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The
HIV / AIDS Millennium Development Goal
What
water, sanitation and hygiene can do
This
Briefing Note focuses on HIV/AIDS only.
There are very few examples to date of the
impact of water supply, sanitation and
improved hygiene on the lives of those with
this disease. However, its impact on
health and the care of the sick is known and
can be applied to HIV/AIDS and this evidence
is presented here.
Compiled
by Julie Fisher of WEDC, 2004
Content
contributions by: Eveline Bolt of IRC and
Kathy Eales of the Mvula Trust
Headline
Facts
The
MDGs are strongly inter-dependent and
programme interventions must reflect
this. Water, sanitation and
hygiene deliver outcomes across the MDGs.
Why
is water, sanitation and hygiene so
important for those living with HIV/AIDS?
HIV/AIDS
and Children - Improved water supply,
sanitation and hygiene education minimises exposure
of infants to HIV/AIDS through unsafe breastfeeding
and protects those who are infected from further
opportunistic disease.
HIV/AIDS
and Staying Healthy - Where there is access
to safe water and appropriate sanitation facilities,
home based care of HIV/AIDS patients and the task of
ensuring their dignity, is made easier.
HIV/AIDS
and Home-Based Care - Where
there is access to safe water and appropriate
sanitation facilities, home based care of HIV/AIDS
patients and the task of ensuring their dignity, is
made easier.
HIV/AIDS
and Income Generation - Safe water supply
and sanitation facilities provide time and resources
to take up economic opportunities, to supplement the
income of households living with HIV/AIDS.
HIV/AIDS
and Children
The
facts
-
Babies
born to HIV positive mothers have a 10-20%
chance of contracting the virus through breast
milk and breastfeeding.
-
However,
babies who do not breastfeed are six times more
likely to die from diarrhoea or respiratory
infections, than breastfed babies, mostly
because contaminated water is used in mixing the
formula and bottles are unclean.
-
Infant
and child infection and death rates from
HIV/AIDS have risen sharply, with 800,000
children under the age of 15 contracting HIV in
2000, over 90% through parent-to-child
transmission. 14
million children are now orphans because
of the disease. Infection rates for girls and
young women can be twice that of boys.
-
Infants
who are HIV positive are particularly prone to
fevers, diarrhoeas, chronic gastroenteritis, ear
infections and tuberculosis. Therefore, there is
a vital need for safe water, sound sanitation
and good hygiene practice to minimise exposing
children to disease agents, which could stress
or compromise their immune systems.
-
Children
caring for relatives suffering water-related
illness or replacing the role of a deceased
parent also miss school.
Why
water, sanitation and hygiene?
-
There
are no figures for the impact of water,
sanitation and hygiene on infant feeding
related to HIV/AIDS. Research into preventing
mother-to-child transmission of HIV is
ongoing. This is needed as bottle feeding is
not always an affordable and socially
acceptable option, and safe water for hygienic
practice may not be available.
-
Hygiene
education programmes addressing the risks of
HIV/AIDS to babies are important, but these
are rare. Rajah Ramawamy Mudaliar Maternity
Hospital for antenatal care in Chennai, India,
holds monthly sessions providing women with
information about pregnancy, diet, exercise,
breastfeeding and HIV/AIDS.
-
Education
is a key defence against the spread of
HIV/AIDS. However, of the 120 million
school-age children not in school, the
majority are girls. Girls are less likely to
go to school if there are not separate and
private sanitation facilities for girls and
boys. One of many examples of impact on school
attendance by girls is shown in four
communities in Arappalipatti and Panjapatti,
India, where girls’ attendance has risen
since the introduction of water points.
HIV/AIDS
and Staying Healthy
The Facts
-
HIV/AIDS
cannot be spread or prevented through water
supply, sanitation or hygiene. However, access
to reliable, affordable and safe water and
sanitation can significantly mitigate against
some impacts of the disease and improve the
quality of life of those living with it.
-
Diarrhoea
and skin disease are among the most common
opportunistic infections which affect those
living with HIV/AIDS, but these can be reduced
by safe water supply and sanitation.
-
It
is important to reduce the chances of HIV/AIDS
patients getting diarrhoea and skin diseases, to
allow them to remain healthy for as long as
possible.
-
In
order to optimise the impact of water supply and
sanitation services, they must be integrated
with hygiene promotion that focuses on safe
water handling and appropriate sanitation
practices.
Why
water, sanitation and hygiene?
Water,
sanitation and hygiene can mitigate against the
occurrence of illness
-
The
incidence of water-related diseases and skin
diseases decreased in WaterAid’s studies of
water provision in Ethiopia, Ghana, India and
Tanzania.
