The locked taps

Credit: WaterAid / Simon de Trey

In the slums of Addis Ababa, Ethiopia's capital city, toilets are in short supply and water is expensive. Life is hard enough already, but for people living with HIV and AIDS it is tougher still, as discrimination
prevents them from accessing the safe water and sanitation they need to keep healthy.

HIV is a growing problem in Ethiopia where 13 percent of adults living in urban areas are estimated to be infected. But understanding is still limited and HIV and AIDS are widely feared, leading to discrimination against those living with the infection. They can be denied access to water taps and toilets, even though their needs for safe water and sanitation increase in order to manage the symptoms of HIV.

In the slums of Addis Ababa, public water taps are few and far between and so water is usually bought by the bucket, often from private vendors. Having your own private water connection is a luxury.

Toilets are generally shared by several families in a house compound or neighbourhood. There are also public toilets, with up to 50 households using a single toilet. But maintenance is generally poor.

Those without access to any toilets use open ditches along the streets, or potties emptied into plastic bags. The bags are then slung into skips (often by children), earning them the term 'flying toilets'.

People living with HIV are more vulnerable to water-related diseases, and they and their carers need extra water to prevent infections and cope with the symptoms of disease, such as fever and skin problems. Some sufferers in Addis Ababa are now taking Anti-retroviral Treatment (ART) and they need to drink several litres of safe water a day to limit the side-effects of their treatment. Mothers who are HIV positive are advised to bottle-feed their children, which also requires adequate safe water.

Those who are infected suffer from diarrhoea more regularly than the general population and, according to local HIV support organisations, it appears to be a leading cause of death among AIDS patients in Ethiopia. It has been reported that Cryptosporidium, an opportunistic water-borne disease which causes diarrhoea, has been found in the public water supply of Addis Ababa, and among hospitalised AIDS patients. There is no effective treatment.

Bereket has frequent diarrhoea which does not respond to medication. He has to queue for hours to use the toilet even when he suffers from diarrhoea. Abeba also suffers from frequent diarrhoea, but the nearest public toilet is six minutes walk away. It is also dirty, with 30 households sharing the same toilet. So instead she uses a potty in the house, which her husband and children then take to the latrine.

Some people living with HIV or AIDS find their access to water and sanitation facilities are limited by their sickness, especially if they do not have adequate care and support. But the most striking finding of WaterAid's research was that access is also limited by discrimination against them. This can include being locked out of toilets, bathrooms and tapstands by family members, neighbours and house owners. People are even reluctant to share washing lines or water containers, fearing that these may spread the HIV virus.

Solomon used to live in private rented accommodation. As soon as he started to visit the latrine frequently, his neighbours suspected him of having the HIV virus and locked him out from the toilet and the water tap. They washed the ground where he walked to the toilet, and made him pay extra money for the water he was using.

Lemlem gets her water from a communal water point. After she collects water people wash the tap. They don't want to put their water container next to hers. Neighbours don't like to lend her bottles, glasses and containers.

The lives of many people like Solomon, Lemlem and Berket are made much harder because education about their water and sanitation needs and about sharing facilities is lacking. Any sign of sickness, including frequent visits to the toilet, is seen as a possible indicator of HIV which can trigger acts of discrimination.

Aster is not taking ART, fearing that this will identify her as HIV positive and lead to her housemate throwing her out of the house. Her neighbours ask questions even when she takes antibiotics and painkillers. They suspect her HIV status and won't drink coffee with her. She even avoids having the social worker visit her. More than anything she is afraid to be identified as HIV positive.

Discrimination in water and sanitation is often part of a complex web of discrimination which also affects housing, employment, medical services, social life and childcare. People living with HIV or AIDS feel that tackling discrimination through community counselling and the mass media is as important as improved water and sanitation facilities. Earlier publicity about HIV increased fear, leading to ostracism of those known to be HIV positive. Although this is now changing, more coverage is needed, especially in relation to water and sanitation, a neglected topic.

WaterAid now aims to incorporate HIV issues into its water and sanitation work, and is urging other organisations in Ethiopia, including the Government, to do the same. As well as ensuring more people gain access to these essential needs it is also hoped this will help increase understanding about HIV and AIDS and ensure people who are infected are able to use the water and sanitation facilities they so desperately need.

By Priscilla Magrath

Meeting the needs for water and sanitation of people living with HIV/AIDS ( PDF 902Kb)

¹ Names have been changed to protect identity.