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.
The new report shows that 70% of the approximately 35 million people living with HIV in the world reside in Sub-Saharan Africa. This equates to approximately 25 million people.
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. Many life-threatening opportunistic infections are caused by exposure to unsafe drinking water, inadequate sanitation, and poor hygiene.
Diarrhoea is a very common symptom that can occur throughout the course of HIV and AIDS and affects 90% of PLHIV resulting in significant morbidity and mortality. 88% of diarrhoeal cases are directly linked to unsafe drinking water, inadequate sanitation and poor hygiene.
Dr. Michael Ojo, WaterAid Nigeria Country Representative, said: “Thanks to the great strides in medical research over the last three decades, HIV is now a much more manageable condition and no longer the death sentence it used to be. It seems to be counter-productive that in spite of such progress on education and in delivering anti-retroviral drugs, there’s no focus on ensuring 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 are crucial in helping those living with the illness to lead healthier, more dignified and more productive lives.”
Lack of access to clean water nearby means 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.
The 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.