Imagine living with HIV and all the health issues and vulnerability it entails.
Now imagine that reality without having access to safe drinking water, a basic and hygienic toilet, and a way to keep yourself and your surroundings clean.
Unfortunately this is the reality for many in southern Africa, where an estimated 12.7 million people are living with HIV. Almost two thirds of the southern African population â€“ 174 million people â€“ do not have access to a basic toilet, and more than 100 million do not have safe water.
For Regis Sicheuunga, 48, in Hambale, Zambia, a diagnosis of HIV was complicated by the great difficulty of finding clean water close to home.
â€œBefore we had the hand-pump, I was given containers and chlorine by the hospital to keep boiled water because it is so important. I got the water from the well, it was a long wayâ€¦ Iâ€™d get up at 3am because if you were late the water would be gone,â€ she told WaterAid researchers before a new borehole and hand-pump was installed in her community.
In a region with such a high prevalence of HIV and poor water and sanitation coverage, it may seem obvious that the provision of safe drinking water, sanitation and hygiene (Wash) should be essential to support people who are HIV positive to live healthy and dignified lives. We carried out a study in partnership with fellow non-governmental organisation SAfAIDS: â€œAn integrated approach to HIV and water, sanitation and hygiene in southern Africa, to find out how well services for HIV and Wash were being integrated in Lesotho, Mozambique, Swaziland, and Zambia, and to identify ways to improve the situation.
When you consider that taking antibiotic resistant virus (ARV) drugs alone requires 1.5 litres of safe, clean water each day, and staying clean and healthy requires up to 100 litres a day, it only makes sense to integrate these services. A person living with HIV needs clean, safe water for drinking, food preparation, laundry and washing, and for mothers with HIV, for safely formula-feeding babies.
Many life-threatening opportunistic infections are caused by poor sanitation and poor hygiene. Diarrhoea affects 90% of people living with HIV, and the overwhelming majority of cases of diarrhoea (88%) are linked to a lack of safe water, basic toilets and good hygiene.
Diarrhoea also makes ARV drugs less effective, by reducing the bodyâ€™s ability to absorb nutrients from food and medicine.
Our assessment, funded by the Anglo American Group Foundation, found weaknesses in links between Wash and HIV policies and guidelines.
At implementation level the links are ad-hoc, with limited coordination. It means that people responsible for working on HIV do not always consider access to water, good sanitation and good hygiene practice in their work, and people working on water and sanitation do not always understand the particular issues faced by people living with HIV.
The situation in each of the four countries is different, but in all of them there are opportunities for better integration. Programming for HIV/Aids is a priority for all four countries â€“ adding consideration for water, sanitation and good hygiene into this structure would not be difficult.
Alongside SAfAIDS, we are now drafting practical guidelines on how to combine approaches, so that more people with HIV/Aids are able to live longer, more dignified lives with the benefit of clean water, sanitation and good hygiene.
â€œ[The water] has been particularly beneficial for me as now I donâ€™t have diarrhoea, because with the diarrhoea it would reduce my high immunity,â€ Regis Sicheuunga said.