-
Households
with a 10 per cent increase in water use for
cleaning purposes enjoy a decrease in cases of
diarrhoea by 1.3%.
-
Access
to water can increase food security, which in
turn helps people to remain healthy. Nutrition
can be improved by making food softer and
easier to eat by mixing it with safe water
where people are suffering from mouth ulcers
or thrush and cannot eat solid foods.
HIV/AIDS
and Home-Based Care
The Facts
-
Home-based
care (caring for people living with HIV/AIDS
within communities) is now regarded as an
essential element in the continuum of care,
where hospital admission is not feasible.
Although traditionally this is the
responsibility of women, it increasingly falls
to children and the elderly in cases
of HIV/AIDS. Access to basic services can ease
this burden.
-
A
reliable water supply and good sanitation
facilities are indispensable for this and assist
in the tasks of bathing, washing, cleaning and
disinfecting the home environment, providing
water for taking drugs, using latrines to avoid
contamination of water sources, ensuring the
increased comfort and dignity of patients, and
safe human waste disposal for those who are
bed-ridden.
Why
water, sanitation and hygiene?
There
is no direct evidence of impact of water, sanitation
and hygiene on the care of HIV/AIDS patients. It is
clear from other studies, however, that water,
sanitation and hygiene makes care of the sick within
the home easier.
-
Due
to the establishment of a safe water supply,
water used for personal bathing, washing
clothing and utensils increased from about 30%
to more than 50% of total water consumption.
-
Volume
of water consumption for potable and non
potable purposes increased from 40 to 100
litres per day in India.
-
Bathing
using soap increased from less than once a
week to as often as every day.
-
The
existence of a yard tap nearly doubles the
chances of a mother washing her hands after
cleaning a child’s anus, and doubles the
chances of her washing faecally soiled linen
immediately.
-
Households
with a distant water source cooked little, and
only once a day because of a lack of water.
-
A
study in Salvador, Brazil, showed that
children in households with no toilet, had
twice the incidence of diarrhoea than those
with sanitary toilets.
HIV/AIDS
and Income Generation
The Facts
-
HIV/AIDS
imposes very high direct cost burdens on
households, of between 8% and 20% of annual
household income, rising in the latter stages of
the disease to 50% to 100%.
-
It
is important for households living with HIV/AIDS
to maximise opportunities for income generation.
Improved access to water supply provides
important labour saving benefits to households
affected by HIV/ AIDS. Less time dedicated to
fetching water frees up time for income
generation and enterprise development.
Why
water, sanitation and hygiene?
Easing
the domestic work burden
-
Improved
water and sanitation facilities allow carers
to devote greater time to the sick and to
provide a better quality of care.
-
African
and Asian women walk an average of 6km in
order to fetch water. Indian women spend on
average 2.2 hours per day in this activity.
Water, sanitation and hygiene projects in
Ethiopia reduced this time from 6 to 8 hours
down to 5 to 20 minutes.
-
Improved
water supply increased the amount of water
available for domestic uses from 10 litres per
day per person to 18-22 litres. Women reported
that their domestic chores were easier as the
amount of water used was not so severely
restricted.
Increasing
economic productivity
Improved
water supply allows the development of income
generating work due to time saved and to enterprises
which depend on an adequate water supply. The
following examples relate to women rather than
men, as these initiatives have been found to have
the greatest impact on the economic status of women.
-
Women
potters in Ghana had time to increase their
production and trade. Also, there was water
now available for cola nut and palm oil
processing and for distilling Akpeteshie, a
local alcoholic drink for sale.
-
Gujarati
women’s economic productivity increased due
to time saved by a new water supply system. An
additional programme of support for the women
to develop handicrafts addressed the usual
constraints to taking up new enterprises –
lack of funds and access to credit.
Key
references
-
Kamminga,
E. and Wegelin, M. (2003). HIV/AIDS and water,
sanitation and hygiene. Thematic Overview Paper.
Delft: IRC International Water and Sanitation
Centre. http://www.irc.nl/page.php/111
-
WaterAid
(2001). Looking back: The long-term impacts of
water and sanitation projects. WaterAid. London.
UNICEF (2004) HIV/AIDS http://www.unicef.org/aids/index.html
Full
list of references for Briefing Note 5 (Word file)
For
further information contact:
WELL
Water,
Engineering and Development Centre (WEDC)
Loughborough
University
Leicestershire
LE11 3TU UK
Email:
well@lboro.ac.uk
Phone:
+44 (0)1509 228304
Fax:
+44 (0)1509 223970
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