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HIV/AIDS & Water

Author: Peter Ashton & Vasna Ramasan ~ CSIR

( Article Type: Explanation )

Since the 1980s, when the first HIV and Aids cases were reported in southern Africa, the pandemic has come to be regarded as a major threat to human development and not simply a health issue. In southern Africa, adult HIV and Aids prevalence rates are among the highest in the entire world; in Botswana, Lesotho and Swaziland, at least one third of the adult population has been infected with HIV, while in South Africa, approximately one fifth of all adults are infected. The age group of 15- to 49-year-olds, which represents the most economically productive sector of society, is regarded as particularly vulnerable to infection. An associated feature of the HIV/Aids pandemic is increased mortality and this is seen as one of the main influences on the current and projected decline in life expectancy at birth.

The impact of HIV and Aids is reflected by the rising cost of health care, changes in the structure of the population, and increased dependency ratios. Southern African studies indicate that HIV and Aids impacts negatively on all sectors of society, for example by: increased operating costs of business; high staff turnover; increase in absenteeism; higher training costs; declining household incomes and diminished ability to pay for services; the increased numbers of orphans and teenage-headed households. The growing appreciation of these implications has created greater political support for efforts to deal with HIV and Aids. While HIV and Aids pose enormous problems for all sectors of society, the pandemic has some important implications for the water sector in particular. Specific groups associated with the water sector, such as mobile teams of workers involved in water infrastructure projects and communities living close to water projects, are particularly vulnerable to HIV and Aids. Within communities, good access to safe and reliable sources of water is essential for people living with HIV and Aids, especially for the provision of home-based care. Water is needed for bathing and washing clothing and linen. Nearby latrines are necessary for weak patients who are unable to walk long distances. Water is needed to maintain cleanliness in order to reduce the risk of opportunistic infections. Water and sanitation provision also increases the sense of dignity of both patients and caregivers.

Arguably the main objective of the water supply sector is to improve health by providing access to safe water supply and sanitation. With HIV and Aids, this is even more urgent because of the need to address opportunistic infections such as diarrhoea, cholera and skin diseases. For some patients, diarrhoea can become chronic, weakening them even further. In order for HIVinfected people to remain healthy as long as possible and for people with Aids to reduce their chances of contracting other diseases, adequate water supplies and sanitary facilities are of the utmost importance. Safe water is also needed to take medicines and to make up formula feeds for bottle-fed babies.

Responses made by the water sector also play an important role in society’s ability to cope with the HIV/Aids pandemic. Although there are significant disparities between urban and rural areas and within them, access to safe water has been improving. The United Nations Statistics Division Millennium Indicators Database shows that the level of access ranged from 78% in Lesotho to 95% in Botswana in 2000. Consistent advances in the provision of improved sanitation systems and reliable water supplies have helped communities to cope with many of the opportunistic infections associated with HIV and Aids, as well as helping to reduce some of the social stigma associated with the pandemic.

Water supply and water resource management institutions also play a key leadership role in promoting awareness among their staff, and by helping to reduce the rate of new infections through educational and other support initiatives.

Without an appropriate cross-sector response to HIV/Aids, all components of development may be jeopardised by the impacts of HIV and Aids. The water sector is not immune from the long-term social, economic and environmental impacts and could become vulnerable to impacts, such as difficulty in recouping water charges from households that have lost their income generators, increased vulnerability of water service provision as water service institutions lose staff to Aids-related morbidity and mortality, which ultimately leads to an inability to continue to provide and extend water service provision to those who need it the most.

Globally there has been a recognition of the importance of addressing both water and HIV/Aids issues, and a commitment has been made through the Millennium Development Goals to reduce by half the proportion of people without sustainable access to safe drinking water (goal 7) and to halt and begin to reverse the spread of HIV/Aids (goal 6) by 2015. Since HIV and Aids affect every segment and stratum of society, everyone has to share the responsibility for preventing the spread of HIV and Aids and for minimising its adverse social and economic impacts. It is simply not appropriate for society to expect any national government to shoulder the full responsibility for dealing with this pandemic.