1. Why AIDS makes a difference to WSH principles

AIDS is not a water-related disease. HIV is not spread via contaminated water or poor hygiene. So why do we need a paper on the influence of HIV/AIDS on the water, sanitation and hygiene (WSH) sector?

The first answer to that question lies in the devastating impact of the HIV/AIDS epidemic on the staff and the customers of WSH service providers in the worst-hit countries. Five million extra people are infected with HIV every year and 6,000 lives are lost to AIDS-related diseases each day. The drain on human resources – including the productive time lost by those caring for sufferers – forces agencies to look anew at the sustainability of WSH systems that depend on skilled staff and paying customers to keep them operating.

The second reason that this paper is pertinent relates to the changing demands for WSH services brought about by the effects of HIV/AIDS on households and communities. As more and more adult men and women succumb to the debilitating effects of the disease, the tasks of caring, water-carrying, laundry and cleaning pass to the old and the young. Old people and children, and their sick relatives, cannot cope with long treks with heavy water containers, or with handpumps that demand physical stature and strength, or with a lack of toilet facilities that forces them to seek privacy in remote places when they need to relieve themselves. Increasingly too, care by family members has to be supplemented by a core of caregivers and volunteers, for whom hygiene education is vitally important. Service providers need to rethink their approaches and the technologies that are deemed appropriate for societies where HIV/AIDS is already a major factor – and for those that may come into that category in the foreseeable future.

Thirdly, improved WSH services can and do have a crucial role to play in slowing the progression of HIV and in reducing the number of AIDS-related deaths. AIDS kills by drastically reducing the sufferer’s immunity to common diseases. Death comes when the patient succumbs to one or other of these “opportunistic” diseases. Among the most common opportunistic diseases are diarrhoea and skin diseases. Safe water supplies and good hygiene practices are the main weapons in preventing infections and reducing the spread of diarrhoea and skin diseases. They thereby enable HIV-infected people to stay healthy longer and help those with AIDS to be protected against infection. A simplistic example is that HIV/AIDS patients must have clean water to take their medication. More complex arguments surround the use of formula feeds as an alternative to breast-feeding of babies and infants. One of the many tragic statistics in the AIDS story is that an HIV-positive mother has a one-in-three chance of passing the virus to her baby through breast milk. For some, that means favouring powdered milk rather than breastfeeding. Where that approach is adopted, it is essential that the milk is prepared with clean water and handled hygienically.

The battle against AIDS is multi-disciplinary and the WSH sector is a very important actor. To play its full part, the sector needs to take a fresh look at some of its operating principles and adapt them to the demographic, social and economic changes forced by HIV/AIDS. The agriculture and transport sectors are ahead of the water sector in adopting new approaches. That needs to change, and it is the aim of this TOP to point practitioners to sources of knowledge and examples that will help speed appropriate reforms.