Safe Drinking Water, Sanitation, and HIV/AIDS

Recently published on the Pulitzer Center's World Water Day Writing Contest:

It's springtime 2010 and you are traveling through sub-Saharan Africa, say Malawi, Botswana, South Africa, back up to Uganda, in rural farming communities, in slums, in burgeoning cities. You see farmers supporting their families, workers putting in long days, parents stretching to send their sons and daughters to school and trying to save for a rainy day, presented with opportunities and obstacles similar to those facing many others across the planet.

You also see those same people struggling to escape from two massive public health challenges that for most of the rest of the planet are increasingly rare: a lack of safe drinking water and toilets, and HIV/AIDS. You return to your relatively comfortable home inspired to do something tangible and holistic about both issues.

In trying to figure out the linkages between WASH (Water, Sanitation, and Hygiene) and HIV/AIDS, your research reveals that the two issues are more closely connected than you realized.

According to USAID, "People living with HIV/AIDS (PLWHA) are at increased risk for diarrheal diseases, and are far more likely to suffer severe and chronic complications if infected. Recent evidence demonstrates the efficacy of hand washing, safe water and sanitation in reducing diarrhea among PLWHA by 25% or more." That makes sense, and is even more convincing to you than the brutally true soundbite "You can't take antiretrovirals without safe drinking water, because you'll either throw them up or lose them out the other end because of diarrhea."

And on the flipside, USAID continues: "And people living without safe water and sanitation, with the dire poverty that often accompanies it, are likely less educated and more likely to contract HIV." So people living with HIV need safe water and toilets to prevent potentially fatal opportunistic diarrhea, and those people with safe water and toilets are less likely to become the next victims of HIV.

So what do you do?

You start by volunteering with a water and sanitation nonprofit focused on providing HIV/AIDS treatment centers and surrounding communities in Tanzania with safe drinking water, with toilets, and with handwashing stations and soap. That nonprofit with its holistic approach to both drinking water and HIV works with entire communities to make sure there is 100% handwashing with soap, and zero open defecation, thus reducing the risk of waterborne diarrhea (e.g. cholera) transmission, particularly for those with immune systems compromised by HIV. All brought to you by safe water.

You write letters to Congress, suggesting that taxpayer-funded HIV treatment initiatives like PEPFAR continue their life-saving work with ARVs, but also include complementary safe drinking water and sanitation programs both for outpatients at HIV clinics and for their families and communities.

You blog and tweet that HIV/AIDS is receiving an enormous amount of funding, and justifiably so, but diarrheal disease, 90% of which is caused by unsafe drinking water and inadequate sanitation, continues to kill millions of under fives annually. You underscore to your followers that the world has known how to solve the water problem for over a century and that fatal waterborne diarrhea should be eliminated across the planet.

You acknowledge to yourself that if every human life is indeed equal, you can ignore neither HIV-positive people nor those susceptible to easily preventable, fatal waterborne diarrhea.

This holistic approach will take a big bite out of the 4,500 daily child deaths associated with unsafe water and sanitation, and contribute to a better quality of life and longer survival times for people living with HIV/AIDS.

So the next time you travel through sub-Saharan Africa, you will see farmers farming, workers earning their paychecks, girls going to school, without the twin scourges of unsafe water and HIV shadowing their lives.

On the nexus of HIV/AIDS and safe drinking water and sanitation

These webinars are very helpful whether you are a funder, a practitioner, a policy wonk, or simply a sentient human who wants development to work better and in a more integrated fashion:
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You are invited to a webinar hosted by the USAID Hygiene Improvement Project (HIP) on Meeting the Water, Sanitation, and Hygiene (WASH) Needs of People Living with HIV/AIDS, on April 8, 2010, at 10 am Eastern Daylight Time (New York time, or GMT-5).

People living with HIV/AIDS (PLWHA) are at increased risk for diarrheal diseases, and are far more likely to suffer severe and chronic complications if infected. Recent evidence demonstrates the efficacy of hand washing, safe water and sanitation in reducing diarrhea among PLWHA by 25% or more.

This webinar will highlight why WASH matters for people living with HIV/AIDS, give an overview of HIP's approach to reducing diarrheal disease by promoting improvement in key hygiene practices for PLWHA and their families and care givers, and share WASH-HIV integration resources HIP has developed.

To register for the webinar, go to: https://www1.gotomeeting.com/register/947962744

If you can't join us for this event, a recorded version of the webinar will be available on HIP's website at http://www.hip.watsan.net/page/4105.

Questions? Contact Patricia Mantey, USAID-HIP, tel. 202-884-8960, pmantey -at- aed.org

Please forward this invitation to other colleagues who may be interested in this topic.

Water, Sanitation, Hygiene and HIV/AIDS

Thought I'd do a little research on the nexus of safe drinking water, sanitation, hygiene and HIV/AIDS tonight. I found a very interesting presentation given recently by USAID staffperson Merri Weinger at AfricaSan 2008 in Durban:

http://www.ehproject.org/PDF/ehkm/weinger-africasan2008_presentation.pdf
(PDF document)

It's a quick, introductory read. I'm not sure if you all will find anything new there but for me it does a good job of laying out the linkages between water, sanitation, hygiene and HIV/AIDS, and of quantifying the positive impact of WASH on HIV+ patients and to a certain extent the larger communities.

Note that Pepfar funds can be used for drinking water and hygiene improvements. Sanitation improvements (latrines) need outside sources of funding.

Page 14 discusses 'small doable actions' that need to be scaled up, out and over.

Then I thought of the ongoing debate (as seen in the recent LA Times article "Unintended victims of Gates Foundation generosity") between vertical (viz. disease-specific) and horizontal (viz. basic public health care) approaches to global public health challenges. The facts are, plenty of financial and political capital is flowing to one individual disease: HIV/AIDS. In my mind, it is premature to determine whether that is a good or bad idea (and there are others: malaria, TB). But how can the global watsan community work within the current situation of HIV getting a lot of attention and water getting relatively less?

Every water development organization (UNICEF, CARE, WaterPartners, WaterAid, Water For People, Living Water, and myriad others) that is working in a community where there are HIV positive people should approach Pepfar and ask for support for drinking water and hygiene promotion. Those water development organizations could make that more attractive to Pepfar by agreeing to provide sanitation facilities from their own funds. Essentially the water community should do a better job of grabbing onto the coattails of the HIV/AIDS juggernaut and get a bigger piece of the pie. The end game? - Every HIV clinic, and perhaps the surrounding families and communities could not only have ARVs and medical professionals trained in treating HIV, but also safe drinking water, sanitation and hygiene, and therefore significantly less diarrheal morbidity and mortality.