Living without water, with HIV—a dangerous cycle

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Dirty water and poor sanitation threaten the health and development of the world’s poorest communities. A lack of these basic human rights keeps children out of school and impacts on women’s ability to earn a living. 

For nearly 28 million people in sub-Saharan Africa, living with HIV, a virus that compromises their immune system, lack of clean water, decent sanitation and good hygiene could be life-threatening. In these circumstances, people living with HIV constantly face an increased risk of diseases and infections, including pneumonia and diarrhoea.

The World Health Organization recommends a minimum of 20 litres of water per person per day, to cover consumption, food preparation, cleaning, laundering and personal hygiene. For a person living with HIV, the need can increase, to over 100 litres per day due to the additional need for taking medication and cleaning. 

Yet populations worst hit by HIV are often also those with poor access to clean water, decent sanitation and good hygiene. While life changing antiretroviral medicines have improved the prospects for many living with HIV in Southern Africa, the continued low access to basic services continues to threaten their quality of life and resulting state of health. 

The Kingdom of eSwatini has the highest adult prevalence of HIV in the world, with 27% of adults aged between 15 and 49 living with the condition. Alongside this, a third of people lack access to clean water close to home and two in five have no decent toilet 

People living with HIV must take antiretroviral medicines daily. However, many have no choice but to take them with dirty water that regularly causes sickness and diarrhoea, raising the risk of food and medication being flushed through them, down the toilet and not absorbed in the right quantity to keep the virus under control—a dangerous cycle.

Minky Sithole, a 40-year-old mother at the heart of her community in the Lubombo region of eSwatini, says “Sometimes when you have to take the pills, you don’t even have a sip of water in the house.” 

Minky was diagnosed with HIV in 2006, after a period of denial she decided to use her diagnosis as an opportunity for change and set up a local support group to help the people around her living with HIV. Minky’s support group has become a safe haven for those coping with the disease. They help each other through the daily struggles of living with the condition. In the support group we share our problems at home, and we also support each other by taking medicine on time” she says.

The community has endured three years of low rainfall and now, after a long dry season, are facing dire conditions. 

“I feel hurt every day. Especially when I open my eyes. In the morning I go crazy because—wow… Where are we going to find water for today?” Minky laments.  

The burden and strain of fetching water from distant sources is even higher for people living with HIV who often live with reduced energy levels or side effects from medication and symptoms of opportunistic infections. 

Minky and her family travel a significant distance to a dirty water source every day in the dry season. During the rainy season, the family collects rainwater from the rooftop. Although it is contaminated with dust and sometimes insects, it is cleaner than the river water. 

Where we fetch water in the river it is not clean. Sometimes because you are weak, you can’t even go and fetch the water. You have to wait for the school kids to come back from school, then go and collect the water for you,” she says. 

When children take time out of their day to collect water, they are taking time out of their education and their childhood, hindering their chances of a brighter future. As such, families like Minky’s stand little chance to break the cycle of extreme poverty.

WaterAid is working in Minky’s community to ensure there is sustainable access to water, by rehabilitating and installing ten water systems across the region, specifically targeting drought affected communities. WaterAid eSwatini is collaborating with Minky and her community to build and run water kiosks and toilets to improve the lives of those in her community.

We see the transformational impact that clean water can have.It can improve the health of entire villages. WaterAid is working to install sustainable water systems across the Lubombo region of eSwatini to reduce the vulnerability of these rural communities. We also work at international level to highlight the need for the provision of water and sanitation to be integrated into HIV programmes. 

By ensuring families like Minky’s have access to clean water, in addition to the antiretroviral services available to them, we are ensuring that their communities have the chance to be healthy, educated and financially secure. 

We all need to do even more to strengthen efforts towards universal access to water and sanitation. It is essential that there be continuous empowerment of people living with HIV to demand their right to water, sanitation and a focus on water resource management particularly in light of threats to water supply by climate variability.

Chilufya Chileshe, Regional Advocacy Manager for Southern Africa, WaterAid

Competing interests: None declared

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