (ARV) drugs and for the good hygiene required to minimise infections.Yet 35% of people in Sub-Saharan Africa are living without access to clean water and 70.4% are without basic sanitation. This leaves 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. 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, WaterAid Chief Executive, said:

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

These basic services can help those living with the illness to lead healthier, more dignified and more productive lives – even where HIV infection rates are high.

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’s is 11.1%.

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

Taking ARV drugs requires 1.5 litres of safe, clean water each day. However, a person living with HIV might require up to 100 litres a day to stay clean and healthy. This takes into account basic needs for drinking, food preparation, laundry and washing, as well as for formula-feeding babies born to mothers with HIV, for watering gardens to improve nutrition, and for extra cleaning, washing and laundering during cases of diarrhoea. 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 prioritise 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.

With less than a year until UN member states agree the new Sustainable Development Goals (SDGs), WaterAid and sector partners are calling for a stand-alone goal on water and sanitation. Universal access to water, sanitation and hygiene services, already recommended in the initial draft, will play a critical role in supporting health targets such as eliminating AIDS by 2030.

WaterAid also calls for proposals around universal health coverage to include environmental factors such as water, basic toilets and good hygiene education within households. For people living with HIV, this would help to prevent opportunistic infections and enable healthier, more productive lives.

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